Excess weight and its association with cardiometabolic risk in adolescents: comparative analysis of national and international classifications

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Abstract
Objective: To evaluate the agreement between the overweight and obesity classifications of the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the Brazilian Reference (BR) proposed by Conde and Monteiro in adolescents, and to verify the association of these classifications with cardiometabolic risk (CMR). Methods: A cross-sectional study was conducted with 823 adolescents (aged 10-19 years) from municipal schools in Fortaleza, Ceará. Nutritional status was classified according to three body mass index references. CMR was defined by the simultaneous presence of insulin resistance, identified by the waist-to-height ratio, and dyslipidemia, assessed by biochemical tests (total cholesterol, HDL-c, LDL-c, and triglycerides). Agreement between classifications was assessed using the Kappa (κ) statistic, and the association with CMR was analyzed using Poisson regression. Results: All classifications showed excellent agreement, with weighted κ values ranging from 0.85 to 0.95. The highest agreement was between WHO and IOTF references (κ=0.95; 95%CI 0.93-0.97), while the lowest was between WHO and BR (κ=0.85; 95%CI 0.82-0.88). Despite the lower agreement, the diagnosis of obesity according to the BR reference demonstrated strong clinical relevance, being associated with an 8.51-fold higher prevalence of CMR in adolescents (95%CI 6.38-11.35). Conclusions: BR showed a stronger association with CMR. The inclusion of this classification may optimize the early detection of CMR in Brazilian health services, helping to prevent cardiometabolic disorders in this population.

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