Microcirculation, Adiposity, and Traditional and Emerging Cardiovascular Risk Factors in Prepubertal Children

Abstract

Purpose:Previous studies have shown that microvascular dysfunction (MD) is associated with a number of cardiovascular risk factors, including obesity. Few studies have assessed microvascular reactivity in children, and in most of these, results were confounded by the effects of puberty. Our aim was to establish whether MD is already present in obese prepubertal children.Methods:This cross-sectional study included 52 obese, 18 overweight, and 28 eutrophic children, with a mean ± standard deviation age of 7.44 ± 1.22 years. We evaluated cardiovascular risk factors and nutritive microvascular function by using nailfold dynamic videocapillaroscopy and determined functional capillary density (FCD), red blood cell velocity at resting conditions (RBCV) and at peak (RBCVmax), and time to reach peak velocity during the post-occlusive reactive hyperemic response following 1 minute ischemia.Results:On univariate analysis, differences in microvascular reactivity were not observed among the groups. Obese and overweight children had significantly higher scores than eutrophic children for the following parameters: body mass index, waist circumference, waist-to-height ratio, mean arterial pressure, homeostasis model assessment for insulin resistance, levels of insulin, leptin, glucose, triglycerides, total cholesterol, uric acid, and C-reactive protein. Multivariate analysis demonstrated the association between metabolic, anthropometric, and microvascular variables, stratified according to the degree of adiposity and body fat distribution.Conclusions:Univariate analysis did not show any difference in microvascular reactivity between groups but, by testing these variables by multivariate means, we noticed a common and direct variation between cardiovascular/metabolic risk factors and microvascular reactivity occurring early in life.

The Relationship between TNF-a, IL-35, VEGF and Cutaneous Microvascular Dysfunction in Young Patients with Uncomplicated Type 1 Diabetes

“…Capillaroscopy or videocapillaroscopy is a method commonly used by researchers in the assessment of cutaneous microvasculature and evaluation of endothelial function. Researchers have utilized capillaroscopy when studying various disease entities, namely peripheral vascular disease [30], hypertension [31], chronic kidney disease [32], type 1 diabetes [27,[33][34][35][36][37], type 2 diabetes [38], obesity [39][40][41] or post-bariatric procedures [42]. Microcirculation reactivity has also been investigated in patients suffering from infective endocarditis [43] or ischemic, with no obstructive coronary artery disease [44].…”

Establishing reference values for macro- and microvascular measurements in 4-to-5 year-old children of the ENVIRONAGE prospective birth cohort

“…Establishing reference values of cardiovascular phenotypes early in life before the first signs of atherosclerosis appear is equally important and necessary to develop targeted health promotion strategies as well as to get a better understanding of the life course changes of both small and large blood vessels and early cardiovascular health trajectories within the Developmental Origins of Health and Disease (DOHaD). Untill now, very few population-based studies have been conducted that evaluate overall cardiovascular health and macrovascular stiffness markers in young children under the age of eight [5][6][7] . Long-term studies on the microvasculature are needed as well, to assess the prediction of its reactivity 7 and function throughout childhood into adolescence.…”

“…Untill now, very few population-based studies have been conducted that evaluate overall cardiovascular health and macrovascular stiffness markers in young children under the age of eight [5][6][7] . Long-term studies on the microvasculature are needed as well, to assess the prediction of its reactivity 7 and function throughout childhood into adolescence.…”

“…For the macrovasculature, references have been determined for the carotid artery intima-media thickness (CIMT) and the arterial stiffness parameters, including the pulse-wave velocity (PWV), carotid distensibility (DC) and compliance coefficients(CC), the carotid stiffness β index (SIβ) and Young's Elastic Modulus (YEM) and blood pressure (BP). Microvascular measurements are based on retinal vessel analysis using fundus photography, different than other studies where microvascular measurements were performed by the assessment of skin microcirculation 6 , nail fold videocapillaroscopy 7 or by recording the pulse wave amplitudes of fingertips 5 . Diameters of the central retinal vessels, summarized as the central retinal arteriole equivalent (CRAE) and central retinal venular equivalent (CRVE), were used as proxies.…”