From the Guidelines
For a 9-year-old overweight boy, recommended laboratory tests include fasting lipid panel, fasting blood glucose, hemoglobin A1C, liver function tests, and thyroid function tests. These tests are crucial for assessing the risk of dyslipidemia, type 2 diabetes, non-alcoholic fatty liver disease, and hypothyroidism, which are common comorbidities associated with childhood obesity 1. The lipid panel and glucose tests are essential because childhood obesity increases the risk for dyslipidemia and type 2 diabetes 1. Liver function tests, such as ALT and AST, help screen for non-alcoholic fatty liver disease, which is increasingly common in overweight children 1. Thyroid testing is important to rule out hypothyroidism as a potential contributor to weight gain 1. Additional tests may be recommended based on the child's specific symptoms, family history, or physical examination findings. These laboratory tests should be part of a broader approach that includes assessment of diet, physical activity, sleep patterns, and psychosocial factors 1. Early identification of metabolic abnormalities allows for timely intervention to prevent long-term health complications associated with childhood obesity. Some key points to consider when ordering these tests include:
- The American Heart Association recommends screening for elevated blood cholesterol levels in children 9 to 11 years of age who are overweight or obese 1.
- The American Academy of Pediatrics recommends annual screening for depression in children and adolescents 11 through 21 years of age, which may be relevant for overweight children who are at higher risk for mental health concerns 1.
- A comprehensive evaluation should include assessment of the child's BMI, blood pressure, and lifestyle habits, in addition to laboratory tests 1.
From the Research
Laboratory Tests for Overweight Children
For a 9-year-old boy who is overweight, several laboratory tests are recommended to assess his metabolic health and risk of developing conditions like type 2 diabetes and metabolic syndrome.
- Metabolic Syndrome Components: According to 2, the following components should be measured:
- High-density-lipoprotein cholesterol
- Triglycerides
- Homeostasis assessment model of insulin resistance
- Mean arterial pressure
- Waist circumference
- Hemoglobin A1c (HbA1c): 3 and 4 suggest that HbA1c can be used as a diagnostic tool for prediabetes and diabetes in adolescents, but the cutoff values may need to be adjusted for pediatric populations.
- Lipid Profile: 5 found a significant correlation between HbA1c values and serum levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol, indicating that lipid profile testing may be useful in assessing the risk of dyslipidemia in overweight children.
- Comprehensive Metabolic Panel (CMP): 6 recommends that a basic metabolic panel (BMP) may be sufficient for pediatric emergency department patients without certain clinical variables, such as liver disease or heart disease, but a CMP may be necessary for children with these conditions.
Additional Considerations
When interpreting laboratory results for an overweight 9-year-old boy, it is essential to consider the following:
- Age-modified cutpoints: 2 emphasizes the importance of using age-modified cutpoints when assessing metabolic syndrome components in children.
- Pediatric-specific reference values: 3 and 4 highlight the need for pediatric-specific reference values for HbA1c and other laboratory tests to accurately diagnose and manage conditions like type 2 diabetes in children.