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Wolters M, Foraita R, Moreno LA, Molnár D, Russo P, Tornaritis M, De Henauw S, Lissner L, Veidebaum T, Winter T, Marron M, Nagrani R. Longitudinal associations between vitamin D status and biomarkers of inflammation in a pan-European cohort of children and adolescents. Eur J Nutr 2024:10.1007/s00394-024-03488-7. [PMID: 39231874 DOI: 10.1007/s00394-024-03488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE To investigate longitudinal associations between the vitamin D status and inflammatory markers in children and adolescents. METHODS Children from eight European countries from the IDEFICS/I.Family cohort with repeated measurements were included in this study. A linear mixed-effect model was used to model the association of serum 25(OH)D as independent variable and z-scores of inflammatory markers [CRP, cytokines, adipokines, combined inflammation score] as dependent variables, where one level accounts for differences between individuals and the other for changes over age within individuals. RESULTS A total of 1,582 children were included in the study. In the adjusted model, 25(OH)D levels were positively associated with adiponectin (β = 0.11 [95% CI 0.07; 0.16]) and negatively with the inflammation score (β = - 0.24 [95% CI - 0.40; - 0.08]) indicating that the adiponectin z-score increased by 0.11 units and the inflammation score decreased by 0.24 units per 12.5 nmol/l increase in 25(OH)D. In children with overweight or obesity, only a positive association between 25(OH)D and IP-10 was observed while in children with normal weight adiponectin was positively and the inflammation score was negatively associated. Associations of vitamin D with adiponectin and the inflammation score were stronger in girls than in boys and a positive association with TNF-α was observed only in girls. CONCLUSION Our results suggest that an increase in vitamin D concentrations may help to regulate inflammatory biomarkers. However, it seems to be no benefit of a better vitamin D status in children with overweight/obesity unless their weight is managed to achieve an improved inflammatory marker status.
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Affiliation(s)
- Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany.
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), University of Zaragoza, Saragossa, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Dénes Molnár
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | | | - Stefaan De Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Theresa Winter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - Rajini Nagrani
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
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Widjaja NA, Caesar LA, Nova S, Ardianah E. Beyond the Scale: Investigating Adiponectin, ICAM-1, and VCAM-1 as Metabolic Markers in Obese Adolescents with Metabolic Syndrome. J Obes 2023; 2023:4574042. [PMID: 37822716 PMCID: PMC10564580 DOI: 10.1155/2023/4574042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
Background Adiponectin acts to prevent vascular dysfunction due to obesity by inhibiting ICAM-1 and VCAM-1 expressions. Objective We investigate adiponectin ICAM-1, VCAM-1, and metabolic syndrome (MetS) in obese adolescents. Methods A cross-sectional study with healthy obese adolescents aged 13 to 18 years was conducted from October 2019 to January 2020. Statistical analysis conducted was a test of normality and homogeneity tests, ANOVA/Kruskal-Wallis, independent sample T-test/Mann-Whitney U test, and Spearman correlation and determined as significant if p value <0.05. Results 125 obese adolescents were recruited. 42 (33.6%) were obese with MetS (we grouped as MetS) and 83 (66.4%) subjects without MetS (non-MetS group). VCAM-1 was significantly higher on boys with MetS compared to girls with MetS, and even girls with MetS had lower levels of VCAM-1 than boys with non-MetS. ICAM-1 was significantly higher in boys with low-level HDL-c (p < 0.05) and correlated weakly with HDL-c, while adiponectin levels were significantly lower in girls with central obesity and hypertriglyceridemia. Path analysis showed that triglyceride had a direct effect on ICAM-1 but not VCAM-1 in both obese boys and girls. Adiponectin had a negative direct effect on ICAM-1 and VCAM-1 in girls. However, on boys, diastole blood pressure had a negative direct effect, which might be the role of sex hormones indirectly. Conclusion VCAM-1 was significantly higher in boys than girls, which showed that boys had a higher risk of atherosclerosis. ICAM-1 showed no significant difference in both gender and metabolic states. Adiponectin showed a protective effect by lowering ICAM-1 and VCAM-1 directly on girls.
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Affiliation(s)
- Nur Aisiyah Widjaja
- Faculty of Medicine, Child Health Department, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Leonardo Alexander Caesar
- Faculty of Medicine, Child Health Department, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Suhasta Nova
- Faculty of Medicine, Child Health Department, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Eva Ardianah
- Ikatan Dokter Indonesia Surabaya, Jl. Mayjen Prof. Dr. Moestopo No. 117, Surabaya 60132, Indonesia
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Peña AS, Harrington J, Peters Black SK, Gent R, Hirte C, Couper JJ, Wiltshire E. Vascular Function and Distribution of Adiponectin Isomers during Puberty in Children and Adolescents with Obesity. Horm Res Paediatr 2022; 94:186-193. [PMID: 34348299 DOI: 10.1159/000518649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Youth with obesity have abnormal vascular function that relates to the anti-atherogenic adipose-derived hormone, adiponectin. The distribution of adiponectin isomers changes during normal puberty, but there are no data in relation to vascular function. We aimed to evaluate vascular function, adiponectin, and its isomers longitudinally in peri-pubertal youth with obesity and controls. METHODS The study is a cohort longitudinal study involving 30 children and adolescents with obesity (body mass index [BMI] z-score 2.31 ± 0.24; age 12.8 ± 3 years, 17 male participants) and 28 age-/sex-matched healthy controls (12.8 ± 3 years, 14 male participants). Vascular function (flow-mediated dilatation [FMD], glyceryl trinitrate-mediated dilatation [GTN]), total adiponectin and isomers, and laboratory and clinical variables were assessed at 0, 18, and 36 months. RESULTS FMD and GTN were stable during puberty in both groups, remaining consistently lower in obese children (p = 0.02, p < 0.001). The change in total (p = 0.02) and high-molecular weight (HMW) (p = 0.02) adiponectin differed between the groups: falling in controls by the end of puberty but not falling further during puberty in obesity. In obesity, impaired GTN was associated longitudinally with lower total (B = 7.85, p = 0.006) and HMW (B = 3.72, p = 0.03) adiponectin. In controls, more favourable GTN was longitudinally associated with a lower BMI z-score (B = -3.04, p = 0.027) and lower waist circumference (B = -0.35, p = 0.009). CONCLUSIONS Vascular dysfunction and lower levels of adiponectin are associated in children and adolescents with obesity during puberty and do not deteriorate further. Healthy children's better vascular function, within the normal range, is associated with a lower BMI z-score and waist circumference.
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Affiliation(s)
- Alexia Sophie Peña
- Robinson Research Institute and Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jennifer Harrington
- Robinson Research Institute and Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Sarah Kate Peters Black
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Roger Gent
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Craig Hirte
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jennifer J Couper
- Robinson Research Institute and Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Esko Wiltshire
- Paediatrics and Child Health, University of Otago Wellington, Wellington South, New Zealand
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High molecular weight adiponectin levels are inversely associated with adiposity in pediatric brain tumor survivors. Sci Rep 2020; 10:18606. [PMID: 33122755 PMCID: PMC7596561 DOI: 10.1038/s41598-020-75638-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
While children with brain tumors are surviving at record rates, survivors are at risk of cardiovascular disease and type 2 diabetes mellitus; these conditions may be driven by excess body fat. Adiponectin in an adipokine that is inversely associated with the fat mass, and has been linked to cardiometabolic risk stratification in the general population. However, adiponectin’s profile and determinants in SCBT have not been established. We tested the hypothesis that high molecular weight (HMW) adiponectin levels, the more biologically active form of adiponectin, were associated with adiposity in SCBT similarly to non-cancer controls. Seventy-four SCBT (n = 32 female) and 126 controls (n = 59 female) who were 5–17 years old were included. Partial correlations and multivariable regression analyses assessed the relationship between HMW adiponectin and adiposity. HMW adiponectin was inversely associated with total and central adiposity (FM%: β − 0.21, 95% CI − 0.15, − 0.08; p value < 0.0001; WHR: β − 0.14, 95% CI − 0.02, − 0.01; p value < 0.0001 ;WHtR: β − 0.21, 95% CI − 0.05, − 0.03; p value < 0.0001). In conclusion, HMW adiponectin is inversely correlated with adiposity in SCBT. Adiponectin may serve as a biomarker of cardiometabolic risk and response to interventions to prevent and manage obesity and its comorbidities in SCBT.
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5
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Varda NM, Medved M, Ojsteršek L. The associations between some biological markers, obesity, and cardiovascular risk in Slovenian children and adolescents. BMC Pediatr 2020; 20:81. [PMID: 32085704 PMCID: PMC7033855 DOI: 10.1186/s12887-020-1978-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/12/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The occurrence of cardiovascular diseases and metabolic disorders steadily increases with the body mass index (BMI). Since the latter is not the best and earliest indicator of obesity and cardiovascular risk, the aim of the study was to evaluate some potential biological markers that would allow us to detect children and adolescents at higher risk at an early stage. METHODS A sample of 330 children and adolescents were included in the study and divided into four groups: obese patients with hypertension, normal-weight patients with hypertension, patients with mildly elevated lipids and a control group of healthy children and adolescents. Some clinical parameters (age, body weight, body height, BMI, waist circumference, hip circumference, blood pressure), biochemical parameters (glucose, total cholesterol, triglycerides, HDL, LDL, apolipoprotein A1, homocysteine) and biological markers of obesity (ghrelin, adiponectin, leptin) were evaluated. RESULTS Ghrelin and adiponectin were found to have a strong negative statistically significant correlation with BMI in all three observed groups (p < 0.001), but not in the control group (p = 0.053 and p = 0.316, respectively). In addition, leptin had a strong positive statistically significant correlation with BMI in all four groups (p < 0.001 for the research groups, p = 0.009 for the controls). In the group of obese patients with hypertension, statistically significant differences in all three markers of obesity were found in comparison to the control group (p < 0.001 for all markers). In the group of patients with mildly elevated lipids, ghrelin and leptin were significantly different (p = 0.002 and p < 0.001, respectively). In the group of normal-weight hypertensive patients, only values of ghrelin were different compared to the control group (p = 0.001). CONCLUSION In the research groups, significant differences were found in clinical, biochemical and biological parameters compared to the control group. The observed biological markers of obesity are useful early markers for identifying groups of patients that are at cardiovascular risk.
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Affiliation(s)
- Nataša Marčun Varda
- Department of Pediatrics, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Martina Medved
- University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Laura Ojsteršek
- University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
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6
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Seppä S, Tenhola S, Voutilainen R. Fibroblast Growth Factor 21, Adiponectin, and Irisin as Markers of Unfavorable Metabolic Features in 12-Year-Old Children. J Endocr Soc 2019; 3:825-837. [PMID: 30963140 PMCID: PMC6446887 DOI: 10.1210/js.2018-00399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Among cytokines, fibroblast growth factor 21 (FGF21), adiponectin (Adn), and irisin have been considered potential biomarkers for insulin sensitivity (IS). OBJECTIVE We evaluated whether serum FGF21, Adn, and irisin associate with markers of IS and serum lipids in 12-year-old children. DESIGN PARTICIPANTS AND MAIN OUTCOME MEASURES This cohort study included 192 12-year-old children (109 girls). Seventy-eight of them had been born appropriate for gestational age (AGA), 70 small for gestational age (SGA), and 44 from preeclamptic pregnancies (PREs) as AGA. Fasting serum FGF21, Adn, irisin, lipids, inflammatory markers, and IS markers were measured. Quantitative insulin sensitivity check index (QUICKI) was calculated. RESULTS The means of serum FGF21, high molecular weight (HMW) Adn, and irisin did not differ between the sexes or between the SGA, AGA, and PRE children. In the whole study population, FGF21 associated positively with irisin and uric acid and negatively with leptin and high-density lipoprotein cholesterol (HDL-C). HMW Adn associated positively with total Adn, HDL-C, leptin, and SHBG. Apart from FGF21, irisin associated positively with insulin, high-sensitivity C-reactive protein, γ-glutamyltransferase, and triglycerides, and negatively with QUICKI, SHBG, and IGF binding protein-1. In multivariate regression analyses, irisin predicted lower IS and HMW Adn predicted higher HDL-C body mass index-independently, whereas FGF21 had no independent contribution to IS or lipid variables. CONCLUSION In 12-year-old children, serum irisin was associated with markers reflecting reduced IS. HMW Adn predicted HDL-C, whereas FGF21 did not contribute to IS or lipid parameters in multivariate regression analyses.
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Affiliation(s)
- Satu Seppä
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Sirpa Tenhola
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio
- Department of Pediatrics, Kymenlaakso Central Hospital, Kotka, Finland
| | - Raimo Voutilainen
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio
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7
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Kaur Y, Wang DX, Liu HY, Meyre D. Comprehensive identification of pleiotropic loci for body fat distribution using the NHGRI-EBI Catalog of published genome-wide association studies. Obes Rev 2019; 20:385-406. [PMID: 30565845 DOI: 10.1111/obr.12806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Abstract
We conducted a hypothesis-free cross-trait analysis for waist-to-hip ratio adjusted for body mass index (WHRadjBMI ) loci derived through genome-wide association studies (GWAS). Summary statistics from published GWAS were used to capture all WHRadjBMI single-nucleotide polymorphisms (SNPs), and their proxy SNPs were identified. These SNPs were used to extract cross-trait associations between WHRadjBMI SNPs and other traits through the NHGRI-EBI GWAS Catalog. Pathway analysis was conducted for pleiotropic WHRadjBMI SNPs. We found 160 WHRadjBMI SNPs and 3675 proxy SNPs. Cross-trait analysis identified 239 associations, of which 100 were for obesity traits. The remaining 139 associations were filtered down to 101 unique linkage disequilibrium block associations, which were grouped into 13 categories: lipids, red blood cell traits, white blood cell counts, inflammatory markers and autoimmune diseases, type 2 diabetes-related traits, adiponectin, cancers, blood pressure, height, neuropsychiatric disorders, electrocardiography changes, urea measurement, and others. The highest number of cross-trait associations were found for triglycerides (n = 10), high-density lipoprotein cholesterol (n = 9), and reticulocyte counts (n = 8). Pathway analysis for WHRadjBMI pleiotropic SNPs found immune function pathways as the top canonical pathways. Results from our original methodology indicate a novel genetic association between WHRadjBMI and reticulocyte counts and highlight the pleiotropy between abdominal obesity, immune pathways, and other traits.
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Affiliation(s)
- Yuvreet Kaur
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dominic X Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Hsin-Yen Liu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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Greydanus DE, Agana M, Kamboj MK, Shebrain S, Soares N, Eke R, Patel DR. Pediatric obesity: Current concepts. Dis Mon 2018; 64:98-156. [DOI: 10.1016/j.disamonth.2017.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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Euclydes VLV, Castro NP, Lima LR, Brito C, Ribeiro L, Simões FA, Requena G, Luzia LA, Rondó PH. Cord blood concentrations of leptin, zinc-α2-glycoprotein, and adiponectin, and adiposity gain during the first 3 mo of life. Nutrition 2018; 54:89-93. [PMID: 29758496 DOI: 10.1016/j.nut.2018.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Adipose tissue development starts in intrauterine life and cytokines are involved in this process. Therefore, understanding the role of cytokines in the fat mass gain of infants is crucial to prevent obesity later in life. Furthermore, recent evidence indicates a sex-specific link between cytokines and adipose tissue development. The objective of this study was to assess sex-specific relationships of cord blood concentrations of the cytokines leptin, zinc-α2-glycoprotein (ZAG), and adiponectin with infant adiposity during the first 3 mo of life. METHODS This was a prospective cohort study of 104 mother-infant pairs that were selected from a maternity hospital in Sao Paulo, Brazil. Cord blood leptin, ZAG, and adiponectin were determined by enzyme-linked immunosorbent assays. The body composition of the infants was assessed monthly by air displacement plethysmography. A multiple linear regression analysis was conducted with the average fat mass gain from birth to the third month of life as the outcome and cord blood leptin, ZAG, and adiponectin as the variables of interest. RESULTS Leptin was inversely associated with fat mass gain in the first 3 mo of life (P = 0.003; adjusted R2 = 0.09). There were inverse associations of leptin (P = 0.021), ZAG (P = 0.042), and maternal body mass index (P = 0.04) with fat mass gain in girls (adjusted R2 = 0.29) but fat mass gain in boys was positively associated with gestational age (P = 0.01; adjusted R2 = 0.15). CONCLUSIONS The results of this study suggest that adiposity programming is sex-specific, which highlights the need to investigate the different metabolic mechanisms that are involved in adipogenesis.
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Affiliation(s)
- Verônica L V Euclydes
- Postgraduate Program in Applied Human Nutrition, University of Sao Paulo, Sao Paulo, Brazil
| | - Natalia P Castro
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Lourdes R Lima
- Laboratory of Immunology, Adolfo Lutz Institute, Sao Paulo, Brazil
| | - Cyro Brito
- Laboratory of Immunology, Adolfo Lutz Institute, Sao Paulo, Brazil
| | - Laisa Ribeiro
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Agapito Simões
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Guaraci Requena
- Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil
| | - Liania Alves Luzia
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia Helen Rondó
- Postgraduate Program in Applied Human Nutrition, University of Sao Paulo, Sao Paulo, Brazil; Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
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Ochiai H, Shirasawa T, Nanri H, Nishimura R, Hoshino H, Kokaze A. Influence of eating quickly and eating until full on anthropometric gains in girls: A population-based, longitudinal study. Child Care Health Dev 2017; 43:918-925. [PMID: 28612455 DOI: 10.1111/cch.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/16/2017] [Accepted: 05/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In examining childhood overweight/obesity, there is a need to consider both eating quickly and eating until full. This longitudinal study investigated the influence of eating quickly and/or eating until full on anthropometric variables and becoming overweight/obese among Japanese schoolgirls. METHODS Study participants were fourth-grade schoolgirls (aged 9 or 10 years) in Ina Town, Japan. Physical examinations and a questionnaire survey were performed at baseline (fourth grade) and after 3 years (seventh grade). Height, weight, and waist circumference were measured in the physical examinations, while the data on eating quickly and eating until full were collected in the questionnaire survey. Analysis of variance and analysis of covariance were used to compare the differences in each anthropometric variable between fourth and seventh grade among groups. RESULTS Data on 425 non-overweight/obese schoolgirls in fourth grade were analyzed. Gains in anthropometric variables (body mass index, waist circumference, and waist-to-height ratio) from fourth to seventh grade were significantly larger in the "eating quickly and eating until full" group than in the "not eating quickly and not eating until full" group. In contrast, there were no significant differences in the gains between the "eating quickly or eating until full" group and the "not eating quickly and not eating until full" group. The proportion of overweight/obese girls in seventh grade was higher in the "eating quickly and eating until full" group than in the other groups. CONCLUSIONS Eating quickly and eating until full had a substantial impact on excess gains in anthropometric variables among schoolgirls, suggesting that modifying these eating behaviors may help prevent non-overweight/obese girls from the excess gains. Accordingly, school health programs need to focus on not eating quickly and/or not eating until full to prevent overweight/obesity; it is necessary to emphasize "the risk of overweight/obesity associated with these eating behaviors" in schools.
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Affiliation(s)
- H Ochiai
- Department of Public Health, Showa University School of Medicine, Tokyo, Japan
| | - T Shirasawa
- Department of Public Health, Showa University School of Medicine, Tokyo, Japan
| | - H Nanri
- Department of Public Health, Showa University School of Medicine, Tokyo, Japan
| | - R Nishimura
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - H Hoshino
- Department of Public Health, Showa University School of Medicine, Tokyo, Japan
| | - A Kokaze
- Department of Public Health, Showa University School of Medicine, Tokyo, Japan
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Yang F, Tiano J, Mittal S, Turakhia M, Jacobowitz I, Greenberg Y. Towards a Mechanistic Understanding and Treatment of a Progressive Disease: Atrial Fibrillation. J Atr Fibrillation 2017; 10:1627. [PMID: 29250240 DOI: 10.4022/jafib.1627] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/19/2017] [Accepted: 08/14/2017] [Indexed: 01/08/2023]
Abstract
Atrial fibrosis appears to be a key factor in the genesis and/or perpetuation of atrial fibrillation (AF). The pathological distribution of atrial fibrosis is geographically consistent with the attachments between the posterior left atrium and the pericardium along the reflections where wall stiffness is increased and structural changes are found. While there is a wide range of complex etiological factors and electrophysiological mechanisms in AF, there is evidence for a common pathophysiological pathway that could account for deliberate substrate formation and progression of AF. Anatomical stresses along the atrium, mediated by the elastic modulus mismatch between atrial tissue and the pericardium, result in inflammatory and fibrotic changes which create the substrate for atrial fibrillation. This may explain the anatomical predominance of pulmonary vein triggers earlier in the development of atrial fibrillation and the increasing involvement of the atrium as the disease progresses. Ablative treatments that address the progressive nature of atrial fibrillation and fibrosis may yield improved success rates.
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Affiliation(s)
- Felix Yang
- Maimonides Medical Center (Brooklyn, NY)
| | | | | | - Mintu Turakhia
- Stanford University (Stanford, CA).,VA Palo Alto Health Care System (Palo Alto, CA)
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12
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Adiponectin, interleukin-6 and high-sensitivity C-reactive protein levels in overweight/obese Indian children. Indian Pediatr 2017; 54:848-850. [DOI: 10.1007/s13312-017-1148-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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Wang K, Ye P, Wang X, Wang D, Wu Y, Li J, Chen Q. Associations of PPAR-γ , APM1 and APOC1 gene polymorphisms with metabolic syndrome in children: A case-control study. Meta Gene 2017. [DOI: 10.1016/j.mgene.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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14
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Higgins V, Adeli K. Pediatric Metabolic Syndrome: Pathophysiology and Laboratory Assessment. EJIFCC 2017; 28:25-42. [PMID: 28439217 PMCID: PMC5387698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pediatric overweight and obesity is an emerging public health priority as rates have rapidly increased worldwide. Obesity is often clustered with other metabolic abnormalities including hypertension, dyslipidemia, and insulin resistance, leading to increased risk of cardiovascular disease. This cluster of risk factors, termed the metabolic syndrome, has traditionally been reported in adults. However, with the increased prevalence of pediatric obesity, the metabolic syndrome is now evident in children and adolescents. This complex cluster of risk factors is the result of the pathological interplay between several organs including adipose tissue, muscle, liver, and intestine with a common antecedent - insulin resistance. The association of the metabolic syndrome with several systemic alterations that involve numerous organs and tissues adds to the complexity and challenge of diagnosing the metabolic syndrome and identifying useful clinical indicators of the disease. The complex physiology of growing and developing children and adolescents further adds to the difficulties in standardizing laboratory assessment, diagnosis, and prognosis for the diverse pediatric population. However, establishing a consensus definition is critical to identifying and managing children and adolescents at high risk of developing the metabolic syndrome. As a result, the examination of novel metabolic syndrome biomarkers which can detect these metabolic abnormalities early with high specificity and sensitivity in the pediatric population has been of interest. Understanding this complex cluster of risk factors in the pediatric population is critical to ensure that this is not the first generation where children have a shorter life expectancy than their parents. This review will discuss the pathophysiology, consensus definitions and laboratory assessment of pediatric metabolic syndrome as well as potential novel biomarkers.
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Affiliation(s)
- Victoria Higgins
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Nishimura R, Sano H, Shirasawa T, Matsudaira T, Miyashita Y, Ochiai H, Kokaze A, Tajima N, Utsunomiya K. Changes in the Composition of Adiponectin Fractions over a 3-Year Period in Children: A Population-Based Cohort Study. Child Obes 2016; 12:440-445. [PMID: 27584617 DOI: 10.1089/chi.2016.0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little information is available regarding changes in adiponectin fractions. The objective of this study was to examine changes in the composition of differing adiponectin fractions using a population-based, prospective pediatric cohort. METHODS A total of 358 fourth graders (9-10 years old) from Ina town in Saitama, Japan, were followed up for 3 years. BMI and total adiponectin (TAD), high-molecular weight adiponectin (HAD), medium-molecular weight adiponectin, and low-molecular weight adiponectin levels were measured in these subjects at baseline and at the end of the follow-up. RESULTS Of the fourth graders participating in the study, 326 (172 boys and 154 girls; follow-up rate, 91.1%) became available for follow-up. No significant changes were observed in TAD values after 3 years. HAD values were significantly decreased in both the boys (2.4 to 2.2 μg/mL: p < 0.001) and girls (3.1 to 2.7 μg/mL: p = 0.005). All values in the parameters examined at baseline and after 3 years were significantly correlated. A negative correlation was found between the ratios of follow-up compared to baseline values for BMI and those for TAD (boys, r = -0.322, p < 0.001; girls, r = -0.433, p < 0.001) as well as those for HAD (boys, r = -0.353, p < 0.001; girls, r = -0.351, p < 0.001). CONCLUSIONS HAD had the most robust correlation between its values at baseline and those after 3 years in both boys and girls. The changes in HAD also had the most robust correlation between the changes in BMI in 3 years.
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Affiliation(s)
- Rimei Nishimura
- 1 Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan .,2 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, PA
| | - Hironari Sano
- 1 Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | - Takako Shirasawa
- 3 Department of Public Health, Showa University School of Medicine , Tokyo, Japan
| | - Toru Matsudaira
- 1 Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | - Yumi Miyashita
- 1 Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | - Hirotaka Ochiai
- 3 Department of Public Health, Showa University School of Medicine , Tokyo, Japan
| | - Akatsuki Kokaze
- 3 Department of Public Health, Showa University School of Medicine , Tokyo, Japan
| | - Naoko Tajima
- 4 Jikei University School of Medicine , Tokyo, Japan
| | - Kazunori Utsunomiya
- 1 Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
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Karatzi K, Moschonis G, Polychronopoulou MC, Chrousos GP, Lionis C, Manios Y, Manios Y, Moschonis G, Skenderi KP, Grammatikaki E, Androutsos O, Tanagra S, Koumpitski A, Siatitsa PE, Vandorou A, Kyriakou AE, Dede V, Kantilafti M, Farmaki AE, Siopi A, Micheli S, Damianidi L, Margiola P, Gakni D, Iatridi V, Mavrogianni C, Michailidou K, Giannopoulou A, Argyri E, Maragkopoulou K, Spyridonos M, Tsikalaki E, Kliasios P, Naoumi A, Koutsikas K, Aggelou E, Krommyda Z, Aga C, Birbilis M, Kosteria I, Zlatintsi A, Voutsadaki E, Papadopoulou EZ, Papazi Z, Papadogiorgakaki M, Chlouveraki F, Lyberi M, Karatsikaki-Vlami N, Dionysopoulou E, Daskalou E. Cutoff points of waist circumference and trunk and visceral fat for identifying children with elevated inflammation markers and adipokines: The Healthy Growth Study. Nutrition 2016; 32:1063-7. [DOI: 10.1016/j.nut.2016.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 11/15/2022]
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17
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Ciccone MM, Faienza MF, Altomare M, Nacci C, Montagnani M, Valente F, Cortese F, Gesualdo M, Zito A, Mancarella R, Leogrande D, Viola D, Scicchitano P, Giordano P. Endothelial and Metabolic Function Interactions in Overweight/Obese Children. J Atheroscler Thromb 2016; 23:950-9. [PMID: 26903398 PMCID: PMC7399297 DOI: 10.5551/jat.31740] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIM Although the underlined mechanisms are still unknown, metabolic/coagulation alterations related to childhood obesity can induce vascular impairments. The aim of this study was to investigate the relationship between metabolic/coagulation parameters and endothelial function/vascular morphology in overweight/obese children. METHODS Thirty-five obese/overweight children (22 pre-pubertal, mean age: 9.52±3.35 years) were enrolled. Body mass index (BMI), homeostasis model assessment index (HOMAIR), metabolic and coagulation parameters, [adiponectin, fibrinogen, high molecular weight adiponectin (HMW), endothelin-1, and vonWillebrand factor antigen] ultrasound early markers of atherosclerosis [flow-mediated dilatation (FMD), common carotid intima-media thickness (C-IMT), and anteroposterior diameter of infra-renal abdominal aorta (APAO)] were assessed. RESULTS APAO was related to anthropometric (age: r=0.520, p=0.001; height: r=0.679, p<0.001; weight: r=0.548, p=0.001; BMI: r=0.607, p<0.001; SBP: r=0.377, p=0.026) and metabolic (HOMAIR: r=0.357, p=0.035; HMW: r=-0.355, p=0.036) parameters. Age, height, and systolic blood pressure were positively related to increased C-IMT (r=0.352, p=0.038; r=0.356, p=0.036; r=0.346, p=0.042, respectively). FMD was not related to any clinical and biochemical characteristics of the pediatric population. Age, HOMAIR, fasting glucose levels, and HMW were independent predictors for APAO increase. Each unit decrease in HMW concentrations (1 μg/ml) induced a 0.065 mm increase in APAO. CONCLUSION High molecular weight adiponectin is related to cardiovascular risk in overweight/obese children.
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Affiliation(s)
- Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University
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Tan W, Wang L, Ma Q, Qi M, Lu N, Zhang L, Han B. Adiponectin as a potential tumor suppressor inhibiting epithelial-to-mesenchymal transition but frequently silenced in prostate cancer by promoter methylation. Prostate 2015; 75:1197-205. [PMID: 25877612 DOI: 10.1002/pros.23002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/18/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent evidence suggests a particular role for obesity in prostate cancer (PCa) progression. Adiponectin (ADN) is a hormone secreted by adipose tissue and has a variety of functions including the inhibition of PCa cell proliferation. Although serum ADN levels have been identified to be related with carcinogenesis in a tissue-specific context, the exact role of endogenous ADN in PCa cells remains largely unknown. METHODS Two tissue microarrays were constructed and immunohistochemistry (IHC) was utilized to detect ADN's expression in a cohort of 96 Chinese PCa patients with radical prostatectomy as well as 15 cases with Benign Prostatic Hyperplasia (BPH). MTS and transwell assays were applied to validate the effects of ADN on proliferation and invasive capacity of PCa cells. Real-time PCR and Western blot were performed to evaluate the expression at transcript and protein levels. Epigenetic modifications of ADN's promoter after TGF-β1 treatment in 22RV1 cells was monitored by chromatin immunoprecipitation (ChIP). Methylation-Specific PCR (MSP) was performed to determine the methylation status of ADN's promoter. RESULTS IHC showed decreased levels of ADN in 1 of 15 (6.7%) BPH cases, 6 of 27 (22.2%) PCa cases with low Gleason score (<7), 18 of 26 (69.2%) cases with Gleason score 7, but 32 of 43 (74.4%) cases with high Gleason score (>7). Silencing endogenous ADN could promote proliferation and invasion of 22RV1 cells via orchestrating Epithelial-to-mesenchymal Transition (EMT) process. TGF-β1, a potent EMT inducer, could decrease levels of chromatin markers associated with active genes (H3K4me3, H4acetylK16), and increase levels of repressive marker (H3K27me3) at ADN promoter in 22RV1 cells. Additionally, 5-aza and TSA treatment restored ADN expression in LNCaP cells in which the ADN expression was almost absent. MSP analysis revealed that methylation in the promoter might be involved in decreased expression of ADN in PCa tissues. CONCLUSION Our findings indicated that endogenous ADN may function as a tumor suppressor gene through inhibiting EMT of PCa cells but is down-regulated in PCa via promoter hypermethylation.
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Affiliation(s)
- Weiwei Tan
- Department of Pathology, Shandong University Medical School, Jinan, China
| | - Lin Wang
- Department of Pathology, Shandong University Medical School, Jinan, China
- Research Center for Medicinal Biotechnology, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Academy of Medicinal Sciences, Jinan, China
| | - Quanping Ma
- Department of Clinical Laboratory, The Fourth People's Hospital of Jinan, Jinan, China
| | - Mei Qi
- Department of Pathology, Shandong University Medical School, Jinan, China
| | - Ning Lu
- Department of Pathology, Shandong University Medical School, Jinan, China
| | - Lili Zhang
- Department of Pathology, Shandong University Medical School, Jinan, China
| | - Bo Han
- Department of Pathology, Shandong University Medical School, Jinan, China
- Department of Pathology, Shandong University Qilu Hospital, Jinan, China
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Adiponectin oligomers are similarly distributed in adequate-for-gestational-age obese children irrespective of feeding in their first year. Pediatr Res 2015; 77:808-13. [PMID: 25760548 DOI: 10.1038/pr.2015.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 12/05/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nutrition and growth in early postnatal life have a role in future diseases. Our aim was to investigate adiponectin oligomers in adequate-for-gestational-age obese children with respect to type and duration of feeding in the first year of life. METHODS Adiponectin oligomers and cardiometabolic risk factors were measured in 113 adequate-for-gestational-age obese children, divided into group A (prolonged breast feeding, >6 mo), group B (short breast feeding, 1-6 mo), and group C (formula feeding from birth). RESULTS All the parameters were similar among the groups. Adiponectin oligomers did not correlate with gestational age, months of breast feeding, and time of weaning. Total and high-molecular weight adiponectin were differently distributed across gender and pubertal stages (P < 0.02), being lower in males from the start of puberty. Prepregnancy BMI and at the end of the pregnancy were negatively associated (P < 0.04) with total and medium-molecular weight adiponectin in female and male offspring, respectively. CONCLUSIONS Adiponectin oligomers and metabolic characteristics are similarly distributed in adequate-for-gestational-age obese children, irrespective of the type and duration of the feeding in the first year of life. Gender and mother's BMI in pregnancy are contributors to adiponectin regulation. Further studies will explain whether breastfeeding protects against metabolic impairment later in life.
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Ochiai H, Shirasawa T, Nishimura R, Nanri H, Ohtsu T, Hoshino H, Tajima N, Kokaze A. Waist-to-height ratio is more closely associated with alanine aminotransferase levels than body mass index and waist circumference among population-based children: a cross-sectional study in Japan. BMC Pediatr 2015; 15:59. [PMID: 25980380 PMCID: PMC4477294 DOI: 10.1186/s12887-015-0378-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/08/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND An association between anthropometric measurements, including waist circumference (WC), and alanine aminotransferase (ALT) levels has been reported among adults. However, studies conducted among population-based elementary schoolchildren to date have been limited, especially in Japan, where the measurement of WC and blood collection are not usually performed in the annual health examination at elementary schools. The present study investigated the association between anthropometric measurements and ALT levels among population-based elementary schoolchildren in Japan. METHODS Subjects were fourth-grade schoolchildren (aged 9 or 10) from the town of Ina in Saitama Prefecture, Japan during 2004-2009. The height, weight, and WC of each subject were measured, and blood samples were drawn to measure ALT levels. Childhood overweight or obesity was defined according to the age- and sex-specific cut-off points proposed by the International Obesity Task Force. Spearman's correlation coefficients between anthropometric measurements (body mass index (BMI), WC, and waist-to-height ratio (WHtR)) and ALT levels were calculated. RESULTS Data from 2499 subjects (1293 boys and 1206 girls) were analyzed. BMI, WC, and WHtR were significantly positively correlated with ALT levels; the correlation coefficient of ALT levels with WHtR was higher than that with BMI and WC in boys and girls. In the analysis stratified by physique (non-overweight/obesity, overweight, or obesity), all anthropometric measurements were significantly positively correlated with ALT levels among boys, while only WHtR was significantly positively correlated with ALT levels among girls. Moreover, the correlation coefficient of ALT levels with WHtR was more pronounced than that with BMI and WC in the non-overweight/obesity group, in the overweight group, and in the obesity group for each sex. CONCLUSIONS The present study showed that WHtR was more closely associated with ALT levels than BMI and WC. Furthermore, only WHtR was significantly positively associated with ALT levels regardless of sex and physique. This study suggests that it is more useful to monitor WHtR than BMI and WC as a surrogate for ALT levels among population-based elementary schoolchildren.
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Affiliation(s)
- Hirotaka Ochiai
- Department of Public Health, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Takako Shirasawa
- Department of Public Health, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Rimei Nishimura
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
| | - Hinako Nanri
- Department of Public Health, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Tadahiro Ohtsu
- Department of Public Health, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Hiromi Hoshino
- Department of Public Health, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Naoko Tajima
- Jikei University School of Medicine, Tokyo, Japan.
| | - Akatsuki Kokaze
- Department of Public Health, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
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The Implications of Obesity for Cardiac Arrhythmia Mechanisms and Management. Can J Cardiol 2015; 31:203-10. [DOI: 10.1016/j.cjca.2014.10.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 01/02/2023] Open
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Mahajan R, Lau DH, Sanders P. Impact of obesity on cardiac metabolism, fibrosis, and function. Trends Cardiovasc Med 2015; 25:119-26. [DOI: 10.1016/j.tcm.2014.09.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 12/13/2022]
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