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Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population. Metabolites 2023; 13:metabo13030327. [PMID: 36984767 PMCID: PMC10056524 DOI: 10.3390/metabo13030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Excess weight and high waist circumference (WC) are associated with increased blood pressure (BP), starting from the pediatric age. Insulin resistance is associated with elevated BP in childhood. The aim of the study was to assess the role of insulin resistance in mediating the relationship between body mass index (BMI), WC, and BP values in a pediatric population referred to a cardio-pediatric center for the presence of one or more cardiovascular risk factors. In 419 children (mean age 10.7 [standard deviation, SD 2.5] years), the following parameters were collected both in basal conditions and after 18.6 (SD 9.3) months of follow-up during which a treatment based on lifestyle and dietary modifications was given: systolic and diastolic BP (SBP and DBP), WC, plasma glucose, and insulin values. The HOMA (Homeostasis Model Assessment)-index was considered as an expression of insulin resistance. At baseline there was a significant correlation between HOMA-index and SBP z-score (β = 0.081, p = 0.003), and insulin resistance was a mediator of the relationship between BMI and SBP z-score (p = 0.015), and between waist circumference to height (WtHr) and SBP z-score (p = 0.008). The effect of BMI z-score modifications on SBP z-score changes from baseline to follow-up was totally mediated by HOMA-index changes (p = 0.008), while HOMA-index only partially mediated the effect of WtHr modifications on SBP z-score changes (p = 0.060). Our study strongly suggests that, in a pediatric population at cardiovascular risk, the HOMA-index is an important mediator of the relationship between BMI, WC and SBP.
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Nimkarn N, Sewarit A, Pirojsakul K, Paksi W, Chantarogh S, Saisawat P, Tangnararatchakit K. Waist-to-height-ratio is associated with sustained hypertension in children and adolescents with high office blood pressure. Front Cardiovasc Med 2023; 9:1026606. [PMID: 36712271 PMCID: PMC9874100 DOI: 10.3389/fcvm.2022.1026606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Background Waist-to-height-ratio (WHtR) has been proposed as another indicator for cardiometabolic risk factors including hypertension. Normally, hypertension can be diagnosed in the office setting by detecting high blood pressure for three occasions. However, patients with high office blood pressure may not exhibit high blood pressure outside the office. Ambulatory blood pressure monitoring (ABPM) is a procedure to measure blood pressure over 24-h. Sustained hypertension is characterized as hypertension detected by both office measurement and ABPM. This study aimed to evaluate the performance of WHtR in the diagnosis of sustained hypertension in patients with high office blood pressure. Materials and methods Demographic data, height, body weight, body mass index (BMI), and waist circumference were retrospectively reviewed in children and adolescents who underwent ABPM due to persistently high office blood pressure. Patients were separated into two groups: a sustained hypertension group and a normal ABPM group. BMI was adjusted to z-score using the WHO Anthroplus software. WHtR was calculated by the formula: waist circumference (cm)/height (m). The performances of different parameters were analyzed using the receiver operating characteristic (ROC) curve and multivariate logistic regression. Results Sixty patients (63% male) with a mean age of 12.9 ± 3.7 years had persistently high office blood pressure. Twenty-nine (48.3%) had high ambulatory blood pressure parameters so-called "sustained hypertension." The sustained hypertension group had a higher mean BMI z-score (2.32 vs. 1.31, p = 0.01) and a higher mean WHtR (57.7 vs. 49.2 cm/m, p < 0.001) than those of the normal ABPM group. For the diagnosis of sustained hypertension, the ROC analysis revealed that WHtR had a greater area under the ROC curve (AUC) than that of BMI z-score (0.772 vs. 0.723). WHtR remained associated with sustained hypertension (OR 1.2, 95% CI 1.022-1.408, p = 0.026) after adjusting for age, gender, and BMI z-score. Conclusions Apart from being a more user-friendly metric, WHtR tended to outperform BMI z-score in predicting sustained hypertension in children and adolescents with persistently high office blood pressure.
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Di Bonito P, Pacifico L, Licenziati MR, Maffeis C, Morandi A, Manco M, Del Giudice EM, Di Sessa A, Campana G, Moio N, Baroni MG, Chiesa C, De Simone G, Valerio G. Elevated blood pressure, cardiometabolic risk and target organ damage in youth with overweight and obesity. Nutr Metab Cardiovasc Dis 2020; 30:1840-1847. [PMID: 32736956 DOI: 10.1016/j.numecd.2020.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM To compare cardiometabolic risk profile and preclinical signs of target organ damage in youth with normal and elevated blood pressure (BP), according to the American Academy of Pediatrics (AAP) guidelines. METHODS AND RESULTS This cross-sectional multicenter study included 2739 youth (5-17 year-old; 170 normal-weight, 610 overweight and 1959 with obesity) defined non hypertensive by the AAP guidelines. Anthropometric, biochemical and liver ultrasound data were available in the whole population; carotid artery ultrasound and echocardiographic assessments were available respectively in 427 and 264 youth. Elevated BP was defined as BP ≥ 90th to <95th percentile for age, gender and height in children or BP ≥ 120/80 to <130/80 in adolescents. The overall prevalence of elevated BP was 18.3%, and significantly increased from normal-weight to obese youth. Young people with elevated BP showed higher levels of body mass index (BMI), insulin resistance and a higher prevalence of liver steatosis (45% vs 36%, p < 0.0001) than normotensive youth, whilst they did not differ for the other cardiometabolic risk factors, neither for carotid intima media thickness or left ventricular mass. Compared with normotensive youth, individuals with elevated BP had an odds ratio (95%Cl) of 3.60 (2.00-6.46) for overweight/obesity, 1.46 (1.19-1.78) for insulin-resistance and 1.45 (1.19-1.77) for liver steatosis, controlling for centers, age and prepubertal stage. The odds for insulin resistance and liver steatosis persisted elevated after correction for BMI-SDS. CONCLUSION Compared to normotensive youth, elevated BP is associated with increased BMI, insulin resistance and liver steatosis, without significant target organ damage.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Licenziati
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | | | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppina Campana
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Nicola Moio
- Department of Cardiology, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - Marco Giorgio Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Giovanni De Simone
- Hypertension Research Centre, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
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Bonito PD, Licenziati MR, Baroni MG, Maffeis C, Morandi A, Manco M, Miraglia Del Giudice E, Sessa AD, Campana G, Moio N, Gilardini L, Chiesa C, Pacifico L, Simone GD, Valerio G. The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines. Eur J Prev Cardiol 2019; 27:8-15. [PMID: 31387383 DOI: 10.1177/2047487319868326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH. OBJECTIVES We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile. METHODS A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth. RESULTS Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% (p = 0.008) as compared with ESH-/AAP-. CONCLUSIONS The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, 'S. Maria delle Grazie', Pozzuoli Hospital, Naples, Italy
| | | | - Marco G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | - Anita Morandi
- Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | | | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Nicola Moio
- Department of Cardiology, 'S. Maria delle Grazie', Pozzuoli, Naples, Italy
| | - Luisa Gilardini
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences and Rehabilitation, Milan, Italy
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni de Simone
- Hypertension Research Centre and Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giuliana Valerio
- Department of Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, Italy
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Genovesi S, Giussani M, Orlando A, Battaglino MG, Nava E, Parati G. Prevention of Cardiovascular Diseases in Children and Adolescents. High Blood Press Cardiovasc Prev 2019; 26:191-197. [PMID: 31041682 DOI: 10.1007/s40292-019-00316-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/23/2019] [Indexed: 01/21/2023] Open
Abstract
The atherosclerotic alterations that are the basis of cardiovascular diseases can start already in childhood. For this reason the prevention of cardiovascular diseases should be undertaken very early both in the general population and, in a targeted manner, in subjects at cardiovascular risk. Preventive strategies should include measures to encourage physical activity and correct eating habits and to reduce exposure to pollutants. The main actors responsible for carrying out these preventive interventions are the local and national political authorities. Moreover, particular attention should be paid to the first thousand days of life starting from conception, to prevent unfavorable epigenetic modifications. In addition to initiatives aimed at the general population, interventions should be planned by the medical community to assess the individual risk profile. The current obesity epidemic has in fact made it relatively frequent even among children and adolescents to find some cardiovascular risk factors known in adults such as arterial hypertension, dyslipidemia, glucose metabolism disorders and increased of uric acid values. The purpose of this review is to indicate lines of intervention for cardiovascular prevention in children and adolescents.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University Milano-Bicocca, Milan, Italy. .,Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy.
| | | | - Antonina Orlando
- Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Maria Grazia Battaglino
- Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Nava
- Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, University Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
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Bonafini S, Giontella A, Tagetti A, Montagnana M, Benati M, Danese E, Minuz P, Maffeis C, Antoniazzi F, Fava C. Markers of subclinical vascular damages associate with indices of adiposity and blood pressure in obese children. Hypertens Res 2019; 42:400-410. [DOI: 10.1038/s41440-018-0173-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 01/01/2023]
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Nogueira-de-Almeida CA, de Mello ED. Different Criteria for the Definition of Insulin Resistance and Its Relation with Dyslipidemia in Overweight and Obese Children and Adolescents. Pediatr Gastroenterol Hepatol Nutr 2018; 21:59-67. [PMID: 29383306 PMCID: PMC5788952 DOI: 10.5223/pghn.2018.21.1.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia. METHODS A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests. RESULTS Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP. CONCLUSION The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.
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Affiliation(s)
| | - Elza Daniel de Mello
- Department of Pediatric, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Sladoje DP, Kisić B, Mirić D. The Monitoring of Protein Markers of Inflammation and Serum Lipid Concentration in Obese Subjects with Metabolic Syndrome. J Med Biochem 2017; 36:366-374. [PMID: 30581334 PMCID: PMC6294090 DOI: 10.1515/jomb-2017-0009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 01/15/2023] Open
Abstract
Background Obesity is one of the most common modern health problems worldwide. Proinflammatory cells accumulate in the adipose tissue of the obese, and the presence of a low level chronic inflammation in obesity is associated with the emergence of a range of metabolic disorders in cluding cardiovascular disease, insulin resistance, type-2 diabetes, fatty-liver disease, and others. Neutrophils are early parti - cipants in inflammatory processes. After the appropriate stimu lation, these cells release reactive oxygen and nitrogen species, which leads to degranulation and secretion of myeloperoxidase and other enzymes. Myelo per oxidase and its reactive oxidants contribute to tissue damage during inflammatory processes in the human body. Methods The study included 175 subjects who were, in com - pliance with the International Diabetes Federation criteria, divided into 3 groups: normal weight subjects (N=106), subjects with abdominal obesity (N=37) and the third group consisted of subjects with the metabolic syndrome (N=32). Results By analyzing the myeloperoxidase enzyme activity (kU/L), and the levels of high-sensitivity C-reactive protein in the blood of all subjects, we detected their significantly higher activity and levels in subjects with the metabolic syndrome, as compared to normal weight subjects (p<0.001). Conclusions Based on our results, we can conclude that the MPO activity in the serum progressively increases with obesity and the metabolic syndrome, which indicates that this prooxidant enzyme may play a role in the pathophysiological mechanisms of the obesity and the metabolic syndrome related complications.
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Affiliation(s)
- Dragana Puhalo Sladoje
- Faculty of Medicine Foča, University of East Sarajevo, Foča, Republic of Srpska, Bosnia and Herzegovina
- University Hospital Foča, Foča, Republic of Srpska, Bosnia and Herzegovina
| | - Bojana Kisić
- Institute of Biochemistry, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | - Dijana Mirić
- Institute of Biochemistry, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
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High blood pressure and its relationship to adiposity in a school-aged population: body mass index vs waist circumference. Hypertens Res 2017; 41:135-140. [DOI: 10.1038/hr.2017.93] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 11/08/2022]
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Viazzi F, Rebora P, Giussani M, Orlando A, Stella A, Antolini L, Valsecchi MG, Pontremoli R, Genovesi S. Increased Serum Uric Acid Levels Blunt the Antihypertensive Efficacy of Lifestyle Modifications in Children at Cardiovascular Risk. Hypertension 2016; 67:934-40. [PMID: 27021006 DOI: 10.1161/hypertensionaha.115.06852] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
Abstract
Primary hypertension is a growing concern in children because of the obesity epidemic largely attributable to western lifestyles. Serum uric acid is known to be influenced by dietary habits, correlates with obesity, and could represent a risk factor for hypertension. Preliminary studies in children highlighted uric acid as a potentially modifiable risk factor for the prevention and treatment of hypertension. The effect of lifestyle changes (increase of physical activity and dietary modifications) on blood pressure values, weight status, and serum uric acid levels in a cohort of 248 children referred for cardiovascular risk assessment were evaluated over a mean 1.5-year follow-up. At baseline, 48% of children were obese and 50% showed blood pressure values >90th percentile. At follow-up, a significant improvement in weight class (24% obese;P<0.0001) and blood pressure category (22% >90th percentile;P<0.0001) was found. Systolic blood pressure z-score (P<0.0001), uric acid value (P=0.0056), and puberty at baseline (P=0.0048) were independently associated with higher systolic blood pressure z-score at follow-up, whereas a negative association was observed with body mass index z-score decrease during follow-up (P=0.0033). The risk of hypertension at follow-up was associated with body mass index (P=0.0025) and systolic blood pressure (P<0.0001) z-score at baseline and inversely related to delta body mass index (P=0.0002), whereas the risk of showing hypertension ≥99th percentile was more than doubled for each baseline 1 mg/dL increase of serum uric acid (P=0.0130). Uric acid is a powerful determinant of blood pressure over time, independent of lifestyle modifications.
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Affiliation(s)
- Francesca Viazzi
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Paola Rebora
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Marco Giussani
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Antonina Orlando
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Andrea Stella
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Laura Antolini
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Maria Grazia Valsecchi
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Roberto Pontremoli
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.)
| | - Simonetta Genovesi
- From the University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la ricerca sul Cancro, Genova, Italy (F.V., R.P.); University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy (P.R., A.S., L.A., M.G.V., S.G.); University of Milano-Bicocca, Center of Biostatistics for Clinical Epidemiology, Monza, Italy (P.R., A.O., L.A., M.G.V.); Family Paediatrician, Milano, Italy (M.G.); Nephrology Unit, San Gerardo Hospital, Monza, Italy (S.G.); and Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milano, Italy (S.G.). simonetta.genovesi@unimib
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11
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Eklioğlu BS, Atabek ME, Akyürek N, Alp H. Evaluation of Periaortic Adiposity and Metabolic Disorders in Obese Children. J Clin Res Pediatr Endocrinol 2016; 8:74-9. [PMID: 26758313 PMCID: PMC4805052 DOI: 10.4274/jcrpe.2308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between periaortic fat thickness (PAFT) and parameters involved in the development of metabolic complications of the cardiovascular system in obese children and to assess the usefulness of echocardiographic measurements of PAFT in correlation with cardiovascular risk factors. METHODS The study was conducted with 263 obese and 100 healthy children and adolescents. PAFT was measured with echocardiography method which was recently performed in obese children and adolescents. RESULTS PAFT was significantly higher in the obese group (0.258±0.031 mm) than in the control group (0.137±0.032 mm) (p<0.001). In multivariable regression analysis, body mass index-standard deviation score and total body fat were predictors of PAFT. The area under the receiver operating characteristic curve was 0.989 and was quite significant at p<0.001. PAFT above 0.179 mm was determined as the cut-off value in obese children and adolescents (sensitivity=1, specificity=0.97). CONCLUSION The measurement of PAFT in obese children and adolescents may be a good method to reveal the presence of early cardiovascular risk.
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Affiliation(s)
- Beray Selver Eklioğlu
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Konya, Turkey, E-mail:
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Konya, Turkey
| | - Nesibe Akyürek
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology and Diabetes, Konya, Turkey
| | - Hayrullah Alp
- Malatya State Hospital, Clinic of Pediatric Cardiology, Malatya, Turkey
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12
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Moss A, Sievert K, Siegfried W, Siegfried A, Brandt S, Koenig W, Wabitsch M. Sonographically Assessed Intra-Abdominal Fat And Cardiometabolic Risk Factors in Adolescents with Extreme Obesity. Obes Facts 2016; 9:121-37. [PMID: 27058884 PMCID: PMC5644824 DOI: 10.1159/000443690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 07/12/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The metabolic and cardiovascular risk of obesity is predominantly defined through the amount of intra-abdominal fat (IAF). Regarding this risk and the benefits of weight reduction gender-specific differences have been described. The aim of this study was to examine the gender-specific relationship between IAF assessed via ultrasound and the cardiometabolic risk profile in extremely obese adolescents before and after weight loss. METHODS In 107 consecutively admitted adolescents (n = 59 girls, mean age 15.4 ± 2.6 years boys and 15.1 ± 2.1 years girls, mean BMI z-score 3.2 ± 0.6 boys and 3.5 ± 0.6 girls) anthropometric and fasting laboratory chemical parameters were measured before and after an in-patient long-term therapy (mean durance 5.6 ± 2.3 months). IAF was determined by measuring the intra-abdominal depth (IAD) via ultrasound. RESULTS IAD was higher in boys as compared to girls (58.0 ± 22.4 mm vs. 51.3 ± 16.0 mm). IAD values were positively associated with BMI-z scores, waist circumferences, HOMA-IR and serum levels of x03B3;GT, hs-CRP and IL-6 in both genders. In boys, but not in girls, IAD was significantly correlated with systolic and diastolic blood pressure, serum levels of triglycerides, ALT as well as adiponectin and HDL-cholesterol. After a marked mean weight loss of -27.1 ± 16.2 kg (-20.1 ± 7.9%) in boys and of -20.5 ± 11.5 kg (-17.3 ± 7.1%) in girls, IAD decreased by -20.7 ± 16.2 mm (--32.4 ± 16.9%) in boys and by -18.4 ± 12,7 mm (-34.3 ± 18.4%) in girls, resulting in more pronounced ameliorations of cardiovascular risk factors in boys than in girls. CONCLUSIONS The present study indicates that IAF assessed by ultrasound is a good indicator for the cardiometabolic risk factor profile in extremely obese adolescents. Associations between IAF and risk factors are more pronounced in boys than in girls.
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Affiliation(s)
- Anja Moss
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
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13
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Fasting Plasma Insulin at 5 Years of Age Predicted Subsequent Weight Increase in Early Childhood over a 5-Year Period-The Da Qing Children Cohort Study. PLoS One 2015; 10:e0127389. [PMID: 26047327 PMCID: PMC4457927 DOI: 10.1371/journal.pone.0127389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/15/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The association between hyperinsulinemia and obesity is well known. However, it is uncertain especially in childhood obesity, if initial fasting hyperinsulinemia predicts obesity, or obesity leads to hyperinsulinemia through insulin resistance. OBJECTIVE To investigate the predictive effect of fasting plasma insulin on subsequent weight change after a 5-year interval in childhood. METHODS 424 Children from Da Qing city, China, were recruited at 5 years of age and followed up for 5 years. Blood pressure, anthropometric measurements, fasting plasma insulin, glucose and triglycerides were measured at baseline and 5 years later. RESULTS Fasting plasma insulin at 5 years of age was significantly correlated with change of weight from 5 to 10 years (ΔWeight). Children in the lowest insulin quartile had ΔWeight of 13.08±0.73 kg compare to 18.39±0.86 in the highest insulin quartile (P<0.0001) in boys, and similarly 12.03±0.71 vs 15.80±0.60 kg (P<0.0001) in girls. Multivariate analysis showed that the predictive effect of insulin at 5 years of age on subsequent weight gain over 5 years remained statistically significant even after the adjustment for age, sex, birth weight, TV-viewing time and weight (or body mass index) at baseline. By contrast, the initial weight at 5 years of age did not predict subsequent changes in insulin level 5 years later. Children who had both higher fasting insulin and weight at 5 years of age showed much higher levels of systolic blood pressures, fasting plasma glucose, the homeostasis model assessment for insulin resistance (HOMA-IR) and triglycerides at 10 years of age. CONCLUSIONS Fasting plasma insulin at 5 years of age predicts weight gain and cardiovascular risk factors 5 year later in Chinese children of early childhood, but the absolute weight at 5 years of age did not predict subsequent change in fasting insulin.
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14
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Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, Miraglia del Giudice E, Pacifico L, Pellegrin MC, Tomat M, Baroni MG. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis 2015; 25:489-494. [PMID: 25813687 DOI: 10.1016/j.numecd.2015.01.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/12/2015] [Accepted: 01/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Lipid ratios to estimate atherosclerotic disease risk in overweight/obese children are receiving great attention. We aimed to compare the performance of non-high-density lipoprotein-cholesterol (HDL-C) versus triglycerides-to-HDL-C ratio (Tg/HDL-C) in identifying cardiometabolic risk factors (CMRFs) or preclinical signs of organ damage in outpatient Italian overweight/obese children. METHODS AND RESULTS In this retrospective, cross-sectional study, 5505 children (age 5-18 years) were recruited from 10 Italian centers for the care of obesity, of which 4417 (78%) showed obesity or morbid obesity. Anthropometric, biochemical, and blood pressure variables were analyzed in all children. Liver ultrasound scan, carotid artery ultrasound, and echocardiography were performed in 1257, 601, and 252 children, respectively. The entire cohort was divided based on the 75th percentile of non-HDL-C (≥130 mg/dl) or Tg/HDL-C ratio (≥2.2). The odds ratio for insulin resistance, high blood pressure, metabolic syndrome, presence of liver steatosis, increased levels of carotid intima-media thickness (cIMT) and concentric left ventricular hypertrophy (cLVH) was higher in children with high levels of Tg/HDL-C with respect to children with high levels of non-HDL-C. CONCLUSIONS In an outpatient setting of overweight/obese children, Tg/HDL-C ratio discriminated better than non-HDL-C children with CMRFs or preclinical signs of liver steatosis, and increased cIMT and cLVH.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, Pozzuoli Hospital (Napoli), Naples, Italy
| | - G Valerio
- Department of Movement Sciences and Wellness, Parthenope University, Naples, Italy.
| | - G Grugni
- Division of Auxology, Italian Auxological Institute, Verbania, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | - M Manco
- Bambino Gesù Children's Hospital, Rome, Italy
| | - E Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, Second University of Napoli, Naples, Italy
| | - L Pacifico
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - M C Pellegrin
- Department of Pediatrics, University of Trieste, Trieste, Italy
| | - M Tomat
- Pediatric Unity, AOU Udine, Udine, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
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Velásquez-Rodríguez CM, Velásquez-Villa M, Gómez-Ocampo L, Bermúdez-Cardona J. Abdominal obesity and low physical activity are associated with insulin resistance in overweight adolescents: a cross-sectional study. BMC Pediatr 2014; 14:258. [PMID: 25301371 PMCID: PMC4286933 DOI: 10.1186/1471-2431-14-258] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/23/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous studies have assessed the metabolic changes and lifestyles associated with overweight adolescents. However, these associations are unclear amongst overweight adolescents who have already developed insulin resistance. This study assessed the associations between insulin resistance and anthropometric, metabolic, inflammatory, food consumption, and physical activity variables amongst overweight adolescents. METHODS This cross-sectional study divided adolescents (n = 120) between 10 and 18 years old into 3 groups: an overweight group with insulin resistance (O + IR), an overweight group without insulin resistance (O-IR), and a normal-weight control group (NW). Adolescents were matched across groups based on age, sex, pubertal maturation, and socioeconomic strata. Anthropometric, biochemical, physical activity, and food consumption variables were assessed. Insulin resistance was assessed using homeostatic model assessment (HOMA Calculator Version 2.2.2 from ©Diabetes Trials Unit, University of Oxford), and overweight status was assessed using body mass index according to World Health Organization (2007) references. A chi-square test was used to compare categorical variables. ANOVAs or Kruskal-Wallis tests were used for continuous variables. Multiple linear regression models were used to calculate the probability of the occurrence of insulin resistance based on the independent variables. RESULTS The risk of insulin resistance amongst overweight adolescents increases significantly when they reach a waist circumference > p95 (OR = 1.9, CIs = 1.3-2.7, p = 0.013) and watch 3 or more hours/day of television (OR = 1.7, CIs = 0.98-2.8, p = 0.033). Overweight status and insulin resistance were associated with higher levels of inflammation (hsCRP ≥1 mg/L) and cardiovascular risk according to arterial indices. With each cm increase in waist circumference, the HOMA index increased by 0.082; with each metabolic equivalent (MET) unit increase in physical activity, the HOMA index decreased by 0.026. CONCLUSIONS Sedentary behaviour and a waist circumference > p90 amongst overweight adolescents were associated with insulin resistance, lipid profile alterations, and higher inflammatory states. A screening that includes body mass index, in waist circumference, and physical activity evaluations of adolescents might enable the early detection of these alterations.
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Affiliation(s)
| | - Marcela Velásquez-Villa
- Research Group in Food and Human Nutrition, Universidad de Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia
| | - Leidy Gómez-Ocampo
- Research Group in Food and Human Nutrition, Universidad de Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia
| | - Juliana Bermúdez-Cardona
- Research Group in Food and Human Nutrition, Universidad de Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia
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Precisión diagnóstica del índice cintura-talla para la identificación del sobrepeso y de la obesidad infantil. Med Clin (Barc) 2013; 140:296-301. [DOI: 10.1016/j.medcli.2012.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/03/2012] [Accepted: 01/10/2012] [Indexed: 11/30/2022]
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Ethnic and socioeconomic influences on childhood blood pressure: the Child Heart and Health Study in England. J Hypertens 2013; 30:2090-7. [PMID: 22990353 DOI: 10.1097/hjh.0b013e32835837c9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compared to UK white European adults, UK black African-Caribbean adults have higher mean SBP and DBP; UK South Asian adults have higher mean DBP but lower SBP. Information on blood pressure (BP) in UK children from different ethnic groups is limited. The aim of this study was to compare BP levels in UK children of black African-Caribbean, South Asian and white European origin. METHODS BP and body build were measured in 5666 children in a cross-sectional study of UK primary school children of South Asian, black African-Caribbean and white European origin aged 9-10 years. Ethnic and socioeconomic differences in BP were obtained from multilevel linear regression models. RESULTS After adjustment for height and adiposity, black African-Caribbean children had lower mean SBP than white Europeans [difference 1.62 mmHg, 95% confidence interval (CI) 0.86-2.38 mmHg], whereas mean DBP was similar (difference 0.58 mmHg, 95% CI -0.12 to 1.28 mmHg). The lower SBP was particularly marked in black African rather than Caribbean children (P = 0.002). South Asian children had lower mean SBP (difference 1.10 mmHg, 95% CI 0.34-1.86 mmHg) than white Europeans and higher mean DBP (difference 1.07 mmHg, 95% CI 0.37-1.76 mmHg). The higher mean DBP was particularly marked among Indian and Bangladeshi, rather than Pakistani, children (P = 0.01). BP was unrelated to socioeconomic circumstances; ethnic differences in BP were not affected by socioeconomic adjustment. CONCLUSION A BP pattern similar to that in adults is present in UK South Asian but not in UK black African-Caribbean children at 9-10 years.
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Gerber PA, Locher R, Schmid B, Spinas GA, Lehmann R. Smoking is associated with impaired long-term glucose metabolism in patients with type 1 diabetes mellitus. Nutr Metab Cardiovasc Dis 2013; 23:102-108. [PMID: 22118957 DOI: 10.1016/j.numecd.2011.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/23/2011] [Accepted: 08/24/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND AIMS Smoking is known to negatively influence glucose metabolism both in healthy subjects and in patients with diabetes. The aim of this study was to compare glycemic control in patients with type 1 diabetes mellitus who were smokers with those who did not smoke during a prospective long-term follow-up. METHODS AND RESULTS In a single center, 763 patients with type 1 diabetes mellitus were included, 160 (21.0%) of them were smokers. Patients were treated with intensive insulin therapy according to existing guidelines. Glucose control was monitored quarterly, diabetes related complications and cardiovascular risk factors were assessed at least once a year. Glucose control in smokers was significantly worse than in non-smokers at baseline and during follow-up (mean HbA1c during 5047 patient-years of follow-up 7.9 ± 1.3% in smokers and 7.3 ± 1.1% in non-smokers, p < 0.001) despite a higher insulin dosage in smokers (0.71 ± 0.30 U/kg vs. 0.65 ± 0.31 U/kg in non-smokers, p = 0.046). HDL cholesterol was lower in smokers at baseline (1.53 ± 0.45 vs. 1.68 ± 0.51 in non-smokers, p = 0.048). Diabetes related complications tended to occur with a higher frequency in smokers, with a significant difference in macroalbuminuria (9.8% vs. 4.8% in non-smokers, p = 0.047). CONCLUSION Smoking is associated with worse glucose control in patients with type 1 diabetes mellitus despite the same treatment strategies as in non-smokers. Hyperglycemia, therefore, may contribute to an earlier incidence of diabetes related complications in these patients, in addition to direct toxic effects of smoking.
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Affiliation(s)
- P A Gerber
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland.
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Insulin resistance, prehypertension, hypertension and blood pressure values in paediatric age. J Hypertens 2012; 30:327-35. [DOI: 10.1097/hjh.0b013e32834e4aaa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The epidemic of overweight and obesity in youth is increasing the prevalence of prehypertension and hypertension among children and adolescents. The younger the child is at presentation and the more severe the blood pressure abnormality, the more likely a secondary cause of hypertension is to be present. Measurement of blood pressure in children requires adaptation to the age and size of the child. Interpretation must be related to normative values specific for age, sex, and height. Evaluation is primarily aimed at identifying secondary causes of hypertension, associated comorbidities, additional risk factors, and evidence of target-organ damage. Ambulatory blood pressure monitoring is emerging as a useful tool for evaluation of some patients, particularly for those with suspected 'white coat' hypertension. Management of prehypertension and hypertension is directed at the underlying cause, exacerbating factors, and the magnitude of the blood pressure abnormality. Healthy behavioral changes are a primary management tool for treating hypertension and, more particularly, prehypertension and for addressing other cardiovascular risk factors, such as obesity. Pharmacological management is reserved for patients with hypertension who do not respond to behavioral changes, have additional cardiovascular risk factors or diabetes, are symptomatic, or have developed target-organ damage.
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Affiliation(s)
- Brian W McCrindle
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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