Obese children often have increased total cholesterol (TC), low-density lipoproteins (LDL), total body and abdominal fat, and reduced high-density lipoproteins (HDL).20-22 Recently, fatty streaks were found in the arteries of children as young as 13 years.23 The relationship between coronary artery disease (CAD) and type 2 diabetes mellitus is well established; their roles in metabolic disease are clearly evident. Therefore, in children with early signs of CAD, especially in those who are obese, the risk of developing type 2 diabetes mellitus is even greater. Hullman and asso! ci- ates24 and Vanhalla25 published results that implicate obesity in childhood with metabolic disorders during adulthood. In children with obese parents and a family history of diabetes mellitus, the risk for obesity and diabetes mellitus is far greater. These at-risk children may be predisposed genetically and behaviorally to the early manifestation of subtle, nonsymptomatic metabolic abnormalities working synergistically to create a childhood obesity phenotype for chronic disease.26 Thus, in at-risk children, the metabolic disorders that promote chronic diseases, such as diabetes mellitus, most likely originate early in childhood,23,26-28 perhaps earlier than originally proposed or defined by the limited technology available. .
Childhood obesity promotes advanced physical maturation in especially severe conditions.29 Obese children have advanced bone age, higher bone density and area, and increased sex hormone levels.30 Increased estradiol levels have been associated with obesity in adult females.31 Precocious puberty32 or premature pubarche33,34 were recently associated with insulin resistance,33,35 longterm changes in body composition,32,36 increases in IGFl, exalt Berated adrenal response, and polycystic ovary syndrome.37 Metabolic defects resulting from parental (environmental and genetic) influences and early onset obesity may promote hormonal alterations that predispose obese children to advanced physical maturation.