Abstract Body (Do not enter title and authors here): Background:
The cardiovascular-kidney-metabolic (CKM) syndrome is a driver of cardiovascular disease (CVD). Stage 2 CKM (metabolic risk factors or chronic kidney disease) is an important threshold for intervention to prevent progression to stage 3 (subclinical CVD). The 2023 AHA CKM presidential advisory calls for early life assessment for CKM, but CKM risk factor data in contemporary pediatric populations are limited.

Research Question:
Among adolescents with overweight or obesity, what is the prevalence of additional CKM risk factors?

Methods:
This study used the most recent well child visit (2021-2023) from children aged 13-17y to identify those with BMI ≥85th percentile (overweight threshold) in a Northern California healthcare system who had measures of blood pressure (BP), hemoglobin A1c, and non-fasting triglyceride (TG) within 1-year of the visit. Adapted CKM metabolic risk factors included hypertensive BP ≥130/80, elevated TG≥150 mg/dL, and prediabetes A1c ≥5.7%. Demographic predictors of having at least 1 metabolic risk factor (in addition to overweight/obesity) were examined using logistic regression, adjusted for age, sex, race/ethnicity and neighborhood deprivation index.

Results:
Among 34,262 adolescents with overweight/obesity (mean age 15.6±1.4y, 49.2% female); 20.7% were non-Hispanic white (NHW), 40.1% Hispanic, 17.4% Asian/Pacific Islander (PI), 9.4% Black and 12.3% other/unknown. While all adolescents had at least overweight, 40.8% had moderate and 29.9% had severe obesity (BMI 100-119% and ≥120% of 95th percentile, respectively).

Overall, 49.7% of adolescents with overweight/obesity had at least one CKM metabolic risk factor (56.5% of males, 42.8% of females) and 15.3% had multiple (16.8% of males, 9.8% females, Figure). Males were more likely than females to have a CKM metabolic risk factor (OR 1.72 [95%CI 1.65-1.80]), as were Asian/PI (OR 1.32 [1.23-1.42]) and Hispanic (OR 1.15 [1.08-1.22]) but not Black adolescents (OR 1.03 [0.95-1.12]) vs NHW. For the subset with obesity, 55.2% had a CKM metabolic risk factor; 16.4% had multiple.

Conclusions:
Half of all adolescents with overweight or obesity had a CKM metabolic risk factor, including many with multiple risk factors. The growing burden of stage 2 CKM risk factors in this high-risk population supports the need for targeted lifestyle interventions and more intensive management. Adolescents with overweight or obesity should be aggressively screened for CKM risk conditions before adulthood.