Cardiovascular risk factors and noninvasive assessment of arterial structure and function in obese Turkish children

Abstract

Obesity is associated with a number of risk factors, such as hyperlipidemia, hyperinsulinemia, hypertension, and early atherosclerosis. Evidence indicates that atherosclerosis begins in childhood and progresses over decades. In this work, we examined the relationship between cardiovascular risk factors and ultrasonographic signs of subclinical atherosclerosis in 77 obese children and adolescents compared to 40 non-obese healthy peers. Carotis intima media thickness (cIMT), carotid artery compliance (CAC), brachial artery flow-mediated dilatation (FMD), and established cardiovascular risk factors were studied. In the obese patients, cIMT was significantly increased (0.57 mm vs 0.45 mm, p < 0.001) whereas CAC (1.84% vs 3.29%, p < 0.001) and FMD (9.67 % vs 14.81%, p < 0.001) were significantly decreased. In multiple linear regression analysis, a relation was observed between cIMT, CAC, brachial FMD on one hand, and body mass index (BMI) on the other. Among the lipid anomalies, only hypertriglyceridemia was found to be positively correlated with cIMT. Additionally, we found a significant association between waist circumference (WC) and FMD. These findings indicate that obesity in children is associated with arterial wall alterations and endothelial dysfunction. In hyperlipidemic situations, only hypertriglyceridemia was found to be positively correlated with cIMT. This finding has consistently indicated TG to be a risk factor for the development of atherosclerosis. To our knowledge this is the first study to determine the relation between FMD and WC, which is used as a parameter of obesity in childhood.

Effect of Obesity on Endothelial Function and Subclinical Atherosclerosis in Children

“…Similar to previous results (17,18,22), we found that FMD levels were significantly lower in the obese group than in the non-obese group, indicating that endothelial function was impaired in obese children. It has been well known that FMD is correlated with various risk factors such as WC, (17), extent of obesity, arterial hypertension, fibrinogen, C-reactive protein, (18), BMI,(22) uric acid (23).…”

“…cIMT measurements are used to detect subclinical atherosclerosis (24) and increased cIMT values have been observed in overweight and obese children (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Not surprisingly, we found that cIMT values were significantly higher in the obese compared with non-obese group, (14,16,19) and that cIMT values were significantly correlated with WC, BMI Z score, serum insulin level, HOMA index, systolic BP, triglyceride and HDL- (14,(16)(17)(18)(19)(20)(21)27).…”

Ultrasound Evaluation of Carotid Intima-Media Thickness in Children

“…Our negative findings in this regard are consistent with a prior study examining a large cohort of normal children and young adults in which cIMT was found not to be affected by age or sex until 18 years of age 24) . McCarthy and Ashwell found WC to be a highly sensitive and specific marker of upper body fat accumulation in children 25) , and several other studies have shown WC to be associated with carotid artery dimensions 9,12,26,27) . In a study of Turkish children employing linear logistic regression, Hacihamdioğlu et al found that WC was the only parameter associated with increased cIMT 28) .…”

“…cIMT Suzuki et al found that insulin resistance was the most significant risk factor for cIMT in a study of 72 adult patients 29) . Additionally, in a study examining overweight Turkish children, Yilmazer et al found that hyperinsulinemia correlated with increased cIMT 27) . Similar findings have been obtained in other studies 6,9,13,26,28) , although some studies found no association between cIMT and HOMA-IR 30,31) .…”

National Trends in Beverage Consumption in Children from Birth to 5 Years: Analysis of NHANES Across Three Decades

“…Although we found 2 articles describing the absence of endothelial dysfunction in obese children [21,107], numerous research groups have reported on impaired endothelialdependent vasodilation, assessed with FMD, in this population [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122].…”