Risk factors for cardiometabolic disease among children in South East Asia

Background and objectives: The current and projected burden of cardiometabolic diseases in Asia is high, with a notable and rapidly increasing prevalence of associated risk factors among children in this region. Comprehensive evidence on cardiometabolic disease risk factors among children in Asia is required to ensure well-informed strategies to address the future burden of disease in this region. This thesis aims to increase the current understanding of cardiometabolic disease risk factors among children in Asia. Methods: Using previously collected data on 6903 children and 17 656 adults participating in the South East Asia Community Observatory health and demographic surveillance system (SEACO HDSS) in Malaysia, the characterisation, prevalence and sociodemographic determinants of key child risk factors were examined. Furthermore, a feasibility study building upon the SEACO framework (N = 203) was designed and implemented to explore the possibility of increasing the range of cardiometabolic measures obtained from children through the collection and analysis of biological samples from individuals in the HDSS. Results: There was a high burden of cardiometabolic disease risk factors among both adults and children in this population. Among children, prevalence estimates for the four key risk factors (overweight, obesity, underweight and stunting) differed considerably depending upon the anthropometric reference used to classify these measures, but were notable regardless of reference. Nutritional and household environmental indices, including child underweight and household sanitation facilities, were strongly associated with stunting risk in this population. Furthermore, children with parents who were obese or centrally obese had an approximately twofold increased risk of being obese. There was no clear evidence of association between measures of socioeconomic position and cardiometabolic disease risk factors among children. Finally, effective procedures were established for the collection, analysis and storage of biological samples from children and their family members in the HDSS, with implications for potential scale-up to facilitate more detailed characterisation of cardiometabolic disease risk. Conclusions: This work indicates a high burden of cardiometabolic disease risk factors among children in this population, identifies modifiable sociodemographic influences on these risk factors, highlights opportunities to more comprehensively characterise child cardiometabolic disease risk in this population, and hence informs future directions for research and strategies to address the growing burden of risk factors among children in this region