Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening

Abstract

OBJECTIVE:We sought to study arterial endothelial function and carotid intima-media thickness (IMT), both early markers of atherosclerosis, in overweight compared to normal children. DESIGN: Case-control comparison. SUBJECTS: A total of 36 asymptomatic overweight children (body mass index (BMI)423; mean 2573) aged 9-12 y and 36 age-and gender-matched nonobese healthy children (BMIo21) from a school community. MEASUREMENTS: The key parameters were: BMI, arterial endothelial function (ultrasound-derived endothelium-dependent dilation) and carotid artery IMT. The secondary parameters measured included body fat content, waist-hip ratio (WHR), blood pressures, blood lipids, insulin and glucose. RESULTS: The two groups were well matched for blood pressures, cholesterol and glucose levels, but BMI (Po0.0001), body fat (P ¼ 0.001), WHR (Po0.05), fasting blood insulin (P ¼ 0.001) and triglyceride levels (Po0.05) were higher in obese children. Overweight was associated with impaired arterial endothelial function (6.672.3 vs 9.773.0%, Po0.0001) and increased carotid IMT (0.4970.04 mm vs 0.4570.04 mm, P ¼ 0.006). The degree of endothelial dysfunction correlated with BMI (Po0.003) on multivariate analysis. CONCLUSION: Obesity, even of mild-to-moderate degree, is independently associated with abnormal arterial function and structure in otherwise healthy young children.

Endothelial dysfunction and arterial abnormalities in childhood obesity

“…Lipid profile is altered by overweight in childhood, and is characterised by a decrease in high-density lipoprotein (HDL) cholesterol and a rise in low-density lipoprotein (LDL) cholesterol. 3,[34][35][36][37] Blood pressure (BP), insulin resistance and glucose metabolism are also influenced by childhood overweight and obesity. 2,4,[34][35][36][37] There is evidence that the prevalence of sleep apnea, an emerging cardiovascular risk factor, is increased in obese children, as it is in obese adults.…”

“…The impairment of arterial endothelial function in obese children has since been corroborated by at least four other studies. 35,[48][49][50] Furthermore, these studies have extended the observations regarding obesity-related endothelial dysfunction to both children with less severe obesity, 35 obese children as young as 9 years of age, 48 and children with different ethnic backgrounds. 35,49 Corresponding with these marked changes in arterial function and elasticity, childhood obesity is also accompanied by increases in arterial wall thickness.…”

“…35,[48][49][50] Furthermore, these studies have extended the observations regarding obesity-related endothelial dysfunction to both children with less severe obesity, 35 obese children as young as 9 years of age, 48 and children with different ethnic backgrounds. 35,49 Corresponding with these marked changes in arterial function and elasticity, childhood obesity is also accompanied by increases in arterial wall thickness. 35,49,50 These changes in arterial structure may contribute to the association between childhood overweight and adult cardiovascular disease, independent of adult overweight.…”

“…35,49 Corresponding with these marked changes in arterial function and elasticity, childhood obesity is also accompanied by increases in arterial wall thickness. 35,49,50 These changes in arterial structure may contribute to the association between childhood overweight and adult cardiovascular disease, independent of adult overweight.…”

“…86,87 Additionally, these cardiovascular risk factors are all associated with vascular endothelial dysfunction. 88 Indeed, studies in children and adults examining the association between obesity and endothelial dysfunction have identified insulin resistance, 34,35,89 glucose intolerance, 48,57 serum lipoprotein and apolipoprotein levels, 34,49 adipocytokines, 47 inflammation, 40,41 oxidative stress 90 and endothelial nitric oxide synthase 91 as possible pathophysiological intermediaries. Much recent research has focused on the role of adipocytokines and other obesity-related peptides as important molecules in the pathophysiological link between increased adiposity and cardiovascular disease.…”