Ambulatory blood pressure monitoring in obese children: role of insulin resistance

Marcovecchio, M Loredana; Patricelli, Luca; Zito, M.; Capanna, Rita; Ciampani, Mariapaola; Chiarelli, Francesco; Mohn, Angelika

doi:10.1097/hjh.0b013e328010918b

Cited by 49 publications

(47 citation statements)

References 31 publications

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“…It has been shown that overweight, obesity and generally increased visceral accumulation are closely related to increased office SBP (but not DBP) in children, 10,28,29 whereas other studies have indicated that obesity is related with both increased office SBP and DBP. 7,8,30 The present results showed that obesity might explain in greater extent the variability of SBP (both at home and in the office) than that of DBP (r 2 0.092 and 0.122 for office and home SBP vs 0.055 and 0.056 for DBP, respectively; Table 2). However, a major discrepancy was that BMI (z-score) was a more important determinant of home than office SBP.…”

Section: Discussionsupporting

confidence: 49%

“…6 Conflicting data exist regarding the possible predominant effects of weight gain on office systolic blood pressure (SBP) rather than diastolic blood pressure (DBP) in children and adolescents. Some studies suggested that excessive body weight causes a comparative elevation in both SBP and DBP, [7][8][9] whereas others showed that weight gain increases SBP more than DBP. 10,11 Moreover, studies in children and adolescents consistently showed a higher prevalence of systolic rather than diastolic hypertension.…”

Section: Introductionmentioning

confidence: 99%

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Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

et al. 2009

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Obesity is related to office blood pressure (OBP). Important discrepancies exist between OBP and home blood pressure (HBP), providing complementary information for the management of hypertension. The association between obesity and HBP has not been investigated in children. The evidence on the role of obesity in the predominance of systolic blood pressure (SBP) over diastolic (DBP) in paediatric hypertension is limited. A total of 778 healthy subjects aged 6-18 years were recruited in this study. OBP and HBP were measured using electronic devices validated in children. Anthropometric measurements were measured and expressed as z-scores for height or age. Among all indices of obesity (z-scores), body mass index (BMI) showed the best association with BP. The effect of obesity (BMI) was more pronounced on: (i) SBP than DBP and (ii) H-SBP than O-SBP (O-SBP: r 2 ¼ 0.09, O-DBP: r 2 ¼ 0.05, H-SBP: r 2 ¼ 0.12, H-DBP: r 2 ¼ 0.06). The prevalence of systolic hypertension was higher than that of diastolic hypertension. This difference was significant only in office readings and independent from obesity (normal weight: 6.3% systolic hypertension versus 1.2% diastolic; obese: 37.9% versus 6.9%, Po0.05 for both). These data imply that in children and adolescents the z-score of BMI is the most appropriate index of the association between BP and obesity. It also suggests that obesity is probably more closely associated with home than office BP. Finally, although obesity appears to affect SBP more than DBP, these results suggest that the predominance of systolic hypertension in children and adolescents might not be only related to obesity but also to the measurement setting (office).

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

et al. 2009

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“…Insulin resistance in obesity is strictly related to the development of hypertension (36,37), dyslipidemia (38), IGT (39), hepatic steatosis (40), as well as to the combination of these factors, also known as metabolic syndrome (41). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (42) (Fig.…”

Section: Insulin Resistance and Associated Complicationsmentioning

confidence: 99%

Insulin resistance and obesity in childhood

Chiarelli¹,

Marcovecchio²

2008

European Journal of Endocrinology

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229

171

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Childhood obesity is a significant health problem that has reached epidemic proportions around the world and is associated with several metabolic and cardiovascular complications. Insulin resistance is a common feature of childhood obesity and is considered to be an important link between adiposity and the associated risk of type 2 diabetes and cardiovascular disease. Insulin resistance is also a key component of the metabolic syndrome, and its prevalence in the paediatric population is increasing, particularly among obese children and adolescents. Several factors are implicated in the pathogenesis of obesity-related insulin resistance, such as increased free fatty acids and many hormones and cytokines released by adipose tissue. Valid and reliable methods are essential to assess the presence and the extent of insulin resistance, the associated risk factors and the effect of pharmacological and lifestyle interventions. The two most common tests to assess insulin resistance are the hyperinsulinemic euglycemic clamp and the frequently sampled i.v. glucose tolerance test utilizing the minimal model. However, both these tests are not easily accomplished, are time consuming, expensive and invasive. Simpler methods to assess insulin resistance based on surrogate markers derived from an oral glucose tolerance test or from fasting insulin and glucose levels have been validated in children and adolescents and widely used. Given the strong association between obesity, insulin resistance and the development of metabolic syndrome and cardiovascular disease, prevention and treatment of childhood obesity appear to be essential to prevent the development of insulin resistance and the associated complications.European Journal of Endocrinology 159 S67-S74

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“…Central adiposity and insulin resistance have been indicated as determinants of blood pressure levels in childhood. 5 Hypertension is an important risk factor for cardiovascular diseases, which represent one of the principal causes of mortality and morbidity worldwide. 6 Because of the potential for serious complications, hypertension has become a major public health problem.…”

Section: Introductionmentioning

confidence: 99%

Is Breastfeeding Protective for Blood Pressure in Schoolchildren? A Cohort Study in Northeast Brazil

et al. 2014

Breastfeeding Medicine

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Objective: This study assessed the influence of breastfeeding and nutritional status of full-term infants on blood pressure at school age. Subjects and Methods: This was a cross-sectional study nested in a cohort of 375 infants recruited at birth between 1993 and 1994 in the state of Pernambuco, Brazil. A sample of 213 8-year-old children had their blood pressure measured. A multivariate linear regression analysis was used to identify the influence of low birth weight and breastfeeding duration on blood pressure, adjusting for socioeconomic conditions, maternal nutritional status, eating habits, growth rate (0-6 months), and the children's anthropometry at 8 years.Results: Mean values of children's blood pressure were significantly higher with lower duration of breastfeeding. Higher per capita family income, maternal body mass index and height, child's weight and length at birth, and child anthropometric dimensions at 8 years of age were associated with higher levels of blood pressure. The multivariate linear regression analysis showed that children who were breastfed for less than 40 days had higher systolic blood pressures, explaining 2.2% of its variation. Anthropometry at 8 years of age explained the higher variance in systolic blood pressure (12.6%) with emphasis on waist circumference (9.5%), followed by per capita income (3.2%) and maternal height (2.1%). Birth weight and length had no influence on blood pressure levels in this age group. Conclusions: Children's waist circumference, duration of breastfeeding, socioeconomic conditions, and maternal nutritional status influenced blood pressure levels of schoolchildren born full term, rather than low birth weight.

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Ambulatory blood pressure monitoring in obese children: role of insulin resistance

Cited by 49 publications

References 31 publications

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

Insulin resistance and obesity in childhood

Is Breastfeeding Protective for Blood Pressure in Schoolchildren? A Cohort Study in Northeast Brazil

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