Longitudinal changes in cardiovascular risk from childhood to young adulthood in offspring of parents with coronary artery disease: the Bogalusa Heart Study

Mutated CYP17A1 promotes atherosclerosis and early-onset coronary artery disease

BACKGROUND

Coronary artery disease (CAD) is a multi-factor complex trait and is heritable, especially in early-onset families. However, the genetic factors affecting the susceptibility of early-onset CAD are not fully characterized.

METHODS

In the present study, we identified a rare nonsense variant in the CYP17A1 gene from a Chinese Han family with CAD. To validate the effect of this variation on atherosclerosis and early-onset coronary artery disease, we conducted studies on population, cells, and mice.

RESULTS

The mutation precisely congregated with the clinical syndrome in all the affected family members and was absent in unaffected family members and unrelated controls. Similar to the human phenotype, the CYP17A1-deficient mice present the phenotype of metabolic syndrome with hypertension, increased serum glucose concentration, and presentation of central obesity and fatty liver. Furthermore, CYP17A1 knockout mice or CYP17A1 + ApoE double knockout mice developed more atherosclerotic lesions than wild type (WT) with high fat diary. In cell models, CYP17A1 was found to be involved in glucose metabolism by increasing glucose intake and utilization, through activating IGF1/mTOR/HIF1-α signaling way, which was consistent in CYP17A1 knockout mice with impaired glucose tolerance and insulin resistance.

CONCLUSIONS

Through our study of cells, mice and humans, we identified CYP17A1 as a key protein participating in the pathophysiology of the atherosclerotic process and the possible mechanism of CYP17A1 C987X mutation induced atherosclerosis and early-onset CAD involving glucose homeostasis regulation was revealed. Video Abstract.

Prevalence and Correlates of Metabolic Syndrome and Its Components in Chinese Children and Adolescents Aged 7–17: The China National Nutrition and Health Survey of Children and Lactating Mothers from 2016–2017

This descriptive study aimed to determine the prevalence of metabolic syndrome (MetS) and its components among Chinese children and adolescents aged 7–17 from 2016–2017 according to the Cook’s criteria modified for age on the basis of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and to evaluate the associations between the factors of interest (especially vitamin A, vitamin D and hyperuricemia) of MetS and its components, using data from the China National Nutrition and Health Survey of Children and Lactating Mothers from 2016–2017. A total of 54,269 school-aged children and adolescents were ultimately included in this study. Anthropometric measurements and laboratory examinations of the subjects and their relevant information were also collected. A multivariate logistic regression analysis model was applied to analyze the relationships between relevant factors associated with MetS and its components. In the present study, the prevalence of MetS in children and adolescents was 5.98%. Among the five components of MetS, elevated blood pressure (BP) and abdominal obesity were the most prevalent (39.52% and 17.30%), and 58.36% of the subjects had at least one of these components. In the multivariate logistic regression, an overweight condition, obesity and hyperuricemia were positively correlated with the incidence of MetS and all five components. There was also a positive association observed between vitamin A and the risk of MetS and some components of MetS (abdominal obesity and high triglycerides (TG)) and vitamin A was negatively associated with the risk of low high-density lipoprotein cholesterol (HDL-C). Subjects with vitamin D inadequacy had a higher risk of MetS (OR = 1.364, 95%CI: 1.240–1.500) and four of its components, excepting elevated FBG (fast blood glucose). Vitamin D deficiency was positively associated with MetS (OR = 1.646, 95%CI: 1.468–1.845) and all five of its components. Well-designed, large-scale prospective studies are also needed in the future.

Development and Validation of a Large Synthetic Cohort for the Study of Cardiovascular Health Across the Life Span

We developed and validated a synthetic cohort approach to examine numbers of cardiovascular risk factors (CRFs) and adverse clinical events, including incident cardiovascular disease and all-cause mortality, across the life span from ages 20 years to 90 years. The current analysis included 40,875 participants from 7 large, population-based longitudinal epidemiologic studies (1948-2016). On the basis of a joint multilevel imputation model, we multiply imputed each participant's life-span numbers of CRFs and events using available records. To validate the imputed values, we partially removed the observed data and then compared the imputed and observed values. The complete life-span synthetic data set reflected the original observed data trends well. In our validation sample, the distributions of imputed CRFs and events were close to the observed distributions but with less variability. Bland-Altman plots indicated that there was a slightly negative trend in general, and the agreement bias was relatively small for the continuous CRFs. The hypothetical linear regression model suggested that the relationships between the CRFs and events were preserved in the imputed data set. This approach generated valid estimates of CRFs and events across the life span for African-American and White participants. The synthetic cohort may be sufficiently accurate to be useful in assessing the origins and timing of accumulating cardiovascular risk that can inform efforts to avoid cardiovascular disease development.

Links Between Maternal Cardiovascular Disease and the Health of Offspring

Maternal cardiovascular disease (CVD) during pregnancy is on the rise worldwide, as both more women with congenital heart disease are reaching childbearing age, and conditions such as diabetes, hypertension, and obesity are becoming more prevalent. However, the extent to which maternal CVD influences offspring health, as a neonate and later in childhood and adolescence, remains to be fully understood. The thrifty phenotype hypothesis, by which a fetus adapts to maternal and placental changes to survive a nutrient-starved environment, may provide an answer to the mechanism of maternal CVD and its impact on the offspring. In this narrative review, we aim to provide a review of the literature pertaining to the impact of maternal cardiovascular and hypertensive disease on the health of neonates, children, and adolescents. This review demonstrates that maternal CVD leads to higher rates of complications among neonates. Ultimately, our review supports the hypothesis that maternal CVD leads to intrauterine growth restriction (IUGR), which, through the thrifty phenotype hypothesis and vascular remodelling, can have health repercussions, including an impact on CVD risk, both in the immediate newborn period as well as later throughout the life of the offspring. Further research remains crucial in elucidating the mechanism of maternal CVD long-term effects on offspring, as further understanding could lead to preventive measures to optimise offspring health, including modifiable lifestyle changes. Potential treatments for this at-risk offspring group could mitigate risk, but further studies to provide evidence are needed.

Circunferência do pescoço e fatores de risco cardiovascular em crianças e adolescentes

Objetivos: Investigar a associação entre a circunferência do pescoço (CP) e fatores de risco cardiovascular em crianças e adolescentes atendidos ambulatorialmente em um hospital universitário na cidade de Recife, PE, Brasil.Métodos: Foram coletados dados sociodemográficos, antropométricos, bioquímicos, histórico familiar e estilo de vida. A amostra foi por conveniência, composta por crianças e adolescentes acompanhados de seus responsáveis, que aceitassem participar da pesquisa, no período de abril a setembro de 2018, no ambulatório de nutrição/pediatria.Resultados: A amostra foi composta por 144 pacientes com idade média de 11,0±3,0 anos, sendo 73 do sexo masculino (51,4%). 54 (37,6%) pacientes apresentaram CP elevada, dentre eles 59 (41,1%) eram do sexo masculino. Foi visto que 102 (71,5%) pacientes apresentaram tempo de tela elevado. Houve associação entre CP e estado nutricional e 13 (24,8%) indivíduos que tinham CP elevada apresentaram também excesso de peso. Foi observado correlação entre circunferência do pescoço com índice de massa corporal e perfil lipídico.Conclusão: Observou-se que há associação significativa entre CP e algumas medidas antropométricas como IMC e CC, sendo útil para identificação de risco de sobrepeso e de risco cardiovascular. Algumas limitações no estudo podem ser citadas como o limitado número de participantes por ser uma pesquisa transversal, não podendo assim ser estabelecidas medidas de causa e efeito.

Preventing Premature Atherosclerotic Disease

PURPOSE OF REVIEW

Cardiovascular disease (CVD) can begin in youth. Prevention is essential to reducing the burden of CVD-related risk factors in childhood and disease development in adulthood. This review addresses the clinical scope of CVD prevention, including a review of conditions encountered, proposed diagnostic criteria, and management strategies. We also highlight the impact of the intrauterine environment on the development of CVD risk. Finally, we highlight the potential role of telehealth in the management of pediatric patients with risk factors for premature CVD.

RECENT FINDINGS

Growing evidence suggests that maternal obesity, diabetes, and preeclampsia may play an important role in the development of CVD risk among offspring contributing to the development of known traditional CVD risk factors among offspring. As the prevalence of CVD continues to rise, knowledge as well as appropriate diagnosis and management of primordial and traditional risk factors for CVD is needed. The diagnosis and management of CVD risk factors is a central role of the preventive pediatric cardiologist, but it is imperative that the general physician and other pediatric subspecialists be aware of these risk factors, diagnoses, and management strategies. Finally, telehealth may offer an additional method for providing preventive care, including screening and counseling of at risk children and adolescents for traditional risk factors and for providing education regarding risk factors in cases of long distance care and/or during periods of social distancing.

Partial Clinical Remission of Type 1 Diabetes Mellitus in Children: Clinical Applications and Challenges with its Definitions

The honeymoon phase, or partial clinical remission (PCR) phase, of Type 1 diabetes mellitus (T1DM) is a transitory period that is marked by endogenous insulin production by surviving β cells following a diabetes diagnosis and the introduction of insulin therapy. It is a critical window in the course of the disease that has short and long-term implications for the patient, such as a significant reduction in the risk of long-term complications of T1DM. To promote long-term cardiovascular health in children with newly diagnosed T1DM, three key steps are necessary: the generation of a predictive model for non-remission, the adoption of a user-friendly monitoring tool for remission and non-remission, and the establishment of the magnitude of the early-phase cardiovascular disease risk in these children in objective terms through changes in lipid profile. However, only about 50% of children diagnosed with T1DM experience the honeymoon phase. Accurate and prompt detection of the honeymoon phase has been hampered by the lack of an objective and easily applicable predictive model for its detection at the time of T1DM diagnosis, the complex formulas needed to confirm and monitor PCR, and the absence of a straightforward, user-friendly tool for monitoring PCR. This literature review discusses the most up-to-date information in this field by describing an objective predictive model for non-remission, an easy tool for monitoring remission or non-remission, and objective evidence for the cardiovascular protective effect of PCR in the early phase of the disease. The goal is to present non-remission as an independent clinical entity with significantly poorer long-term prognosis than partial remission.

Family History of Premature Coronary Artery Disease (P-CAD)-A Non-Modifiable Risk Factor? Dietary Patterns of Young Healthy Offspring of P-CAD Patients: A Case-Control Study (MAGNETIC Project)

Dietary habits of healthy offspring with a positive family history of premature coronary artery disease (P-CAD) have not been studied so far. The aim of this study was twofold: (1) to identify dietary patterns in a sample of young healthy adults with (cases) and without (controls) family history of P-CAD, and (2) to study the association between dietary patterns and family history of P-CAD. The data came from the MAGNETIC case-control study. The participants were healthy adults aged 18⁻35 years old, with (n = 351) and without a family history of P-CAD (n = 338). Dietary data were collected with food frequency questionnaire FFQ-6. Dietary patterns (DP) were derived using principal component analysis (PCA). The associations between the adherence to DPs and family history of P-CAD were investigated using logistic regression. Two models were created: crude and adjusted for age, sex, smoking status, place of residence, financial situation, education, and physical activity at leisure time. Three DPs were identified: 'prudent', 'westernized traditional' and 'dairy, breakfast cereals, and treats'. In both crude and adjusted models, subjects with family history of P-CAD showed higher adherence by 31% and 25% to 'westernized traditional' DP (odds ratio (OR) 1.31, 95% confidence interval (95% CI): 1.12⁻1.53; p < 0.005; per 1 unit of standard deviation (SD) of DP score and adjOR 1.25, 95% CI: 1.06⁻1.48; p = 0.007; per 1 unit of SD of DP score, respectively). Young healthy adults with family history of P-CAD present unfavorable dietary patterns and are potentially a target group for CAD primary prevention programs.

Children with type 1 diabetes who experienced a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis

Importance

Landmark studies showed that partial clinical remission in new-onset type 1 diabetes is associated with reduced prevalence of long-term complications, but early clinical indicators of this favorable outcome are poorly characterized.

Aim

To determine if there were any differences in lipid parameters, especially LDL-cholesterol, between remitters and non-remitters 4 to 5 years after the diagnosis of type 1 diabetes after controlling for hemoglobin A1c, body mass index, and pubertal status.

Subjects and methods

A longitudinal retrospective cohort study of 123 subjects of mean age 11.9 ± 2.9 years, [male 11.7 ± 2.9 years, (n = 55); female 12.0 ± 2.9 years, (n = 68), p = 0.60] with type 1 diabetes of 4–5 years duration. Anthropometric and biochemical data were collected at the 4^th or 5^th year after diagnosis in line with the American Diabetes Association recommendation to initiate screening for complications in children either at the beginning of puberty or 4–5 years after diagnosis. Puberty was defined by Tanner stages II-V. Partial clinical remission was defined by the gold-standard insulin-dose adjusted hemoglobin A1c (IDAA1c) of ≤9.

Results

There were 44 (35.8%) remitters (age 13.0 ± 2.5y; male 52.3%). Both the total cholesterol and LDL-cholesterol were significantly lower in remitters compared to non-remitters: LDL-C: 78.8 ± 28.7 mg/dL vs. 91.6 ± 26.5 mg/dL, p = 0.023; and total cholesterol: 151.5 ± 32.6 mg/dL vs. 167.0 ± 29.6 mg/dL, p = 0.015. Other lipid fractions were similar between the groups. There were no differences between the groups for glycemic control, body mass index z score, thyroid function, celiac disease occurrence, or vitamin D status. A greater number of remitters were in puberty compared to non-remitters (86.4% vs. 60.8%, p = 0.006). LDL-C concentration was similar in prepubertal remitters vs. non-remitters (p = 0.93), but was significantly lower in remitters in puberty compared to non-remitters in puberty (p = 0.018) after adjusting for age and duration of diabetes.

Conclusions

Children with type 1 diabetes who underwent a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis. This early divergence in lipidemia may explain the dichotomy in the prevalence of long-term complication in type 1 diabetes between remitters and non-remitters. It also offers a pathway for targeted lipid monitoring in type 1 diabetes, by establishing non-remission as a non-modifiable risk factor for vascular complication in type 1 diabetes.

The utility of body mass index as an indicator for lipid abnormalities in non-fasting children

BACKGROUND

Many studies have reported the association between body mass index (BMI) and fasting lipid profiles in children. However, little information exists about the screening of dyslipidemia in the non-fasted state. This study assessed whether BMI can predict non-fasting lipid abnormalities in children.

METHODS

Using gender-separated analysis, 3895 boys and 3866 girls (aged 11-12 years) were investigated. Total cholesterol (TC), triglyceride (TG) and HDL-cholesterol (HDL-C) were measured, and non-HDL-C (=TC-[HDL-C]) was calculated. A BMI z-score was employed as the weight status. Gender-specific 95th percentiles of TC, TG and non-HDL-C were defined as "elevated", with the 5th percentiles of HDL-C defined as "reduced".

RESULTS

TG and non-HDL-C were positively, and HDL-C was negatively correlated with the BMI z-score in both genders. Both obese (2<BMI z-score) and overweight (1<BMI z-score≤2) were associated with the risks of elevated TG, non-HDL-C and reduced HDL-C. In both genders, a receiver operating characteristic curve demonstrated that the utility of predicting the above lipid abnormalities was moderate; the areas under the curve ranged from 0.60 to 0.70. The optimal cut-off for the BMI z-score for predicting elevated TG, non-HDL-C and reduced HDL-C were 0.52, 0.55 and 0.51 in boys and 0.34, 0.38 and 0.35 in girls, respectively.

CONCLUSIONS

The BMI could be an indicator of abnormalities of non-fasting TG, non-HDL-C and HDL-C in both genders.

Investigation of the C-3-epi-25(OH)D3 of 25-hydroxyvitamin D3 in urban schoolchildren

The physiological relevance C-3 epimer of 25-hydroxyvitamin D (3-epi-25(OH)D) is not well understood among youth. The objective of this study was to assess whether demographic/physiologic characteristics were associated with 3-epi-25(OH)D₃ concentrations in youth. Associations between 3-epi-25(OH)D₃ and demographics and between 3-epi-25(OH)D₃, total 25-hydroxyvitamin (25(OH)D) (25(OH)D₂ + 25(OH)D₃), total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides were examined in racially/ethnically diverse schoolchildren (n = 682; age, 8-15 years) at Boston-area urban schools. Approximately 50% of participants had detectable 3-epi-25(OH)D₃ (range 0.95-3.95 ng/mL). The percentage of 3-epi-25(OH)D₃ of total 25(OH)D ranged from 2.5% to 17.0% (median 5.5%). Males were 38% more likely than females to have detectable 3-epi-25(OH)D₃ concentrations. Both Asian and black race/ethnicity were associated with lower odds of having detectable 3-epi-25(OH)D₃ compared with non-Hispanic white children (Asian vs. white, odds ratio (OR) 0.28, 95% confidence interval (CI) 0.14-0.53; black vs. white, OR 0.38, 95%CI 0.23-0.63, p < 0.001). Having an adequate (20-29 ng/mL) or optimal (>30 ng/mL) 25(OH)D concentration was associated with higher odds of having detectable 3-epi-25(OH)D₃ than having an inadequate (<20 ng/mL) concentration (OR 4.78, 95%CI 3.23-6.94 or OR 14.10, 95%CI 7.10-28.0, respectively). There was no association between 3-epi-25(OH)D₃ and blood lipids. However, when considering 3-epi-25(OH)D₃ as a percentage of total 25(OH)D, total cholesterol was lower in children with percent 3-epi-25(OH)D₃ above the median (mean difference -7.1 mg/dL, p = 0.01). In conclusion, among schoolchildren, sex, race/ethnicity, and total serum 25(OH)D concentration is differentially associated with 3-epi-25(OH)D. The physiological relevance of 3-epi-25(OH)D₃ may be related to the 3-epi-25(OH)D₃ as a percentage of total 25(OH)D and should be considered in future investigations.

The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering

Metabolic syndrome (MetS) was developed by the National Cholesterol Education Program Adult Treatment Panel III, identifying adults with at least 3 of 5 cardiometabolic risk factors (hyperglycemia, increased central adiposity, elevated triglycerides, decreased high-density lipoprotein cholesterol, and elevated blood pressure) who are at increased risk of diabetes and cardiovascular disease. The constellation of MetS component risk factors has a shared pathophysiology and many common treatment approaches grounded in lifestyle modification. Several attempts have been made to define MetS in the pediatric population. However, in children, the construct is difficult to define and has unclear implications for clinical care. In this Clinical Report, we focus on the importance of screening for and treating the individual risk factor components of MetS. Focusing attention on children with cardiometabolic risk factor clustering is emphasized over the need to define a pediatric MetS.

Visceral Fat Area and Serum Adiponectin Level Predict the Development of Metabolic Syndrome in a Community-Based Asymptomatic Population

Background

Although it has been demonstrated that visceral adipose tissue content and serum levels of adiponectin are associated with metabolic syndrome, their predictive potential for the development of metabolic syndrome remains to be elucidated.

Methods

We studied 1,130 participants of the Seoul Metabolic Syndrome cohort. A total of 337 subjects without metabolic syndrome underwent the follow-up evaluation and finally analyzed. Visceral fat area (VFA) was measured using dual bioelectrical impedance analysis. We compared the 1-year incidence rate of metabolic syndrome among four different groups: Group 1 (high adiponectin level and low VFA), Group 2 (low adiponectin level and low VFA), Group 3 (high adiponectin level and high VFA) and Group 4 (low adiponectin level and high VFA).

Results

Median follow-up duration was 17 months. Cut-off points of adiponectin level and VFA for metabolic syndrome were 7.34 ng/ml and 84 cm² for men, and 12.55 and 58 cm² ng/ml for women, respectively. The incidence of metabolic syndrome was the highest in Group 4 (Group 1; 16.47%, Group 2; 22.08%, Group 3; 25%, and Group 4; 46.15%, p<0.001). Adjusted logistic regression analyses for metabolic syndrome prediction demonstrated that Group 4 exhibited the highest odds ratio compared with Group 1 (4.918 [2.05–11.795]), which was predominantly affected by waist circumference and serum triglyceride levels. Notably, triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio was significantly higher in Group 4 (p = 0.017).

Conclusion

Incidence rate of metabolic syndrome was the highest in subjects with low serum adiponectin levels and high visceral fat area. Higher TG/HDL ratio in these subjects suggested insulin resistance may contribute to the development of metabolic syndrome.

Association of Parental Overweight and Cardiometabolic Diseases and Pediatric Adiposity and Lifestyle Factors with Cardiovascular Risk Factor Clustering in Adolescents

Cardiometabolic risk factors or their precursors are observed in childhood and may continue into adulthood. We investigated the effects of parental overweight and cardiometabolic diseases and pediatric lifestyle factors on the clustering of cardiovascular risk factors among adolescents, and examined the mediating and modifying effects of pediatric adiposity on these associations. Representative adolescents (n = 2727; age, 12–16 years) were randomly recruited through multistage stratified sampling from 36 schools in Southern Taiwan. Adolescent and parent surveys were conducted in schools and participant homes, respectively. Their demographic factors, diet patterns, and physical, anthropometric, and clinical parameters were collected and analyzed. Adolescents with 1–2 and ≥3 risk components for pediatric metabolic syndrome (MetS) were defined as potential MetS (pot-MetS) and MetS, respectively. Adolescents whose parents were overweight/obese, or with diabetes and hypertension had a higher prevalence ratio of pot-MetS and MetS (1.5–1.6 and 1.9–4.2-fold, respectively). Low physical activity (<952.4 MET·min/week), long screen time (≥3 h/day) and high sugar-sweetened beverage intake (>500 mL/day) were associated with a 3.3- (95% confidence intervals (CI) = 1.5–7.3), 2.2- (95% CI = 1.1–4.4), and 26.9-fold (95% CI = 3.2–229.0) odds ratio (OR) of MetS, respectively. Pediatric body mass index (BMI) accounted for 18.8%–95.6% and 16.9%–60.3% increased prevalence ratios of these parental and pediatric risk factors for MetS. The OR of pot-MetS + MetS for sugar-sweetened beverage consumption was multiplicatively enhanced among adolescents with overweight/obesity (combined OR, 8.6-fold (95% CI = 4.3–17.3); p for multiplicative interaction, 0.009). The results suggest that parental overweight and cardiometabolic diseases and pediatric sedentary and high sugar-intake lifestyles correlate with the development of adolescent MetS, and an elevated child BMI explains a part of these associations. Pediatric adiposity might be multiplicatively associated with sugar-sweetened beverage consumption for enhancing the MetS prevalence ratio among adolescents.

Metabolic syndrome in children (Review)

Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors, including central obesity, insulin resistance, glucose intolerance, dyslipidemia and increased blood pressure. The prevalence of MetS is on the increase worldwide owing to the epidemic of overweight and obesity. The risk of prevalence of MetS greatly increases during adulthood for those children exposed to cardiometabolic risk factors in their early lives. MetS has also been associated with liver fat accumulation in children. Elevated levels of plasma alanine aminotransferase and γ-glutamyl transferase have been associated with liver fat accumulation. The present review aimed to expand knowledge on the clustering of cardiometabolic risk factors responsible for the widespread occurrence of metabolic disease in children.

Household cardiovascular screening of high-risk families: a school-based study

BACKGROUND

A parental history of cardiovascular disease has a strong relationship with risk factor clusters in the offspring. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in both high and low-risk families.

DESIGN

A school-based, cross-sectional study.

METHODS

The middle schools of the 6th district of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group and 105 low-risk children with their families were recruited from the second group of schools. Anthropometric and metabolic measurements were performed.

RESULTS

The means of the waist circumference and waist-to-hip ratio were significantly higher in high-risk fathers. The means of total and low-density lipoprotein (LDL) cholesterol were significantly higher in both parents and children of the high-risk group. The means of the fasting plasma glucose were significantly higher in fathers and offspring of high-risk families. More fathers in high-risk families were smokers. The prevalence of increased total cholesterol, LDL-cholesterol and hyperglycemia (> or = 100 mg/dl) were higher in high-risk parents and children. The prevalence of increased body mass index (> or = 25 kg/m for parents and 85th percentile for children) was higher in fathers and children of high-risk families.

CONCLUSIONS

Cardiovascular risk factors are more prevalent and clustered in high-risk families. The screening of high-risk families is essential to prevent the progression of atherosclerosis from childhood and reduce the burden of cardiovascular disease in adulthood.

Prevalence of dyslipidemia in school children of Kashmir valley

AIM

Increased incidence of CVD has been observed in recent years in the Kashmir valley (North India). Since the risk factor development of the cardiovascular diseases (CVD) takes place during childhood, we undertook an epidemiological survey to assess the prevalence of dyslipidemia in the school children of Kashmir valley.

MATERIALS AND METHODS

1131 children of 5-19 years of age were selected and evaluated for BMI, cholesterol, TGs, LDL and HDL levels from different areas of Srinagar city (urban) region of the Kashmir valley from June 2011-June 2014.

RESULTS

The frequency of dyslipidemia in Kashmiri children varied along the subjects. Hypertriglyceridemia was seen in 82.6% of the males and 47.6% of females in the age group of 5-9 years, 38.5% of males and 51.1% of females in the age group of 10-14 years and 24.7% of males and 35.9% of the females in the age group of 15-19 years. Low levels of HDL than normal were seen in 34.7% of males and 19% of females in the age group of 5-9 years. Similarly low HDL levels were seen in 17.9% of males and 15.5% of females in the age group of 10-14 years. The incidence of low HDL was also seen in 4.9% of males and 10.8% of females in the age group of 15-19 years.

CONCLUSIONS

In the present study dyslipidemia was more common in centrally obese children and the most common component was high triglycerides and low HDL's. Female school children were at higher risk of developing CVD than males.

Feasibility of Recruiting Families into a Heart Disease Prevention Program Based on Dietary Patterns

Offspring of parents with a history of cardiovascular disease (CVD) inherit a similar genetic profile and share diet and lifestyle behaviors. This study aimed to evaluate the feasibility of recruiting families at risk of CVD to a dietary prevention program, determine the changes in diet achieved, and program acceptability. Families were recruited into a pilot parallel group randomized controlled trial consisting of a three month evidence-based dietary intervention, based on the Mediterranean and Portfolio diets. Feasibility was assessed by recruitment and retention rates, change in diet by food frequency questionnaire, and program acceptability by qualitative interviews and program evaluation. Twenty one families were enrolled over 16 months, with fourteen families (n = 42 individuals) completing the study. Post-program dietary changes in the intervention group included small daily increases in vegetable serves (0.8 ± 1.3) and reduced usage of full-fat milk (-21%), cheese (-12%) and meat products (-17%). Qualitative interviews highlighted beneficial changes in food purchasing habits. Future studies need more effective methods of recruitment to engage families in the intervention. Once engaged, families made small incremental improvements in their diets. Evaluation indicated that feedback on diet and CVD risk factors, dietetic counselling and the resources provided were appropriate for a program of this type.

Lipid profile in children with coronary artery disease in Sindh, Pakistan

AIM: To evaluate lipid profile in children with coronary artery disease (CAD) in Hyderabad, Sindh, Pakistan.

METHODS: The study included 100 children (6-15 years), of which 43 were children of young parents (one or both) with recognized CAD, while the other 57 were children with no evidence of CAD (controls). All were evaluated for fasting blood lipid profile. Blood samples were collected from patients with CAD and healthy controls and analysis of the levels of lipid profile were carried out using a kit method on Microlab 300.

RESULTS: Children with CAD had significantly higher levels of total serum cholesterol and triglycerides and decreased levels of high density lipoprotein and low density lipoprotein compared to children in the control group. Systolic and diastolic blood pressures were significantly higher, without any significant difference.

CONCLUSION: CAD risk factors are significant regarding abnormal lipid levels. Genetic tendency seems to be important in the development of CAD in children.

Consumption of sugar-sweetened beverages is associated with components of the metabolic syndrome in adolescents

Sugar-sweetened beverages (SSBs) are the principle source of added sugar in diets. Cardiometabolic disturbances can occur from early childhood to adulthood. The aim of this cross-sectional study was to examine the gender-specific association of SSB intake with metabolic syndrome (MetS) and its components among adolescents in Taiwan. A total of 2727 adolescents aged 12 to 16 years randomly selected from three diverse economic areas in Southern Taiwan by using a multistage-sampling strategy participated in this study. Demographic, dietary, physical and anthropometric parameters were measured, and serum lipid profiles and glucose levels were determined. The International Diabetes Federation (IDF) specifies that MetS requires abdominal obesity and ≥2 abnormal components, and Cook criteria for MetS require ≥3 abnormal components. We applied survey-data modules to data analyses, and used multiple regression and logistic models to adjust for covariates. An increased SSB intake was linked to a greater waist circumference in both sexes and to systolic blood pressure in boys (P for trend: ≤0.043). Male moderate and high consuming SSB drinkers exhibited triglyceride levels that were 8.0 and 8.2 mg/dL significantly higher, respectively, than those of nondrinkers. Compared with nondrinkers, boys who consumed >500 mL/day (high quantity) of SSBs exhibited 10.3-fold (95% confidence intervals (CIs): 1.2-90.2) and 5.1-fold (95% CIs: 1.01-25.5) risks of contracting MetS, as defined by the IDF and Cook criteria for MetS, respectively. In girls, the risk estimates for the same comparison were not significant by the IDF criteria (6.5-fold risk, 95% CIs: 0.9-∞) or Cook criteria (5.9-fold risk, 95% CIs: 0.8-43.8) for MetS. High SSB consumption was also linked to 1.9-fold (95% CIs: 1.1-3.1) and 2.7-fold (95% CIs: 1.3-5.7) higher risks of being at a greater overall metabolic risk in girls and boys, respectively. In conclusion, a high SSB intake is associated with adolescent MetS among boys but not girls in Taiwan.

Parental history of hypertension and dietary intakes in early adolescent offspring: a population-based study

We investigated the cross-sectional association between parental history of hypertension and dietary intakes among early adolescent schoolchildren. A total of 1845 participants aged 12 years had complete data on diet and parental medical history, and thus they were included in the final analyses. Dietary data were assessed from validated semi-quantitative food-frequency questionnaires. Parents completed questionnaires about their medical conditions. Cases where the biological mother and/or father had hypertension were classified as positive parental history of hypertension. After multivariable adjustment, participants with positive versus negative parental history of hypertension had 33% greater likelihood of consuming soft drinks ⩾1 per week. Boys with a parental history versus boys without a parental history of hypertension consumed more energy-dense, nutrient-poor foods: 379.4 g per day and 318.0 g per day, respectively, P=0.02. Girls with a positive versus a negative parental history consumed more vegetables: 164.1 versus 142.6 g per day, P=0.01. Significant associations were not observed between those with and those without a positive parental history in mean dietary intakes of carbohydrates, fats, sugars and sodium. Children with a positive parental history of hypertension were 67% more likely to simultaneously engage in three unhealthy lifestyle behaviors (excessive recreational screen viewing, high consumption of snacks and and high consumption of soft drinks). Parental hypertension was associated with unhealthy dietary behaviors among offspring, including higher consumption of soft drinks and energy-dense, nutrient-poor foods.

Female sex, small size at birth and low family income increase the likelihood of insulin resistance in late childhood: the Healthy Growth Study

OBJECTIVE

To identify among a wide range of perinatal indices, as well as certain family sociodemographic and parental characteristics, those independently associated with insulin resistance (IR) in late childhood.

METHODS

A representative sample of 2195 Greek schoolchildren, aged 9-13 yr, was examined, and based on the biochemical indices collected IR was estimated using the homeostasis model assessment (HOMA-IR < 3.16). Perinatal data were recorded from children's medical records, retrospectively, while family sociodemographics and parental anthropometrics were reported by parents.

RESULTS

The overall prevalence of IR was 28.4%, with a higher prevalence observed for girls compared with boys (p <0.05). Examination of univariate associations, per se, showed that maternal current and pre-pregnancy overweight/obesity, maternal smoking at early pregnancy, children's small birth weight, and rapid growth at infancy as well as female sex and non-Caucasian race increased the likelihood of IR. In contrast, folate supplementation during pregnancy, as well as higher paternal education and annual family income decreased the likelihood of IR in children. Inclusion of all above variables at a multivariable regression model highlighted female sex [odds ratios (OR): 1.67, 95% confidence intervals (CI): 1.30-2.13], small birth weight (OR: 1.41, 95% CI: 1.03-2.01), and higher annual family income (OR: 0.71, 95% CI: 0.53-0.95 for 12 000-30 000 € and OR: 0.68, 95% CI: 0.48-0.96 for >30 000 €) as the only significant correlates of IR after also controlling for children's body mass index (BMI) and Tanner stage.

CONCLUSIONS

The current study highlighted small birth weight and female sex as the only perinatal factors independently associated with the occurrence of IR in late childhood, when examined at a multivariable level with a wide range of perinatal indices as well as certain family sociodemographic and parental characteristics.

Accuracy of Neck Circumference in Classifying Overweight and Obese US Children

Objective. To evaluate classification accuracy of NC and compare it with body mass index (BMI) in identifying overweight/obese US children. Methods. Data were collected from 92 children (boys: 61) aged 7 to 13 over a 2-year period. NC, BMI, and percent of body fat (BF%) were measured in each child and their corresponding cut-off values were applied to classify the children as being overweight/obese. Classification accuracy of NC and BMI was systematically investigated for boys and girls in relation to true overweight/obesity categorization as assessed with a criterion measure of BF% (i.e., Bod Pod). Results. For boys, Cohen's κ (0.25), sensitivity (38.1%), and specificity (85.0%) of NC were smaller in comparison with Cohen's κ (0.57), sensitivity (57.1%), and specificity (95.0%) of BMI in relation to BF% categorization. For girls, Cohen's κ (0.45), sensitivity (50.0%), and specificity (91.3%) of NC were smaller in comparison with Cohen's κ (0.52), sensitivity (50.0%), and specificity (95.7%) of BMI. Conclusion. NC measurement was not better than BMI in classifying childhood overweight/obesity and, for boys, NC was inferior to BMI. Pediatricians and/or pediatric researchers should be cautious or wary about incorporating NC measurements in their pediatric care and/or research.

Long-term vitamin E supplementation reduces atherosclerosis and mortality in Ldlr-/- mice, but not when fed Western style diet

OBJECTIVES

Epidemiological and experimental evidence have indicated potential health benefits of vitamin E supplementation on coronary heart disease (CHD), but several clinical trials have reported no benefit from vitamin E supplementation on CHD. We hypothesized that supplemental intake of vitamin E from an early age may prevent or retard the development and progression of atherosclerosis and CHD mortality.

METHODS

To test this hypothesis, 300 Ldlr(-/-) mice were divided into groups receiving Western style high fat/cholesterol (HFHC), moderate fat/cholesterol (MFMC), or low fat/cholesterol (LFLC) diets all containing 50 IU of vitamin E. These dietary groups were further subdivided into four sub-groups (n = 25) receiving their respective diets with no vitamin E supplementation or additionally supplemented with vitamin E (500 IU/kg diet) starting at the early age of 5 wks, or 6 mo, or 12 mo. All mice remained on their assigned diets until age 18 mo. Body weight, health status and survival rate of mice were monitored and recorded. After 18 mo of dietary treatments, mice were sacrificed.

RESULTS

Body weight was the highest in HFHC groups and the lowest in LFLC groups. Plasma concentration of cholesterol and triglycerides was high in all dietary groups, and plasma vitamin E was high in vitamin E supplemented groups. Fifty percent of mice fed Western style HFHC diet and 53% of mice fed MFMC diet survived during the 18 mo, whereas 75% of mice fed LFLC diet survived during the 18 mo dietary treatments. At the age of 18 mo, all the Ldlr(-/-) mice, regardless of dietary treatments, had several advanced atherosclerotic lesions in both aortic root and aortic tree. Within the LFLC groups, those that received vitamin E supplements from age 5 wks up to 18 mo had a significantly higher survival rate of 88% (p = 0.04) and lower mortality (12%) compared to mice that did not receive vitamin E supplements (64%). This lower mortality rate and higher survival rate coincided with significantly (p = 0.03) fewer aortic lesions in the vitamin E supplemented LFLC group (50%) compared to LFLC mice that did not receive vitamin E supplements in their diets (65%). Subjective immunohistochemical evaluation of aortic valves showed that LFLC mice that received vitamin E supplements for 18 mo had less intima media thickness compared to LFLC mice that did not receive vitamin E supplements in their diet. The LFLC mice that were supplemented with vitamin E for 18 mo had the lowest mRNA expression of inflammatory markers such as VCAM-1, MCP-1 and CD36 in samples obtained from lesion and non-lesionareas.

CONCLUSION

In conclusion, 500 mg vitamin E/kg diet in Ldlr(-/-) mice is not effective at reducing mortality and atherosclerosis when the diet contained high or medium levels of fat and cholesterol. However, a relatively low dose and long-term vitamin E supplementation started from an early age is effective in reducing mortality and atherosclerotic lesions in genetically prone Ldlr(-/-) mice fed LFLC diet.

Sex hormone-binding globulin and the risk for metabolic syndrome in children of South Asian Indian origin

OBJECTIVE

To determine whether the plasma level of sex hormone-binding globulin (SHBG) identifies South Asian Indian children at risk for metabolic syndrome.

METHODS

Adults and their children aged 5 to 9 years were recruited at the annual health fair at the Hindu temple serving the South Asian Indian community in Louisville, Kentucky. Anthropometric data were collected in adults and children, and blood pressure, lipid, and glucose levels were measured in adults. SHBG levels were measured in children using a fingerstick blood sample. In adults, metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. Twelve months later, follow-up anthropometric data were obtained for a portion of the children.

RESULTS

The study included 30 sets of parents and 30 children. The prevalence of metabolic syndrome among 310 adults attending the health fair was 42% in men and 39% in women. Children with 1 parent with metabolic syndrome had 24% lower SHBG levels that increased to 55% if both parents had metabolic syndrome. SHBG levels were inversely related to waist circumference and to body mass index percentile. Both SHBG and waist circumference predicted weight gain over 1 year in children. CONCLUSIONS Low SHBG levels were found in South Asian Indian children whose parents had attributes of metabolic syndrome. The dose dependency of SHBG is consistent with inheritance of a genetic trait, and if the results are applicable to other racial/ethnic groups, SHBG may be a useful marker to identify at-risk children for early intervention.

Influence of parental history of hypertension on screen time and physical activity in young offspring

OBJECTIVE

Epidemiological data on the relationship between parental hypertension and lifestyle factors among children are limited. We assessed the associations between positive parental history of hypertension with a range of indicators of sedentariness (television viewing, computer and videogame usage) and physical activity (outdoor and indoor activity) among prepubertal children.

METHODS

Six-year-old (1765 of 2238 eligible) students from a random cluster sample of 34 Sydney schools were examined. Parents completed questionnaires about their medical conditions and the child's activities. If the biological mother and/or father had hypertension, then this was classified as positive parental history of hypertension.

RESULTS

Parents of 160 (9.2%) children gave a positive family history of hypertension. After adjusting for age, sex, ethnicity, parental education and employment and exposure to passive smoking, children with, compared with those without, a family history of hypertension were more likely to spend above the median time (hours/day) watching television and playing videogames [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.02-1.96; OR 1.52, CI 1.12-2.06, respectively]. The offspring of hypertensive parents were more likely to spend above the median time in total physical activity (OR 1.67, 95% CI 1.23-2.27). Maternal (but not paternal) hypertension was associated with increased time spent watching television (P = 0.03) and in outdoor activity (P = 0.01).

CONCLUSION

Parental hypertension influences the time that prepubertal offspring spend in both active and sedentary pursuits. These findings highlight potential factors that could be addressed in the development of cardiovascular disease-preventive measures starting early in life among the offspring of hypertensive parents.

Vitamin D deficiency, adiposity, and cardiometabolic risk in urban schoolchildren

OBJECTIVE

To determine the relationship between serum vitamin D levels and cardiometabolic risk factors independent of adiposity in urban schoolchildren.

STUDY DESIGN

We assessed the relationships among serum 25-hydroxyvitamin D [25(OH)D], adiposity measured by body mass index (BMI) z-score (BMIz), and 6 cardiometabolic risk factors (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, interleukin-6, and C-reactive protein [CRP]) in a cross-sectional sample of 263 racially and ethnically diverse schoolchildren from the Boston area during late winter. Multivariate regression analyses adjusting for sociodemographic characteristics and BMIz examined associations of 25(OH)D and cardiometabolic risk factors.

RESULTS

Overall, 74.6% of the children were vitamin D deficient [25(OH)D <50 nmol/L; mean, 41.8 ± 13.7 nmol/L]; 45% were overweight or obese (20% and 25%, respectively; BMIz = 0.75 ± 1.1). The 25(OH)D level was not associated with BMIz, but was positively associated with the cardiometabolic risk factor CRP (β = 0.03; P < .05). BMIz was associated with elevated triglycerides (β = 0.13), CRP (β = 0.58), and interleukin-6 (β= 0.14) and low high-density lipoprotein cholesterol (β = -0.09; all P < .01).

CONCLUSIONS

Vitamin D deficiency is highly prevalent during the late winter months in urban schoolchildren living in the northeastern United States. This widespread deficiency may contribute to the lack of associations between 25(OH)D and both BMIz and cardiometabolic risk factors. The association between 25(OH)D and CRP warrants further study.

Association of visceral fat and risk factors for metabolic syndrome in children and adolescents

PURPOSE

Visceral fat (VF) is closely associated with many metabolic risk factors and is also known to be a strong predictive factor for severe metabolic complications in adults. But there are only a few studies concerning the association of VF and risk factors for metabolic syndrome (MS) in children and adolescents. In our study, we emphasized the association of VF [measured by VF computed tomography (VFCT)] and risk factors for metabolic syndrome in children and adolescents.

MATERIALS AND METHODS

The subjects were outpatients aged 6 to 18 years who underwent VFCT in the family medicine of The Catholic University of Korea from January 2005 to August 2009. There were 82 patients in total (42 children, 40 adolescents). Height, weight, blood pressure (BP), blood tests, body composition analysis and VF were measured. The three groups were also classified by metabolic score.

RESULTS

In children, only high density lipoprotein cholesterol (HDL-C) showed a statistically significant difference, while in adolescents, triglyceride, HDL-C, BP, body mass index (BMI), waist circumference (WC) and VFA showed statistically significant differences. In terms of VFA, fasting glucose, BP, BMI, basal metabolic rate (BMR) and WC showed statistically significant differences. BMI showed a statistically significant difference in terms of BP, BMR, WC, VFA and HDL-C.

CONCLUSION

There is a need to acknowledge the statistically significant associations of VF and risk factors for MS in children and adolescents. Screening tests for BP, cholesterol, fasting glucose and WC should be given in clinics for children and adolescents so that MS can be detected and its risk factors treated early.

Urinary angiotensinogen is correlated with blood pressure in men (Bogalusa Heart Study)

BACKGROUND

The Bogalusa Heart Study is a long-term study on cardiovascular disease and has followed a biracial (black/white) population from childhood. Risk factor data pertaining to many patients have been collected over 35 years, and the time course of hypertension has been documented by repeated examinations and measurements. Considerable sex and racial differences have been found to be related to cardiovascular disease. Urinary angiotensinogen (UAGT) is a novel biomarker for the intrarenal activity of the renin-angiotensin system in hypertension and kidney disease. We aimed to determine the relationship of UAGT with traditional cardiovascular disease risk factors in asymptomatic young adults in this biracial population.

METHOD

We recruited 251 individuals and collected a single random spot urine sample from each one. Because UAGT is significantly increased in diabetic patients and the use of antihypertensive drugs affects UAGT levels, we excluded patients who had diabetes, who were receiving antihypertensive treatment, or both. Consequently, 190 participants were included for this analysis.

RESULTS

UAGT levels did not differ with race or sex, but were significantly correlated with SBP (r = +0.23, P = 0.0015) and DBP (r = +0.24, P = 0.0012). Moreover, high correlations were shown in men, especially in black men (SBP, r = +0.85, P = 0.0005 and DBP, r = +0.72, P = 0.0079). Thus, UAGT is correlated with blood pressure in men, even when they do not show overt proteinuria or albuminuria.

CONCLUSION

The biomarker, UAGT, may facilitate the identification of individuals that are at increased risk for the development of hypertension and early asymptomatic renal disease.

Dose-response relationship between physical activity and dyslipidemia in youth

BACKGROUND

The minimal and optimal amount of physical activity associated with cardiovascular health benefits in young people is unknown.

OBJECTIVE

To determine the dose-response relationship between moderate-to-vigorous physical activity (MVPA) with high-risk low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglyceride values in youth.

METHODS

The study sample consisted of 1235 adolescents (12 to 19 years of age) from the 20032004 and 20052006 cycles of the United States National Health and Nutrition Examination Survey. Objective measures of MVPA were obtained over seven days with accelerometers. LDL cholesterol, HDL cholesterol and triglycerides were measured from a fasting blood sample. High-risk values for these lipidslipoproteins were determined using age- and sex-specific thresholds. Logistic regression models were used to determine the dose-response relationships between MVPA and high-risk lipid levels.

RESULTS

ORs for high-risk HDL cholesterol and triglyceride values decreased in a curvilinear manner with increasing minutes of MVPA. Compared with no MVPA (0 min), the ORs for high-risk HDL cholesterol values at 15 min, 30 min and 60 min per day of MVPA were 0.29 (95% CI 0.13 to 0.67), 0.24 (95% CI 0.10 to 0.64) and 0.21 (95% CI 0.07 to 0.61), respectively. The corresponding ORs for high-risk triglyceride values were 0.40 (95% CI 0.18 to 0.76), 0.22 (95% CI 0.06 to 0.66) and 0.10 (95% CI 0.01 to 0.51). There was no discernible dose-response relationship between MVPA and LDL cholesterol.

CONCLUSIONS

Small amounts of MVPA were associated with a large reduction in the likelihood of having high-risk HDL cholesterol and triglyceride values in this representative sample of adolescents.

Increased levels of proinflammatory cytokines in children with family history of coronary artery disease

BACKGROUND

Parental history of coronary artery disease (CAD) is considered an important risk factor for early atherosclerosis

HYPOTHESIS

The onset of the inflammatory process of atherosclerosis initiates early during childhood in children with positive family history (PFH) of CAD.

METHODS

We studied 55 healthy children (5-15 years), 30 (16 male) with PFH and 25 age and sex matched control subjects. Blood samples were taken to measure white blood count (WBC), glucose, total cholesterol, triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), erythrocyte sedimentation rate (SDE), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-a). We performed cultures on monocytes (from peripheral blood) measuring in the cell culture supernatants the proinflammatory cytokines IL-6 and TNF-a, by using the immunoassay ELISA method.

RESULTS

: Higher values of body mass index (BMI), total cholesterol, LDL, cholesterol, TG, SDE, leucocytes, and CRP were calculated in children with PFH. Significantly higher values of cytokines in monocell cultures were measured in the PFH group compared to the control group (IL-6 = 139.32 +/- 80.84 pg/ml versus 14.30 +/- 12.97 pg/ml, p < 0.001 and TNF-a = 39.91 +/- 11.80 pg/ml versus 8.65 +/- 4.35 pg/ml, p < 0.001). IL-6 values in plasma and cultures were found independently associated with PFH of premature CAD (p < 0.001, p = 0.005, respectively). A similar relation was found for TNF-a values measured in cultures (p = 0.005) and CRP values in plasma (p < 0.001). The values of IL-6 were found proportionally related to TG.

CONCLUSION

In individuals with PFH of CAD the inflammatory process of atheromatosis appears to begin early in childhood. Except for triglycerides, this inflammatory process appears to occur independently of several traditional cardiovascular risk factors.

The prevalence of metabolic syndrome and cardiovascular risk factors in a group of obese Saudi children and adolescents: a hospital-based study

BACKGROUND AND OBJECTIVES

We assessed the distribution of risk factors associated with the metabolic syndrome in a group of obese Saudi children and adolescents. No previous studies had addressed this issue in the Saudi pediatric population.

SUBJECTS AND METHODS

We retrospectively reviewed the medical records of patients evaluated for obesity between 2004 and 2008 and collected data on age, weight, height, body mass index (BMI), BP, fasting lipid profile, fasting glucose, insulin concentrations, and insulin resistance based on the homeostasis assessment model-insulin resistance (HOMA-IR) score. Obesity was defined as a BMI above the 95th percentile for age and gender and metabolic syndrome was diagnosed according to standard criteria.

RESULTS

We studied 57 obese Saudi children and adolescents with a mean (standard deviation) age of 9.8 (3.5) years. Mean weight and body mass index (BMI) were 63.7 (28.3) kg and 31.6 (8.0) kg/m(2) , respectively. Systolic BP was elevated in 24 (42%) of the 57 subjects. Of the 39 children who had a lipid profile in their records, 10 had hypertriglyceridemia, 8 had hypercholesterolemia, 6 had elevated LDL cholesterol levels, and 6 had low HDL cholesterol levels. Impaired fasting glucose was found in 10 of 38 patients in which it was measured, and 9 of 25 patients had fasting hyperinsulinemia. Eleven of 37 patients (29.7%) met the diagnosis of the metabolic syndrome. Diastolic BP correlated positively with BMI (r=0.440, P =.001), and HDL cholesterol correlated negatively with weight and BMI (r=-0.487, P =.002 and r=-0.317, P =.05). HOMA-IR correlated positively with BMI and triglyceride levels and negatively with HDL cholesterol levels.

CONCLUSIONS

Obese Saudi children and adolescents have multiple risk factors associated with metabolic syndrome.

Cardiovascular disease risk factors in a population-based sample of Norwegian children and adolescents

OBJECTIVE

The objective of the study was to describe the distribution of cardiovascular disease (CVD) risk factors, and to evaluate the extent of clustering of CVD risk factors in Norwegian children and adolescents.

MATERIAL AND METHODS

A randomly selected cohort of 9-year-olds and 15-year-olds from all regions of the country was sampled. Of 2,818 subjects invited to participate, 2,299 accepted, giving an overall participation rate of 82%.

RESULTS

Mean (SD) values for the main risk factors for 9-year-old and 15-year-old girls and boys were: total cholesterol (TC) (mmol/L) 4.49 (0.73), 4.37 (0.68), 4.19 (0.76) and 3.80 (0.69), respectively; triglycerides (TG) (mmol/L) 0.72 (0.33), 0.63 (0.32), 0.79 (0.32) and 0.82 (0.47), respectively; high density lipoprotein cholesterol (HDL-c) (mmol/L) 1.70 (0.35), 1.79 (0.40), 1.61 (0.34) and 1.42 (0.30), respectively; systolic blood pressure (mmHg) 102.6 (7.7), 103.3 (7.7), 109.0 (8.8) and 115.3 (9.0), respectively; and homeostasis model assessment score (HOMA) 1.29 (0.83), 1.19 (0.78), 2.10 (1.37) and 2.14 (1.49), respectively. At least five risk factors were found in 11.1 (95% confidence interval (CI) 8.76 to 13.44) times as many participants as expected. A significant degree of clustering of CVD risk factors was found in 11.4% (95% CI, 9.8 to 13.0) of the study population, and these had mean Z scores of 1.24 (0.06) and 1.04 (0.08) for the 9-year-olds and 15-year-olds, respectively.

CONCLUSION

This study presents national reference data on selected CVD risk factors in children and adolescents.

BMI and lipid levels in Mexican American children diagnosed with type 2 diabetes

PURPOSE

The purpose of this study was to determine potential associations between obesity as measured by body mass index (BMI) and lipid values in Mexican American (MA) children diagnosed with type 2 diabetes.

BACKGROUND

Obesity in children is considered to be an emerging epidemic that is accompanied by an increase in prevalence of type 2 diabetes. Literature shows that there is a direct and strong relationship between abnormal lipid levels and obesity in Caucasian and African American children without type 2 diabetes. However, it was unknown whether Mexican American children diagnosed with type 2 diabetes have abnormal lipid levels.

METHOD

A retrospective medical-record review was conducted on paediatric patients who received medical care from a military medical centre in the Southwest region of the United States. A convenience sample of records was used to study the relationship between obesity as measured by BMI and lipid levels in 49 Mexican American children diagnosed with type 2 diabetes. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and BMI were reviewed. Data were analysed using descriptive and logistic regression statistics.

FINDINGS

Ninety percent of the sample was obese and 75% had two or more abnormal lipid values. Abnormal levels of total cholesterol, HDL, and triglycerides were found to be statistically significant.

CONCLUSIONS

The main findings indicate that MA children diagnosed with type 2 diabetes had significant associations between obesity as measured by BMI and abnormal total cholesterol, HDL, and triglyceride levels. As the BMI increased, the probability of abnormal total cholesterol and triglyceride levels increased. Similarly, as the BMI increased, the probability of abnormal HDL values increased. Mexican American children in this study had obesity levels similar to those in a study by the National Center for Health Statistics. In this study a step has been taken toward understanding a physiologic marker for cardiovascular disease in children.

Obesity is associated with premature occurrence of acute myocardial infarction

BACKGROUND

The American Heart Association has classified obesity as a major modifiable risk factor for coronary artery disease, but its relationship with age at presentation with acute myocardial infarction (AMI) is poorly documented.

HYPOTHESIS

The study was undertaken to evaluate the impact of obesity on age at presentation, and on in-hospital morbidity and mortality in patients with AMI.

METHODS

Our analysis includes a consecutive series of 906 Olmsted County patients (mean age 67.7 years, 51% male) admitted with AMI to the Mayo Clinic Coronary Care Unit (CCU). The patients were entered into the Mayo CCU Database, a prospective registry of data pertaining to patients admitted to the Mayo Clinic CCU with AMI. Age at AMI occurrence and in-hospital morbidity and mortality were noted.

RESULTS

Obese patients (body mass index [BMI] >30) with AMI were significantly younger than patients with AMI in the overweight (BMI 25-30) and normal-weight (BMI < 30) groups (62.3+/-13.1 vs. 66.9+/-13.2 and 72.9+/-13.4, respectively. p < 0.001). Obesity and overweight status were associated with male gender, diabetes mellitus, hypercholesterolemia, and smoking history; however, after multivariate adjustment for these risk factors, excess weight and premature AMI remained significantly associated. Compared with normal-weight patients, overweight patients presenting with AMI were 3.6 years younger (p < 0.001, confidence interval [CI] 1.9-5.4) and obese patients 8.2 years younger (p < 0.001, Cl 6.2-10.1). No significant increase in in-hospital morbidity and mortality was seen.

CONCLUSION

In this population-based study, overweight and obese status are independently associated with the premature occurrence of AMI, but not with an increased incidence of in-hospital complications.

Insulin resistance and impaired glucose tolerance in overweight and obese Costa Rican schoolchildren

BACKGROUND

Worldwide obesity has become an unprecedented public health challenge. In addition, a notable increase in the risk of insulin resistance and type 2 diabetes mellitus has emerged. In Costa Rica, there are no epidemiological data to establish the prevalence of type 2 diabetes in the pediatric population. However, information from the Endocrinology Department of the Children's National Hospital indicates an increased number of cases in the last 2 to 3 years.

OBJECTIVE

To determine the prevalence of insulin resistance and impaired glucose tolerance in overweight and obese schoolchildren.

METHODS

This cross-sectional study was conducted among 214 healthy 8- to 10-year-old children from urban schools of San José, Costa Rica. Anthropometric measurements and blood determinations of glucose, insulin, proinsulin, glycosylated hemoglobin, C-peptide, and leptin were performed. Indexes were calculated to assess insulin resistance. Information on social and lifestyle variables was obtained from questionnaires, and acanthosis nigricans was certified by a physician. Statistical analysis was performed with SPSS software for Windows, version 10.0.

RESULTS

The prevalence of type 2 diabetes mellitus was very low (0.5%) in the studied population. However, hyperinsulinemia and impaired glucose tolerance were present in 20.6% and 6.5% of the subjects, respectively. On the basis of the Fasting Glucose-to-Insulin Resistance Ratio (FGIR), 46.7% of the children showed insulin resistance. Girls and obese children (body mass index > or = 95th percentile) were more likely to have higher serum insulin levels and insulin resistance than boys and overweight children (BMI > or = 85th percentile). Compared with the lowest quintile, children in the highest quintile of body-fat tissue had higher insulin resistance but had similar serum concentrations of glucose, C-peptide, and proinsulin. Positive family histories of type 2 diabetes mellitus and sedentarism (73.7% and 40.7%, respectively) were highly prevalent among overweight and obese children.

CONCLUSIONS

The prevalence of impaired glucose tolerance and insulin resistance in obese children indicates a worrisome trend in the incidence of type 2 diabetes in Costa Rica. Strategies for weight reduction, obesity prevention, and promotion of healthy lifestyles are necessary to prevent the onset of type 2 diabetes during childhood and adolescence.

Energy gain and energy gap in normal-weight children: longitudinal data of the KOPS

Population-based prevention of overweight needs evidence-based goals consistent with our present knowledge about energy gap (i.e., daily imbalance between energy intake and energy expenditure resulting in overweight). Longitudinal data of normal-weight children (1,029 girls and 1,028 boys; Kiel Obesity Prevention Study, KOPS) were used to calculate energy gain (i.e., increase in fat mass (FM) and fat-free mass (FFM)) in normal-weight children staying normal weight (persistent children) or becoming overweight (incident children). Taking into account weight gain in proportion to height gain (normal development) energy gap was calculated from increases in FM and FFM exceeding normal development. Children were divided into two groups and were followed from age 6 to 10 (group A) and 10 to 14 years (group B). FM and FFM were measured. Medians of 4-year BMI- (kg/m(2))/weight changes (kg) were +1.8/+13.2 (A) and +3.0/+18.7 (B) in girls, and +1.6/+12.8 (A) and +2.6/21.7 (B) in boys. Corresponding data for FM/FFM (kg) were +3.1/+10.2 (A) and +5.1/12.7 (B) in girls, and +2.3/10.8 (A) and +3.0/18.6 (B) in boys. The 4-year-incidence of overweight (%) were 9.4 (A) and 5.4 (B) in girls, and 11.0 (A) and 3.8 (B) in boys, respectively. Mean energy gains (kcal/day) were 26.8 (A) and 46.4 (B) in girls, and 22.1 (A) and 32.5 (B) in boys. The 90th percentile of energy gap (kcal/day) in incident children were 58.1 (A) and 72.0 (B) in girls and 46.0 (A) and 53.2 (B) in boys. To prevent overweight in children energy gap should not exceed 46-72 kcal/day.

Tioga County Fit for Life: a primary obesity prevention project

Pediatric obesity, which has reached epidemic proportions in the United States in the past 10 years, translates directly into rising rates of adult obesity. This study assessed the impact of a school, family, community, and industry-based primary intervention project on the rates of overweight and obesity in a rural countywide cohort of children in grades kindergarten through 8. It included classroom education, student/ family wellness booklets, point source healthy menus, occupational health analyses, and community health fairs. A 5-year longitudinal analysis of grade-specific rates of overweight and obesity of the participating children showed that overweight and obesity rates increased for all cohorts. Key elements contribute to increasing rates of pediatric obesity. Inadequate penetration of education/information dissemination and lag time represent 2 explanations for the lack of obesity reduction during the program implementation period. Strategies for successful engagement of multiple groups are essential to effectively reverse the pediatric obesity epidemic.

Candidate genes and growth curves for adiposity in African- and European-American youth

OBJECTIVE

Obesity is associated with multiple health problems and often originates in childhood. This study investigated the association of genes with the development of general and central obesity from childhood into adulthood.

DESIGN

Individual growth curves for measures of general adiposity were examined in an 11-year (1987-1998) cohort study. Single-nucleotide polymorphisms (SNPs) in 11 candidate genes were genotyped.

SUBJECTS

Five hundred and twenty-six subjects classified by race (49% African American (AA)), sex (47% male) and socio-economic status (SES).

RESULTS

AA female carriers of the 27Glu allele in the ADRB2 gene had a larger waist circumference (P<0.05). Subjects of high SES with the ApoB 4145Lys allele had a larger mean waist circumference than those without this allele (P<0.05). Only in the presence of an adverse environment (low SES) did carriers of the NOS3 298Asp allele have a larger mean body mass index, waist circumference and sum of skinfolds (P<0.05).

CONCLUSION

These results suggest that several polymorphisms are associated with the mean level of adiposity, with the effects depending on other factors such as race, sex and/or SES.

Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria

OBJECTIVES

The study objectives were to develop age-specific adolescent metabolic syndrome (MetS) criteria that were linked to the health-based Adult Treatment Panel III (ATP) and International Diabetes Federation (IDF) adult criteria.

BACKGROUND

There has been no consistency in the criteria used to diagnose the MetS in adolescents. Studies have either applied adult criteria or arbitrarily chosen adolescent high-risk cut-points.

METHODS

The adolescent (12 to 19 years old) MetS criteria developed in this study were linked to the ATP and IDF adult criteria with LMS growth curve modeling for each MetS component (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides, and glucose). Nationally representative data from the National Health and Nutrition Examination Surveys were used to develop the growth curves.

RESULTS

The growth curves for each MetS component passed through the ATP and IDF cut-points at 20 years of age such that adolescent cut-points were linked to the adult values. Age- and gender-specific cut-points for each MetS component were developed that can be used to define high-risk values in 12- to 19-year-olds. The prevalence of MetS in adolescents nearly doubled over the last decade and was 7.6% on the basis of the newly developed ATP adolescent criteria and 9.6% on the basis of the newly developed IDF adolescent criteria.

CONCLUSIONS

These new criteria should provide improved and age-appropriate approaches for diagnosing MetS among adolescents.

The relationship of blood pressure and cortisol reactivity to family history of hypertension of African American adolescents

Ethnicity and family history of hypertension (FHH) have been associated with the development of hypertension. Blood pressure and cortisol reactivity during physiologic stress are hypothesized to function as biologic markers for hypertension. The purpose of this study was to explore the relationship of blood pressure and cortisol reactivity physiologic to FHH in a selected sample of African American adolescents.

METHODS

Demographic data and physiologic measurements were obtained from 48 African American adolescents (14-17 years). Reactivity was induced by a cold pressor test of hand immersion in cold water. chi, t tests, and multivariate repeated-measures analysis were used to determine relationships.

RESULTS

Thirty-one (65%) subjects reported an FHH. Thirty (63%) subjects demonstrated cardiovascular reactivity. Although the mean systolic blood pressure was 4 mm Hg higher, t tests indicated no significance between group in systolic blood pressure (P = .32), diastolic pressure (P = .73), and cortisol (P =.81). Blood pressure reactivity of the FHH group was significantly different than the no family history group (P = .0338). Cortisol levels for the total group were markedly elevated (19 nmol/dL) and there was no significant difference in reactivity.

CONCLUSION

African American adolescents with FHH demonstrate increased blood pressure reactivity. Cortisol levels were elevated for all participants. This study adds support to the association of blood pressure reactivity, a biologic marker of HTN and FHH.

Distribution of lipoproteins by age and gender in adolescents

BACKGROUND

The current National Cholesterol Education Program lipoprotein classification system for children and adolescents is recommended for use among 2- to 19-year-olds. This classification system does not take into account gender differences or the natural fluctuations in lipoprotein concentrations that occur with growth and maturation.

METHODS AND RESULTS

Data from the National Health and Nutrition Examination Surveys were used to develop age- and gender-specific thresholds that can be used to denote abnormal levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Each curve was linked to the adult National Cholesterol Education Program Adult Treatment Panel III lipoprotein thresholds using LMS (Lambda-Mu-Sigma) growth curve regression methods. A series of growth curves and tables are presented that can be used to diagnose high-risk lipoprotein levels in the clinical and research settings. For example, in 1-year increments for males starting at age 12 and extending to age 19 years, the high-risk thresholds for total cholesterol were 6.03, 5.83, 5.70, 5.70, 5.77, 5.88, 6.02, and 6.16 mmol/L. The corresponding high-risk threshold for adults (> or = 20 years) is 6.22 mmol/L.

CONCLUSIONS

The present study is the first attempt at developing age- and gender-specific lipoprotein threshold concentrations for adolescents. This new classification system should provide a more accurate diagnosis of high-risk lipoprotein levels and associated cardiovascular risks in adolescents.