The importance of carotid artery stiffness and increased intima-media thickness in obese children

Abstract

Childhood obesity is a major health problem throughout the world. Obese children are more likely to become obese adults in whom one can expect a higher rate of hospitalisation, interventions and premature death. 1 In obese people, coronary heart disease generally manifests in middle age or later life. However, atherosclerosis has its roots in childhood, its first signs in obese children appearing before puberty; therefore, it is important to develop efficient strategies to reduce the incidence of cardiovascular disease (CVD) in the population. Carotid artery intima-media thickness (CIMT) serves as a marker of preclinical atherosclerosis.2 CVD develops as a result of arterial damage in the form of arteriosclerosis. Arteriosclerosis is a general term for conditions in which diffuse thickening and stiffening in mainly large-and medium-sized arteries develop under different conditions. Both the media and intima of the arteries could be involved in the pathology. Risk factors diagnosed in childhood can predict the development of preclinical carotid atherosclerosis in adults.2 However, there is limited information about early atherosclerosis and its mechanisms in childhood.Many studies mention close relationships between traditional anthropometric, haemodynamic and biochemical cardiovascular risk factors during childhood and adolescence, and high rates of CIMT and vascular events in the 40s. Importantly, exposure to cardiovascular risk factors is associated with vascular damage. In addition, because of the cumulative nature of risk factors, obesity and central fat distribution in childhood can provide clues about CIMT in adulthood. 3 We aimed to study the effect of obesity on main carotid artery lumen diameter and intima-media thickness and the relationships with the early stages of atherosclerosis. Material and methods PatientsThis was a prospective case-control study from October 2010 to February 2011 on schoolchildren aged 8 -16 years. Obese children were transferred from a primary healthcare paediatrician to our paediatric outpatient clinic in Gaziosmanpasa University Hospital. Patients with dysmorphic syndromes and/or endocrine disorders were excluded. A control group of children of similar age and gender distribution without obesity and dyslipidaemia was included in the study. None of the children was on cardiovascular medication, and all were non-smokers. Children were included only after obtaining informed consent from their guardians. The study protocol was approved by the Committee on Ethical Practice of the hospital. Clinical evaluationFor each patient, data about family and personal history for cardiovascular events, growth curve and nutritional assessment were recorded. Height, weight and blood pressure (BP) were measured.

Obesity and Arterial Stiffness in Children

“…However, pulse pressure amplification may differ with obesity. 30 In addition, as blood pressure and artery diameter measurements are not collected simultaneously, the utility of these measurements are limited by the assumption that there are no hemodynamic variations within this time period. Moreover, for PWV analysis, variability in the determination of length measurement for the carotid-femoral segment hampers the comparison between studies using different procedures for acquiring path length.…”

“…The 12 studies reporting central PWV 12,[19][20][21][22][23][24][25][26][27]30,32 were of good methodological quality (Downs and Black scores ranged from 14 to 16). All but 2 of these papers 12,21 reported increased arterial stiffness in the children with obesity compared with healthy BMI controls.…”

“…Five of these studies accounted for blood pressure in their analysis. 12,23,27,30,32 Six of these studies determined PWV using the carotid-femoral wave forms gated to the ECG, 12,21,24,27,30,32 2 studies used Doppler ultrasound traces from the ascending and descending aorta, 23,25 whereas 4 studies used a single-point method of PWV determination using carotid β stiffness, diastolic blood pressure, and blood density. 19,20,22,26 There were 4 studies assessing carotid β stiffness, 19,20,26,28 all reporting a higher carotid β stiffness index in the children with obesity.…”

Obesity in childhood and adolescence

“…12 Recently Robert C Whitaker from the Department of Health in Philadelphia passed the following thought-provoking comment: 'The childhood obesity epidemic is just one symptom of our way of living. Reversing the epidemic may require that we apply a new approach to improving child and adult health in the 21st century.…”

Estado proinflamatorio en niños obesos

“…Las investigaciones realizadas en niños y adolescentes obesos han evidenciado anormalidades vasculares como disminución de la reactividad vascular periférica, el incremento del espesor de la íntima-media de la arteria carótida, así como niveles elevados de moléculas de adhesión [27][28][29] . En este trabajo se estudiaron los niveles séricos de moléculas proinflamatorias en una población infantojuvenil con obesidad.…”