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Millwood SN, Manczak EM. Patterns of adolescent perceived social support and inflammation in adulthood within major racial groups: Findings from a longitudinal, nationally representative sample. Brain Behav Immun 2023; 110:95-106. [PMID: 36828159 PMCID: PMC10106434 DOI: 10.1016/j.bbi.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
Inflammation, the body's protective response to injury and infection, plays a critical role in physical and mental health outcomes. Elevated chronic inflammation is implicated as a predictor of disease and all-cause mortality and is linked with several psychological disorders. Given that social support is associated with lower rates of mortality and psychopathology, the links between inflammation and social support are well-studied. However, there are many significant gaps related to both the specificity and generalizability of extant findings. There is a paucity of research on the association between social support and inflammation within different racial groups. Additionally, more research is warranted to understand whether social support from different sources uniquely contributes to inflammation, above and beyond other sources of support. Thus, the current study examined whether perceived emotional social support during adolescence predicted inflammation during adulthood within several racial groups. Participants (n = 3,390) were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health), identified as either Asian, Black, Latinx, White, or Multiracial, and had complete data on study variables. Consistent with our hypotheses and previous research, greater perceived support during adolescence was associated with lower inflammation during adulthood, but only for White participants. Contrastingly, greater perceived support during adolescence was associated with higher inflammation during adulthood for individuals who identified as Asian, Latinx, Black, or Multiracial. Furthermore, patterns of social support and inflammation within each racial group varied by relationship type. These results highlight the importance of studying relationship processes and health outcomes within racial groups to understand their unique, lived experiences.
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Affiliation(s)
- Summer N Millwood
- Department of Psychology, University of Denver, 2155 Race St., Denver, CO 80208, United States.
| | - Erika M Manczak
- Department of Psychology, University of Denver, 2155 Race St., Denver, CO 80208, United States
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Park H, Jun S, Lee HA, Kim HS, Hong YS, Park H. The Effect of Childhood Obesity or Sarcopenic Obesity on Metabolic Syndrome Risk in Adolescence: The Ewha Birth and Growth Study. Metabolites 2023; 13:metabo13010133. [PMID: 36677058 PMCID: PMC9865823 DOI: 10.3390/metabo13010133] [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: 12/29/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
The prevalence of obesity and metabolic syndrome (MetS) in the pediatric population has increased globally. We evaluated the impact of childhood obesity and sarcopenic obesity on the risk of MetS in adolescence using the Ewha Birth and Growth Cohort study data. In this study, we analyzed data from 227 participants who were followed up at the ages of 7-9 and 13-15 years. Overweight and obesity were defined as a body mass index of the 85th percentile or higher based on national growth charts, and sarcopenic obesity was defined using body composition data. Metabolic diseases in adolescence were identified by calculating the pediatric simple metabolic syndrome score (PsiMS), continuous metabolic syndrome score (cMetS), and single-point insulin sensitivity estimator (SPISE) as MetS indices. The prevalence of overweight was approximately 15% at both 7-9 and 13-15 years old, and that of sarcopenic obesity (7-9 years old) was 19.5%. Boys aged 13-15 years had a significantly larger waist circumference (WC) and higher systolic blood pressure (SBP) than girls. The MetS indices (PsiMS, cMetS, and SPISE) showed no significant differences by gender. Overweight and sarcopenic obese people have a higher overall risk of MetS components than normal people. The overweight group had a significantly higher prevalence of PsiMS and cMetS than the normal group, while the SPISE was significantly lower and the MetS indicator was worse in the overweight group than in the normal group. Similar results were obtained in the group with sarcopenic obesity. Both overweight and sarcopenic obesity remained significantly associated with MetS indicators, even after adjusting for covariates. Furthermore, metabolic health assessed by the cMetS in adolescence was affected not only by childhood overweight but also by adolescence, which showed an interaction effect. The results of this study emphasize the importance and need for early detection of childhood obesity and effective public health interventions.
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Affiliation(s)
- Hyunjin Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Seunghee Jun
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Hye-Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea
- Correspondence: (H.-A.L.); (H.P.); Tel.: +82-2-2650-2836 (H.-A.L.); +82-2-6986-6241 (H.P.); Fax: +82-2-6986-7019 (H.P.)
| | - Hae Soon Kim
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Young Sun Hong
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
- Correspondence: (H.-A.L.); (H.P.); Tel.: +82-2-2650-2836 (H.-A.L.); +82-2-6986-6241 (H.P.); Fax: +82-2-6986-7019 (H.P.)
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Association of childhood metabolic syndrome and metabolic phenotypes with the carotid intima-media thickness (CIMT) in early adulthood: Tehran lipid and glucose study. Int J Cardiol 2021; 348:128-133. [PMID: 34902503 DOI: 10.1016/j.ijcard.2021.12.010] [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: 10/19/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The clinical significance of metabolic syndrome (MetS) during adolescence and its association with adulthood adverse outcomes is a controversial issue. This study aimed to investigate the association of MetS and metabolic phenotypes with a high carotid intima-media thickness (CIMT) in early adulthood. METHODS MetS was defined as proposed by Cook, de Ferranti, the National Cholesterol Education Program (NCEP), and the pediatric International Diabetes Federation (IDF). Metabolic phenotypes were defined based on the binary clustering of cardiovascular risk factors. The participants were adolescent's individual selected from a large cohort study and followed for 18.2 years. Multivariate-adjusted odds ratios (ORs) were calculated for a high CIMT incidence (≥95th percentile). RESULTS In this study, 862 adolescents (52.3% males), with the mean age of 13.4 ± 2.2 years, were included. The presence of MetS, based on the definitions proposed by Cook (OR = 1.90, 95% CI: 1.01-3.57, P = 0.046) and de Ferranti (OR = 1.74; 95% CI: 1.04-2.90, P = 0.033), was associated with the increased risk of a high CIMT in early adulthood. Metabolic phenotypes, including high waist circumference (WC)/hypertension (HTN), high WC/low high-density lipoprotein-cholesterol (HDL-C), and high triglyceride (TG)/high WC, showed higher risks of a high CIMT. However, these positive associations become insignificant after adjusting for the adulthood BMI, except for the high WC/low HDL-C phenotype (OR = 2.04, 95% CI: 1.02-4.11, P = 0.044). CONCLUSION The high WC/low HDL-C phenotype had a better predictive value and could be used as a simpler alternative for MetS to identify adolescents with a higher risk of high CIMT during early adulthood.
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Asghari G, Hasheminia M, Heidari A, Mirmiran P, Guity K, Shahrzad MK, Azizi F, Hadaegh F. Adolescent metabolic syndrome and its components associations with incidence of type 2 diabetes in early adulthood: Tehran lipid and glucose study. Diabetol Metab Syndr 2021; 13:1. [PMID: 33388084 PMCID: PMC7778813 DOI: 10.1186/s13098-020-00608-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022] Open
Abstract
AIM To investigate the association of youth metabolic syndrome (MetS) and its components, individually and in combination with early adulthood incident type 2 diabetes (T2DM). METHODS A total of 2798 adolescents aged 11-19 years enrolled in the study. At baseline, MetS, its components including blood pressure (BP), waist circumference (WC), triglycerides (TGs), fasting plasma glucose, and low HDL-C, and different combinations of MetS components were defined. After a mean 11.3 years of follow-up, T2DM was determined. Multivariable Cox proportional hazard regression analysis adjusted for age, sex, family history of T2DM, and adult BMI was used for data analysis. The hazard ratio (HR) and 95% confidence interval (CI) were reported. RESULTS During the follow-up, 44 incidents T2DM were developed. Among different individual components, only high WC [HR = 2.63, 95% CI (1.39-4.97)] and high TGs [HR = 1.82, 95% CI (1.00-3.34)] remained as significant predictors only in the age and sex adjusted model. Regarding combinations of MetS components, 'high TGs and high WC' [HR = 2.70, 95% CI (1.27-5.77)], 'high BP and high WC' [HR = 2.52, 95% CI (1.00-6.33)], 'high TGs and high BP' [HR = 2.27, 95% CI (1.02-5.05)] as well as MetS per se [HR = 2.82, 95% CI (1.41-5.64)] had a significant relationship with incident T2DM in the multivariable adjusted model. Among different confounders, being female and having family history of T2DM were consistently associated with higher risk of T2DM, in different combinations of MetS components. CONCLUSIONS Adolescence MetS and some combinations of MetS components predicted early adulthood T2DM. Thus, adolescents, particularly female ones, with combinations of MetS components as well as those with family history of T2DM could be targeted for lifestyle intervention.
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Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Heidari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Guity
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Karim Shahrzad
- Internal Medicine and Endocrinology, Shohada Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Serbis A, Giapros V, Galli-Tsinopoulou A, Siomou E. Metabolic Syndrome in Children and Adolescents: Is There a Universally Accepted Definition? Does it Matter? Metab Syndr Relat Disord 2020; 18:462-470. [PMID: 32795106 DOI: 10.1089/met.2020.0076] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The concept of metabolic syndrome (MetS) as a cluster of cardiovascular risk factors (obesity, altered glucose metabolism, dyslipidemia, and hypertension) has been around for more than 30 years. It is considered to be the result of complex interactions between centrally located fat, insulin resistance, subclinical inflammation, and other factors in genetically predisposed individuals. MetS diagnosis in adults has been linked to increased risk for cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). However, MetS in children and adolescents remains a controversial issue despite the extensive research in the field. It is still uncertain which definition should be used for its diagnosis in this age group, what is the clinical significance of such a diagnosis, and how reliably it can predict the future risk of developing CVD and T2D. Even if a child is diagnosed with MetS, management includes addressing each of the syndrome's components individually with weight loss and lifestyle modifications as the basic approach. Co-morbid conditions, such as nonalcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome should also be considered. It seems that MetS in children and adolescents should be used clinically as a conceptual framework for the identification of risk factors clustered around obesity and insulin resistance rather than a syndrome that needs to be diagnosed by measuring absolute "all-or-none" criteria.
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Affiliation(s)
- Anastasios Serbis
- Child Health Department, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios Giapros
- Child Health Department, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Assimina Galli-Tsinopoulou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Ekaterini Siomou
- Child Health Department, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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McPhee PG, Singh S, Morrison KM. Childhood Obesity and Cardiovascular Disease Risk: Working Toward Solutions. Can J Cardiol 2020; 36:1352-1361. [PMID: 32622878 DOI: 10.1016/j.cjca.2020.06.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
The prevalence of obesity in childhood is high and continues to increase globally. It is currently estimated that 381 million children worldwide have overweight or obesity. This disease stems from multiple complex pathways that can present early in life. This is particularly concerning because childhood obesity is associated with cardiovascular risk factors that can lead to early atherosclerosis and premature cardiovascular disease (CVD). Hypertension, dysglycemia, dyslipidemia, and systemic inflammation are associated with vascular changes in childhood, and these contribute to increased risk of cardiovascular events in adulthood if not adequately treated. Interventions to treat childhood obesity include multicomponent family-based behaviour modification programs, which have been demonstrated to have moderate short-term effects on weight-related outcomes; their effects on cardiovascular risk factors, however, are less well understood. Although supervised, structured exercise interventions result in improvements in blood pressure, inflammation, carotid artery intima media thickness, dysglycemia, dyslipidemia, and endothelial dysfunction in children with obesity in the short term, our understanding of how to translate these interventions into long-term sustainable exercise or physical activity recommendations remains uncertain. Research focus in these areas will help in treating childhood obesity and associated CVD risk factors to prevent CVD development in adulthood.
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Affiliation(s)
- Patrick G McPhee
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Selena Singh
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada.
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Wang HH, Lee DK, Liu M, Portincasa P, Wang DQH. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr 2020; 23:189-230. [PMID: 32483543 PMCID: PMC7231748 DOI: 10.5223/pghn.2020.23.3.189] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Kjellberg E, Roswall J, Bergman S, Almqvist‐Tangen G, Alm B, Dahlgren J. Longitudinal birth cohort study found that a significant proportion of children had abnormal metabolic profiles and insulin resistance at 6 years of age. Acta Paediatr 2019; 108:486-492. [PMID: 30328152 DOI: 10.1111/apa.14599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/10/2018] [Accepted: 09/24/2018] [Indexed: 12/20/2022]
Abstract
AIM Metabolic syndrome represents a cluster of risk factors for cardiovascular disease, and we investigated whether otherwise healthy 6-year-olds showed metabolic alterations. METHODS This study followed up a representative Swedish population-based cohort of full-term infants recruited on the maternity ward at Hallands Hospital Halmstad, Sweden, from 2008 to 2011. They were examined at a mean of 6.6 years of age (range 6.5-6.9) using various measures for signs of metabolic syndrome. RESULTS One key measure showed that 55 (26%) of the 212 children had one or more risk factors for metabolic syndrome requiring action. The 37 who were obese (3%) or overweight (14%) were significantly more likely to be insulin resistant than the normal weight group (28% versus 5%, p < 0.001) and have high triglycerides (8% versus 0%, p < 0.001). Children with high waist circumferences had higher systolic (p = 0.01) and diastolic (p = 0.02) blood pressure than those with normal waist circumferences. Waist circumference identified children at high risk of metabolic syndrome better than body mass index. CONCLUSION A significant percentage of 6-year-old children showed abnormal metabolic profiles, including insulin resistance, which increased their risk of cardiovascular disease. Waist circumference was a stronger marker for metabolic alterations than body mass index.
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Affiliation(s)
- Emma Kjellberg
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Hallands Hospital Halmstad Halmstad Sweden
| | - Josefine Roswall
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Hallands Hospital Halmstad Halmstad Sweden
| | - Stefan Bergman
- Primary Health Care Unit Department of Public Health and Community Medicine Institute of Medicine Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
| | - Gerd Almqvist‐Tangen
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
- Child Health Care Team Halmstad Sweden
| | - Bernt Alm
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
- Child Health Care Team Halmstad Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
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Kim YM, Kim SH, Shim YS. Associations of non-high-density lipoprotein cholesterol with metabolic syndrome and its components in Korean children and adolescents: the Korea National Health and Nutrition Examination Surveys 2008-2014. World J Pediatr 2018; 14:461-469. [PMID: 30043223 DOI: 10.1007/s12519-018-0160-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/08/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND In this study, we aimed to investigate the relationship between single-gender Korean references for non-high-density lipoprotein cholesterol (non-HDL-C) and metabolic syndrome (MetS) in childhood. METHODS A total of 5742 Korean children aged 10-18 years who participated in a national survey were included. The subjects were classified into three groups based on single-gender non-HDL-C levels as follows: < 120 mg/dL (desirable), ≥ 120 and < 150 mg/dL (borderline high), and ≥ 150 mg/dL (high). RESULTS Males in the borderline high non-HDL-C group had odds ratios (ORs) of 2.86 (95% confidence interval, 2.30-3.56) for elevated triglycerides (TG), 1.73 (1.08-1.79) for reduced high-density lipoprotein cholesterol (HDL-C) and 1.73 (1.08-2.78) for MetS compared with males in the desirable non-HDL-C group after adjusting for covariates. Males in the high non-HDL-C group had ORs of 1.65 (1.14-2.41) for elevated blood pressure (BP), 6.21 (4.27-9.05) for elevated TG, and 3.29 (1.49-7.26) for MetS compared with males in the desirable non-HDL-C group. Females in the borderline high non-HDL-C group had ORs of 3.03 (2.43-3.76) for elevated TG, 1.63 (1.13-2.35) for reduced HDL-C, and 4.53 (2.47-8.31) for MetS compared with females in the desirable non-HDL-C group. Females in the high non-HDL-C group had ORs of 1.43 (1.00-2.04) for elevated BP, 6.36 (4.45-9.08) for elevated TG, and 7.64 (3.65-15.96) for MetS compared with females in the desirable non-HDL-C group. CONCLUSION Our results suggest that, in a Korean population, a non-HDL-C level of 120 mg/dL for males and 150 mg/dL for females is the threshold between borderline high and high risk for MetS.
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Affiliation(s)
- Yong Min Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Seoul, 18450, Republic of Korea
| | - So Hyun Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Seoul, 18450, Republic of Korea
| | - Young Suk Shim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Seoul, 18450, Republic of Korea.
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Farello G, Antenucci A, Stagi S, Mazzocchetti C, Ciocca F, Verrotti A. Metabolically healthy and metabolically unhealthy obese children both have increased carotid intima-media thickness: a case control study. BMC Cardiovasc Disord 2018; 18:140. [PMID: 29973145 PMCID: PMC6032770 DOI: 10.1186/s12872-018-0874-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The cardiovascular disease risk was assessed in metabolically healthy obese (MHO) children, obese children with metabolic disorders (MUO), and to a control group of normal-weight children using carotid intima-media thickness (CIMT). METHODS Participants were 204 obese children (114 M, 90 F), including 162 MUO (74 M, 88 F) and 42 MHO (24 M, 18 F), and 99 gender- and age-matched controls (45 M, 54 F). Glucose, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and other serum values were determined in peripheral blood. Anthropometric parameters, blood pressure, and a carotid Doppler ultrasound scan were also acquired. The mean CIMT of obese subjects and controls was compared by analysis of variance. Abnormality of even one of the metabolic parameters assessed involved assignation to the MUO group. Mean CIMT was compared in MHO and MUO children. RESULTS Mean CIMT in control children was 402.97 ± 53.18 μm (left carotid artery) and 377.85 ± 52.47 μm (right carotid artery). In MHO and MUO patients CIMT was respectively 453.29 ± 62.04 and 460.17 ± 92.22 μm (left carotid artery) and 446.36 ± 49.21 and 456.30 ± 85.7 μm (right carotid artery). The mean CIMT was not significantly different in MUO and MHO children, whereas it showed a significant difference between both groups of obese children and controls (p < 0.01). CONCLUSION CIMT was significantly greater in obese patients, also in those without metabolic alterations, than in normal-weight children. Obesity is therefore an important risk factor for cardiovascular disease in itself, also in the absence of metabolic abnormalities.
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Affiliation(s)
- Giovanni Farello
- Department of Pediatrics, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
- Department of Life, Health & Environmental Sciences, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy
| | - Annarita Antenucci
- Department of Pediatrics, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
| | - Stefano Stagi
- University of Firenze, Piazza di San Marco, 4, 50121 Firenze, FI Italy
| | - Chiara Mazzocchetti
- Department of Pediatrics, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
| | - Franco Ciocca
- S.Savatore hospital - L’Aquila, Via Lorenzo Natali, 1, 67100 L’ Aquila AQ, Coppito Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
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Khoury M, Urbina EM. Cardiac and Vascular Target Organ Damage in Pediatric Hypertension. Front Pediatr 2018; 6:148. [PMID: 29881718 PMCID: PMC5976785 DOI: 10.3389/fped.2018.00148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.
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Affiliation(s)
| | - Elaine M. Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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12
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Gupta A, Sachdeva A, Mahajan N, Gupta A, Sareen N, Pandey RM, Ramakrishnan L, Sati HC, Sharma B, Sharma N, Kapil U. Prevalence of Pediatric Metabolic Syndrome and Associated Risk Factors among School-Age Children of 10-16 Years Living in District Shimla, Himachal Pradesh, India. Indian J Endocrinol Metab 2018; 22:373-378. [PMID: 30090730 PMCID: PMC6063189 DOI: 10.4103/ijem.ijem_251_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Recently, an increasing trend in the prevalence of pediatric metabolic syndrome (PMS) among school-age children has been documented in different parts of India. There is lack of data on the prevalence of PMS and its associated risk factors among school-age children living in district Shimla, Himachal Pradesh. Hence, to fill in the gap in the existing knowledge, the present study was conducted. METHODOLOGY A cross-sectional study was conducted during 2015-2016. Thirty clusters (schools) were identified from a list of all schools using population proportionate to size sampling methodology. From each school, 70 children in the age group of 10-16 years were selected. Data was collected on the sociodemographic characteristics, anthropometry, waist circumference, blood pressure, and physical activity. Fasting venous blood samples were collected for estimation of blood glucose, triglycerides, and high-density lipoprotein levels. RESULTS The prevalence of PMS using International Diabetes Federation classification was 3.3% and using modified-adult treatment panel classification criteria was 3.5%. Risk factors identified to be associated with PMS among school-age children were (i) male gender, (ii) high family monthly income, (iii) sedentary lifestyle, (iv) consumption of evening snack, (v) television/computer viewing, and (vi) motorized transportation for commuting to school. CONCLUSION The PMS prevalence was 3.3% in school-age children residing in District Shimla. There is a need to formulate interventions to prevent and correct metabolic syndrome among them for reducing early onset of cardiovascular disease during adulthood.
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Affiliation(s)
- Anmol Gupta
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Amit Sachdeva
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Narender Mahajan
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Aakriti Gupta
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Sareen
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
| | - Neetu Sharma
- Department of Physiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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13
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Saraiva BTC, Ritti-Dias RM, Farah BQ, Suetake VYB, Diniz TA, Costa Júnior P, Milanez VF, Christofaro DGD. CARDIOVASCULAR EFFECTS OF 16 WEEKS OF MARTIAL ARTS TRAINING IN ADOLESCENTS. REV BRAS MED ESPORTE 2018. [DOI: 10.1590/1517-869220182403179093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Sedentary habits increase the chances of developing cardiovascular disease. Physical activity is one of the means of prevention and treatment of these diseases, thus martial arts represent a dynamic option in promoting physical activity. Objective: The objective of the study is analyze the effects of 16 weeks of Martial Arts (Muay Thai or judo) training on cardiovascular variables in adolescents. Methods: The sample consisted of 40 adolescents, aged 11 to 14 years, divided into two groups: Martial Arts (n=28) and control (n=12). Weight and height measurements were taken to calculate body mass index. Systolic and diastolic blood pressure (BP), heart rate (HR) at rest, pulse pressure (PP) and rate-pressure product (RPP), were also measured. The intervention was carried out through Martial Arts (Muay Thai and judo) training held twice a week for 90 minutes, over 16 weeks. The control group did not undergo any training. The statistical analysis was performed using the following tests: Shapiro-Wilks, Levene’s, analysis of covariance (ANCOVA), eta-squared effect size and the net-effect, using SPSS 15.0 software and a significance level of 5%. Results: There was no statistical difference between the control and Martial Arts groups for the sample characterization. There was a significant difference in systolic BP in the Martial Arts group when compared with the control group (p-value=0.049). The effect size can be considered moderate (effect size=0.163), with a good net-effect (3.4 mmHg). Conclusion: This study showed that 16 weeks of Martial Arts decreased systolic BP in normotensive adolescents. Level of Evidence II; Therapeutic studies - Investigating the results of treatment.
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14
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Koskinen J, Juonala M, Dwyer T, Venn A, Thomson R, Bazzano L, Berenson GS, Sabin MA, Burns TL, Viikari JSA, Woo JG, Urbina EM, Prineas R, Hutri-Kähönen N, Sinaiko A, Jacobs D, Steinberger J, Daniels S, Raitakari OT, Magnussen CG. Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood: International Childhood Cardiovascular Cohort Consortium. Circulation 2017; 137:1246-1255. [PMID: 29170152 DOI: 10.1161/circulationaha.117.029726] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data suggest that the prediction of adult cardiovascular disease using a model comprised entirely of adult nonlaboratory-based risk factors is equivalent to an approach that additionally incorporates adult lipid measures. We assessed and compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a lipid model based on nonlaboratory risk factors plus lipids for predicting high-risk carotid intima-media thickness (cIMT) in adulthood. METHODS The study comprised 2893 participants 12 to 18 years of age from 4 longitudinal cohort studies from the United States (Bogalusa Heart Study and the Insulin Study), Australia (Childhood Determinants of Adult Health Study), and Finland (The Cardiovascular Risk in Young Finns Study) and followed into adulthood when cIMT was measured (mean follow-up, 23.4 years). Overweight status was defined according to the Cole classification. Hypertension was defined according to the Fourth Report on High Blood Pressure in Children and Adolescents from the National High Blood Pressure Education Program. High-risk plasma lipid levels were defined according to the National Cholesterol Education Program Expert Panel on Cholesterol Levels in Children. High cIMT was defined as a study-specific value ≥90th percentile. Age and sex were included in each model. RESULTS In univariate models, all risk factors except for borderline high and high triglycerides in adolescence were associated with high cIMT in adulthood. In multivariable models (relative risk [95% confidence interval]), male sex (2.7 [2.0-2.6]), prehypertension (1.4 [1.0-1.9]), hypertension (1.9 [1.3-2.9]), overweight (2.0 [1.4-2.9]), obesity (3.7 [2.0-7.0]), borderline high low-density lipoprotein cholesterol (1.6 [1.2-2.2]), high low-density lipoprotein cholesterol (1.6 [1.1-2.1]), and borderline low high-density lipoprotein cholesterol (1.4 [1.0-1.8]) remained significant predictors of high cIMT (P<0.05). The addition of lipids into the nonlaboratory risk model slightly but significantly improved discrimination in predicting high cIMT compared with nonlaboratory-based risk factors only (C statistics for laboratory-based model 0.717 [95% confidence interval, 0.685-0.748] and for nonlaboratory 0.698 [95% confidence interval, 0.667-0.731]; P=0.02). CONCLUSIONS Nonlaboratory-based risk factors and lipids measured in adolescence independently predicted preclinical atherosclerosis in young adulthood. The addition of lipid measurements to traditional clinic-based risk factor assessment provided a statistically significant but clinically modest improvement on adolescent prediction of high cIMT in adulthood.
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Affiliation(s)
- Juha Koskinen
- Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.) .,Heart Center (J.K.)
| | - Markus Juonala
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.)
| | - Terence Dwyer
- George Institute, University of Oxford, United Kingdom (T.D.).,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)
| | - Russell Thomson
- Centre for Research in Mathematics, School of Computing, Engineering and Mathematics, Western Sydney University, Australia (R.T.)
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.B., G.S.B.)
| | - Gerald S Berenson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.B., G.S.B.)
| | - Matthew A Sabin
- Murdoch Children's Research Institute, The Royal Children's Hospital and University of Melbourne, Australia (M.A.S.)
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.)
| | - Jorma S A Viikari
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.)
| | - Jessica G Woo
- Department of Pediatrics, Division of Biostatistics and Epidemiology (J.G.W.).,Department of Medicine, University of Cincinnati, OH (J.G.W.)
| | - Elaine M Urbina
- Department of Pediatrics, Division of Cardiology (E.M.U.), Cincinnati Children's Hospital Medical Center and University of Cincinnati, OH
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.)
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Finland (N.H.-K.)
| | | | - David Jacobs
- Division of Epidemiology and Community Health (D.J.), University of Minnesota, Minneapolis
| | | | - Stephen Daniels
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (S.D.)
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.).,Department of Clinical Physiology (O.T.R.), Turku University Hospital, Finland
| | - Costan G Magnussen
- Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.).,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)
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15
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Evaluation of endothelial dysfunction in patients with nonalcoholic fatty liver disease: Association of selenoprotein P with carotid intima-media thickness and endothelium-dependent vasodilation. Clin Res Hepatol Gastroenterol 2017; 41:516-524. [PMID: 28760353 DOI: 10.1016/j.clinre.2017.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 01/02/2017] [Accepted: 01/13/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND In patients with NAFLD, there is an increased risk of cardiovascular disease (CVD). Selenoprotein P (SelP), a hepatokine, is associated with insulin resistance (IR) and serum SelP was found to be elevated in patients with NAFLD. AIM This study aimed to determine the risk of CVD in NAFLD patients and the association of serum SelP levels with this NAFLD related CVD risk. METHODS Ninety-three patients with NAFLD and 37 healthy controls were included in the study. Complete blood count, C-reactive protein (CRP), fasting glucose, serum lipid levels, and SelP levels were tested from fasting blood samples. Moreover, body mass index (BMI), HOMA-IR, carotid intima-media thickness (cIMT) and flow-mediated dilatation (FMD) were measured. RESULTS In patients with NAFLD, the FMD ratio was significantly lower than in controls (P=0.027). cIMT measurements were similar in both groups (P=0.996). Serum SelP levels were significantly higher than controls (P<0.001). SelP levels were significantly correlated with BMI, fasting glucose, LDL-cholesterol and HOMA-IR (r=0.395, P<0.001; r=0.322, P=0.002; r=0.353, P<0.001; r=0.521, P<0.001, respectively). Also, SelP levels were significantly lower and correlated with FMD (r=-0.674, P<0.001). SelP, ESR and CRP were significantly higher (P<0.05) and FMD ratios were significantly lower (P<0.05) in patients with nonalcoholic steatohepatitis (NASH) when compared to patients with simple steatosis. CONCLUSION These results suggest that in young NAFLD patients without additional comorbidities, there is an increased risk of CVD. FMD may be a better predictor for assessment of CVD risk when compared with cIMT. We assume that there could also be an important role of SelP in the pathogenesis of NASH.
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Burgos MS, Reuter CP, Possuelo LG, Valim ARDM, Renner JDP, Tornquist L, Tornquist D, Gaya AR. Obesity parameters as predictors of early development of cardiometabolic risk factors. CIENCIA & SAUDE COLETIVA 2017. [PMID: 26221803 DOI: 10.1590/1413-81232015208.11672014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The scope of this study was to verify the association between different overweight and obesity parameters and the metabolic risk profile among school-age students. The randomized cross-sectional study included 1254 children and adolescents, aged 7 to 17, from a city in southern Brazil. Body mass index (BMI), waist circumference (WC) and percentage of fat (PF), measured at the triceps and based on subscapular skinfold thickness, were used as the parameters to evaluate overweight/obesity status. Systolic blood pressure (SBP), total cholesterol, high-density lipoprotein cholesterol (HDL), low-density protein cholesterol (LDL) and triglycerides were also measured. The metabolic risk profile was calculated based on the sum of the z score of the metabolic variables adjusted by age. A three-model Poisson analysis was used to verify the association between BMI, WC and PF with metabolic risk profile. BMI showed the highest probability for developing metabolic risk compared with WC (overweight - PR: 1.63 and obesity - PR: 3.87) and PF (overweight - PR: 1.62 and obesity - PR: 2.92). In conclusion, BMI seems to be a better parameter of overweight/obesity than WC and PF in the assessment of metabolic risk among youths.
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Affiliation(s)
| | | | | | | | | | | | - Debora Tornquist
- Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brasil,
| | - Anelise Reis Gaya
- Escola de Educação Física, Universidade Federal do Rio Grande do Sul, Brasil
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17
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Reina SA, Llabre MM, Vidot DC, Isasi CR, Perreira K, Carnethon M, Parrinello CM, Gallo LC, Ayala GX, Delamater A. Metabolic Syndrome in Hispanic Youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth. Metab Syndr Relat Disord 2017; 15:400-406. [PMID: 28829223 DOI: 10.1089/met.2017.0054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is being diagnosed in youth. Specific diagnostic criteria used to define MetS influence prevalence estimates and populations considered at risk for cardiovascular disease. The National Cholesterol Education Program's Adult Treatment Panel III (ATP), the World Health Organization (WHO), and the International Diabetes Federation (IDF) provide three MetS definitions used in medical research. This study examined concordance among these definitions in 1137 children 10-16 years of age, who participated in the Hispanic Community Children's Health Study/Study of Latino Youth. METHODS Prevalence of MetS and of individual components was estimated using SAS. Mplus was used to test a single-factor model of MetS components (triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, waist circumference, and fasting glucose). RESULTS The ATP definition identified most MetS cases in 10-15 (N = 19, 4.7%) and 16-year-old girls (N = 3, 7.3%). The IDF definition identified most cases of MetS in 10-15 (N = 16, 3.1%) and 16-year-old boys (N = 2, 2.8%). Fewest cases of MetS were identified with the WHO definition across age and sex groups. CONCLUSION Only one participant was classified as having MetS across all three definitions. Confirmatory factor analysis indicated fasting glucose and systolic blood pressure did not reliably cluster with other risk factors that define MetS in Hispanic/Latino adolescents. We conclude that prevalence estimates of MetS in youth are unstable across current criteria, calling into question the accuracy of defining and diagnosing MetS in youth.
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Affiliation(s)
- Samantha A Reina
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
| | - Maria M Llabre
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
| | - Denise C Vidot
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
| | - Carmen R Isasi
- 2 Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, New York
| | - Krista Perreira
- 3 Department of Social Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Mercedes Carnethon
- 4 Department of Preventive Medicine, Northwestern University , Chicago, Illinois
| | - Christina M Parrinello
- 2 Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, New York
| | - Linda C Gallo
- 5 Department of Psychology, San Diego State University , San Diego, California
| | - Guadalupe X Ayala
- 5 Department of Psychology, San Diego State University , San Diego, California
| | - Alan Delamater
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
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18
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Koskinen J, Magnussen CG, Sinaiko A, Woo J, Urbina E, Jacobs DR, Steinberger J, Prineas R, Sabin MA, Burns T, Berenson G, Bazzano L, Venn A, Viikari JSA, Hutri-Kähönen N, Raitakari O, Dwyer T, Juonala M. Childhood Age and Associations Between Childhood Metabolic Syndrome and Adult Risk for Metabolic Syndrome, Type 2 Diabetes Mellitus and Carotid Intima Media Thickness: The International Childhood Cardiovascular Cohort Consortium. J Am Heart Assoc 2017; 6:JAHA.117.005632. [PMID: 28862940 PMCID: PMC5586423 DOI: 10.1161/jaha.117.005632] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background There is paucity of knowledge concerning the specific age in youth when the associations of metabolic syndrome (MetS) begin to be operative. Thus, we investigated the relation of age to the associations of childhood MetS with adult MetS, type 2 diabetes mellitus and high carotid intima‐media thickness. Methods and Results Five thousand eight‐hundred three participants were analyzed in 4 cohort studies (Cardiovascular Risk in Young Finns, Bogalusa Heart Study, Princeton Lipid Research Study, Insulin Study). International cutoffs and previously used 75th percentile cutoffs were used for children to define MetS and its components. Mean follow‐up period was 22.3 years. Logistic regression was used to calculate risk ratios and 95% confidence intervals. Childhood MetS and overweight were associated with over 2.4‐fold risk for adult MetS from the age of 5 years onward. Risk for type 2 diabetes mellitus was increased from the age of 8 (risk ratio, 2.6–4.1; 95% confidence interval, 1.35–6.76 and 1.12–7.24, respectively) onward for the 2 childhood MetS criteria based on international cut‐off values and for childhood overweight. Risk for high carotid intima‐media thickness was significant at ages 11 to 18 years in relation to childhood MetS or overweight (risk ratio, 2.44–4.22; 95% confidence interval, 1.55–3.55 and 2.55–5.66, respectively). Continuous childhood MetS score was associated with adult MetS from the age of 5, with type 2 diabetes mellitus from the age of 14 and with high carotid intima‐media thickness from the age of 11 years onward. Conclusions Adult MetS was predicted by MetS in childhood beginning at age 5. However, adult type 2 diabetes mellitus and subclinical atherosclerosis were not predicted by childhood data until after age 8. Body mass index measurement alone at the same age points provided similar findings.
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Affiliation(s)
- Juha Koskinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland .,Heart Center, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Jessica Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elaine Urbina
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Trudy Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Gerald Berenson
- Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Lydia Bazzano
- Departments of Epidemiology and Biostatistics and Bioinformatics, Tulane University Health Sciences Center, Tulane University, New Orleans, LA
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Terence Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
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19
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Yeboah K, Dodam KK, Affrim PK, Adu-Gyamfi L, Bado AR, Owusu Mensah RNA, Adjei AB, Gyan B. Metabolic syndrome and parental history of cardiovascular disease in young adults in urban Ghana. BMC Public Health 2017; 18:96. [PMID: 28774298 PMCID: PMC5543583 DOI: 10.1186/s12889-017-4652-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Metabolic syndrome (MetS) in young adults poses significant cardiovascular diseases (CVD) risk for later years. Parental history of CVDs is known to affect the prevalence of CVD risk in adulthood. In sub-Saharan Africa, the burden of MetS in young adults and its relationship with parental CVDs is largely unknown. We studied the gender-specific prevalence of MetS and its association with parental history of diabetes, hypertension and CVDs in young adults resident in urban Ghana. Methods In a cross-sectional design, 364 young adults aged 20–30 years were randomly recruited from students of University of Ghana. A structured questionnaire was used to collect data on demography, lifestyle, medical and parental medical history. Anthropometric indices and blood pressures were measured. Fasting blood samples were collected to measure plasma levels of glucose, lipid profile, urea and creatinine. MetS was defined according to the Joint Scientific Statement criteria. Results The prevalence of MetS was 12.4%, higher in females than male participants (18.4% vs 5.7, p = 0.019). Female participants had higher levels of all the components of MetS than the male participants. Compared to participants with no history of parental CVDs, participants with parental CVDs had a higher proportion of abdominal obesity. A positive history of parental CVDs was associated with increase in odds of MetS [OR (95% CI): 1.23 (1.12–3.04), p = 0.037]. Conclusion In our study population, there is relatively high prevalence of MetS; higher in females compared to male participants. Parental history of CVDs was associated with MetS.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P O Box 143, Korle-Bu, Accra, Ghana.
| | - Kennedy Konlan Dodam
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P O Box 143, Korle-Bu, Accra, Ghana
| | - Patrick Kormla Affrim
- Department of Chemical Pathology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Linda Adu-Gyamfi
- Department of Medical Biochemistry, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Anormah Rashid Bado
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P O Box 143, Korle-Bu, Accra, Ghana
| | - Richard N A Owusu Mensah
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P O Box 143, Korle-Bu, Accra, Ghana
| | - Afua Bontu Adjei
- Department of Chemical Pathology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Luo Y, McCullough LE, Tzeng JY, Darrah T, Vengosh A, Maguire RL, Maity A, Samuel-Hodge C, Murphy SK, Mendez MA, Hoyo C. Maternal blood cadmium, lead and arsenic levels, nutrient combinations, and offspring birthweight. BMC Public Health 2017; 17:354. [PMID: 28438148 PMCID: PMC5402649 DOI: 10.1186/s12889-017-4225-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/05/2017] [Indexed: 12/24/2022] Open
Abstract
Background Cadmium (Cd), lead (Pb) and arsenic (As) are common environmental contaminants that have been associated with lower birthweight. Although some essential metals may mitigate exposure, data are inconsistent. This study sought to evaluate the relationship between toxic metals, nutrient combinations and birthweight among 275 mother-child pairs. Methods Non-essential metals, Cd, Pb, As, and essential metals, iron (Fe), zinc (Zn), selenium (Se), copper (Cu), calcium (Ca), magnesium (Mg), and manganese (Mn) were measured in maternal whole blood obtained during the first trimester using inductively coupled plasma mass spectrometry. Folate concentrations were measured by microbial assay. Birthweight was obtained from medical records. We used quantile regression to evaluate the association between toxic metals and nutrients due to their underlying wedge-shaped relationship. Ordinary linear regression was used to evaluate associations between birth weight and toxic metals. Results After multivariate adjustment, the negative association between Pb or Cd and a combination of Fe, Se, Ca and folate was robust, persistent and dose-dependent (p < 0.05). However, a combination of Zn, Cu, Mn and Mg was positively associated with Pb and Cd levels. While prenatal blood Cd and Pb were also associated with lower birthweight. Fe, Se, Ca and folate did not modify these associations. Conclusion Small sample size and cross-sectional design notwithstanding, the robust and persistent negative associations between some, but not all, nutrient combinations with these ubiquitous environmental contaminants suggest that only some recommended nutrient combinations may mitigate toxic metal exposure in chronically exposed populations. Larger longitudinal studies are required to confirm these findings. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4225-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yiwen Luo
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA.,Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | | | - Jung-Ying Tzeng
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA. .,Department of Statistics, North Carolina State University, Raleigh, NC, USA. .,Department of Statistics, National Cheng-Kung University, Tainan, Taiwan.
| | - Thomas Darrah
- School of Earth Sciences, The Ohio State University, Columbus, OH, USA
| | - Avner Vengosh
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Rachel L Maguire
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27533, USA
| | - Arnab Maity
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | | | | | | | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27533, USA.
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Vanlancker T, Schaubroeck E, Vyncke K, Cadenas-Sanchez C, Breidenassel C, González-Gross M, Gottrand F, Moreno LA, Beghin L, Molnár D, Manios Y, Gunter MJ, Widhalm K, Leclercq C, Dallongeville J, Ascensión M, Kafatos A, Castillo MJ, De Henauw S, Ortega FB, Huybrechts I. Comparison of definitions for the metabolic syndrome in adolescents. The HELENA study. Eur J Pediatr 2017; 176:241-252. [PMID: 28058532 DOI: 10.1007/s00431-016-2831-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 02/06/2023]
Abstract
Various definitions are used to define metabolic syndrome in adolescents. This study aimed to compare, in terms of prevalence and differences, five frequently used definitions for this population: International Diabetes Federation, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP) modified by Cook, pediatric American Heart Association (AHA), World Health Organization, and Jolliffe and Janssen. A sample of 1004 adolescents (12.5-17.0 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study was considered. The components of the definitions (waist circumference/BMI, plasma lipids, glycemia, and blood pressure) were applied, and definitions were compared by using crosstabs, sensitivity, specificity, and kappa coefficient. The prevalence of metabolic syndrome varied from 1.6 to 3.8% depending on the used definitions. Crosstabs comparing the definitions showed the fewest cases being misclassified (having metabolic syndrome or not) between NCEP-ATP and AHA. Analyses for kappa coefficient, sensitivity, and specificity confirmed this finding. CONCLUSION The different definitions do not classify the same adolescents as having MS and prevalence varied between diagnostic methods. The modified NCEP-ATP and the AHA definitions were most analogous in defining subjects as having metabolic syndrome or not. What is known? • Metabolic syndrome is not only a problem of adulthood but is already present in children and adolescents. • Several diagnostic methods are used to define metabolic syndrome in adolescents. What is new? • Comparing the most frequently used definitions of metabolic syndrome in adolescents showed that they do not indicate the same adolescents as having metabolic syndrome. • The modified National Cholesterol Education Program Adult Treatment Panel III and the pediatric American Heart Association definitions were most analogous in defining subjects as having metabolic syndrome or not.
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Affiliation(s)
- Tine Vanlancker
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Emmily Schaubroeck
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Krishna Vyncke
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Cristina Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Christina Breidenassel
- Institut für Ernährungs und Lebensmittelwissenschaften Ernährungphysiologie, Rheinische Friedrich Wilhelms, Universität Bonn, Bonn, Germany
- ImFINE Research Group, Faculty of Physical Activity and Sport-INEF, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Faculty of Physical Activity and Sport-INEF, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain
- CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Frederic Gottrand
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Université Lille, 59000, Lille, France
- Inserm, CHU Lille, CIC 1403-Centre d'investigation clinique, Université Lille, 59000, Lille, France
| | - Luis A Moreno
- GENUD-Growth, Exercise, Nutrition and Development, University of Zaragoza, Zaragoza, Spain
- School of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Laurent Beghin
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Université Lille, 59000, Lille, France
- Inserm, CHU Lille, CIC 1403-Centre d'investigation clinique, Université Lille, 59000, Lille, France
| | - Denes Molnár
- Medical Faculty, Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marc J Gunter
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Kurt Widhalm
- Department of Paediatrics, Private Medical University Salzburg, Salzburg, Austria
| | | | - Jean Dallongeville
- Department of Epidemiology and Public Health, U-744 INSERM, Institut Pasteur de Lille, Universite Lille Nord de France, Lille, France
| | - Marcos Ascensión
- Food Science and Technology and Nutrition Institute, Spanish National Research Council, Metabolism and Nutrition, Immunonutrition Research Group, Madrid, Spain
| | - Anthony Kafatos
- School of Medicine, Preventive Medicine and Nutrition Unit, Heraklion, University of Crete, Crete, Greece
| | - Manuel J Castillo
- Department of Medical Physiology, School of Medicine, Granada University, Granada, Spain
| | | | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Inge Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium.
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France.
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Asghari G, Eftekharzadeh A, Hosseinpanah F, Ghareh S, Mirmiran P, Azizi F. Instability of different adolescent metabolic syndrome definitions tracked into early adulthood metabolic syndrome: Tehran Lipid and Glucose Study (TLGS). Pediatr Diabetes 2017; 18:59-66. [PMID: 26825860 DOI: 10.1111/pedi.12349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/28/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There are substantial controversies about the clinical utility of adolescent metabolic syndrome (MetS). The current study examined the stability of adolescent MetS by assessing the agreement and discriminative abilities of four different definitions of adolescent MetS and the adult MetS definition during a 10.4-yr follow up. SUBJECTS AND METHODS For this study, 1424 adolescents (55.2% female), who participated in the framework of the Tehran Lipid and Glucose Study were included. Kappa was calculated for agreement between adolescent MetS definitions [Cook, de Ferranti, pediatric National Cholesterol Education Program (NCEP) and pediatric International Diabetes Federation (IDF)] and the adulthood MetS definition defined by the joint interim statement (JIS) criteria. MetS persistence, instability, and incidence were assessed, and for each of the four adolescent definitions, sensitivity, specificity, and area under receiver operating curve (AUC) for the counting of categorical adulthood MetS components was evaluated. RESULTS The agreement between the four adolescent MetS definitions and JIS was poor (κ = 0.094-0.255). All definitions showed low sensitivity and high specificity, except for de Ferranti's, which contrary to other definitions, had higher sensitivity and lower specificity. All four adolescent definitions revealed generally low AUCs (0.601-0.647). Compared with the pubertal group (11-14 yr), the predictive power was slightly higher in the late-pubertal group (15-18 yr). Cook's and de Ferranti's definitions showed fairly better predictive powers (0.647 and 0.644, respectively). Across all definitions, instability ranged between 5.4 and 19.6%. CONCLUSION The adolescent definitions show considerable amount of instability defined as poor agreement and low discriminative abilities tracked into early adulthood.
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Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anita Eftekharzadeh
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ghareh
- Faculty of Medicine, Islamic Azad University, Mashhad Medical Branch, Mashhad, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
The cutoff points for creating anthropometric indicators of size and growth can be established by three distinct methods: statistical, risk-based, and prescriptive. The theoretical, philosophical, and technical bases for these are quite distinct, but the implications of each method for applications at population and individual levels can be explored by using a common conceptual model. This model posits that any observed anthropometric distribution is a mixed distribution of two (or more) subpopulations, representing some individuals who are or will remain healthy (the specificity distribution) and those who are or will become unhealthy (the sensitivity distribution). The performance and appropriateness of cutoff points based on statistical, risk-based, and prescriptive criteria depend upon the relative sizes of these two subpopulations in a given context, the distance between their means, and the strength and shape of the relationship between the anthropometric indicator and the health outcomes that define these two subpopulations. The risk-based and prescriptive methods both require substantial epidemiologic evidence if they are to fulfill their theoretical and public health expectations, and both face normative (ethical) trade-offs in establishing cutoff points. The prescriptive method faces even stronger normative challenges, especially in relation to overweight and obesity, because its explicit claim regarding the desirable size and growth of children and adolescents may understate the importance of individuality and overstate the strength of the relationship (and the evidence for the relationship) between size, growth, and future health. These concerns are most pronounced for applications at the individual level and for mild-to-moderate elevations of body-mass index and other indicators.
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Affiliation(s)
- David Pelletier
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
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24
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Kim S, So WY. Prevalence of Metabolic Syndrome among Korean Adolescents According to the National Cholesterol Education Program, Adult Treatment Panel III and International Diabetes Federation. Nutrients 2016; 8:nu8100588. [PMID: 27706073 PMCID: PMC5083976 DOI: 10.3390/nu8100588] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
In both adults and children, metabolic syndrome (MetS) has been attributed to risk factors for type 2 diabetes and cardiovascular disease such as insulin resistance, abdominal obesity, hypertension, and dyslipidemia. This descriptive study aimed to compare the prevalence of MetS and diagnostic components according to the National Cholesterol Education Program, Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) in 2330 Korean adolescents (10–18 years), using data from the 2010–2012 Korea National Health and Nutrition Examination Survey-V. The NCEP-ATP III and IDF were used to diagnose MetS and yielded prevalence rates of 5.7% and 2.1%, respectively, with no sex-related differences. The most frequent MetS diagnostic components according to the NCEP-ATP III and IDF criteria were high triglyceride levels (21.2%) and low high-density lipoprotein cholesterol levels (13.6%), respectively; approximately 50.1% and 33.1% of adolescents had at least one MetS diagnostic component according to the respective criteria. Both overweight/obese male and female adolescents exhibited significantly increased prevalence rates of MetS and related diagnostic components, compared to normal-weight adolescents. In conclusion, the prevalence rates of MetS and diagnostic components differ according to the NCEP-ATP III and IDF criteria. Henceforth, efforts are needed to establish diagnostic criteria for Korean adolescents.
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Affiliation(s)
- Seonho Kim
- Department of Nursing, Chungbuk National University, Cheongju-si, Chungbuk 28644, Korea.
| | - Wi-Young So
- Sports and Health Care Major, College of Humanities and Arts, Korea National University of Transportation, 50 Daehak-ro, Chungju-si, Chungbuk 27469, Korea.
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Steinberger J, Daniels SR, Hagberg N, Isasi CR, Kelly AS, Lloyd-Jones D, Pate RR, Pratt C, Shay CM, Towbin JA, Urbina E, Van Horn LV, Zachariah JP. Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e236-55. [PMID: 27515136 DOI: 10.1161/cir.0000000000000441] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This document provides a pediatric-focused companion to "Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association's Strategic Impact Goal Through 2020 and Beyond," focused on cardiovascular health promotion and disease reduction in adults and children. The principles detailed in the document reflect the American Heart Association's new dynamic and proactive goal to promote cardiovascular health throughout the life course. The primary focus is on adult cardiovascular health and disease prevention, but critical to achievement of this goal is maintenance of ideal cardiovascular health from birth through childhood to young adulthood and beyond. Emphasis is placed on the fundamental principles and metrics that define cardiovascular health in children for the clinical or research setting, and a balanced and critical appraisal of the strengths and weaknesses of the cardiovascular health construct in children and adolescents is provided. Specifically, this document discusses 2 important factors: the promotion of ideal cardiovascular health in all children and the improvement of cardiovascular health metric scores in children currently classified as having poor or intermediate cardiovascular health. Other topics include the current status of cardiovascular health in US children, opportunities for the refinement of health metrics, improvement of health metric scores, and possibilities for promoting ideal cardiovascular health. Importantly, concerns about the suitability of using single thresholds to identify elevated cardiovascular risk throughout the childhood years and the limits of our current knowledge are noted, and suggestions for future directions and research are provided.
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26
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Abnormalities of vascular structure and function in pediatric hypertension. Pediatr Nephrol 2016; 31:1061-70. [PMID: 26275663 PMCID: PMC4754169 DOI: 10.1007/s00467-015-3188-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/01/2015] [Accepted: 07/27/2015] [Indexed: 12/17/2022]
Abstract
Hypertension is associated with adverse cardiovascular (CV) events in adults. Measures of vascular structure and function, including increased carotid intima-media thickness (cIMT) and elevated arterial stiffness predict hard CV events in adulthood. Newer data suggest that abnormalities in target organ damage are occurring in adolescents and young adults with high blood pressure. In this review, we discuss the techniques for measuring vascular dysfunction in young people and the evidence linking blood pressure levels to this type of target organ damage.
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Steinberger J, Urbina EM. Childhood Metabolic Syndrome is a Poor Predictor of Adult Cardiovascular Outcomes. J Pediatr 2016; 171:14-5. [PMID: 26795681 DOI: 10.1016/j.jpeds.2015.12.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Julia Steinberger
- Department of Pediatric Cardiology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
| | - Elaine M Urbina
- Department of Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Cardiology, University of Cincinnati, Cincinnati, Ohio
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28
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Magnussen CG, Cheriyan S, Sabin MA, Juonala M, Koskinen J, Thomson R, Skilton MR, Kähönen M, Laitinen T, Taittonen L, Hutri-Kähönen N, Viikari JSA, Raitakari OT. Continuous and Dichotomous Metabolic Syndrome Definitions in Youth Predict Adult Type 2 Diabetes and Carotid Artery Intima Media Thickness: The Cardiovascular Risk in Young Finns Study. J Pediatr 2016; 171:97-103.e1-3. [PMID: 26681473 DOI: 10.1016/j.jpeds.2015.10.093] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/02/2015] [Accepted: 10/29/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To examine the utility of continuous metabolic syndrome (cMetS) scores vs a dichotomous metabolic syndrome (MetS) definition in youth to predict adult type 2 diabetes mellitus (T2DM) and carotid intima-media thickness (IMT). STUDY DESIGN Participants (n = 1453) from the population-based, prospective, observational Cardiovascular Risk in Young Finns Study who were examined in youth (when aged 9-18 years) and re-examined 15-25 years later. Four cMetS scores were constructed according to procedures most often used in the literature that comprised the youth risk factor inputs of body mass index, blood pressure, glucose, insulin, high-density lipoprotein-cholesterol, and triglycerides. Adult outcomes included T2DM and high carotid IMT (≥ 90 th percentile). RESULTS For a 1 SD increase in cMetS scores in youth, participants had a 30%-78% increased risk of T2DM and 12%-61% increased risk of high carotid IMT. Prediction of adult T2DM and high carotid IMT using cMetS scores in youth was essentially no different to a dichotomous MetS definition with area under the receiver-operating characteristic curve ranging from 0.54-0.60 (continuous definitions) and 0.55-0.59 (dichotomous) with 95% CIs often including 0.5, and integrated discrimination improvement from -0.2% to -0.6%. CONCLUSIONS cMetS scores in youth are predictive of cardiometabolic outcomes in adulthood. However, they do not have increased predictive utility over a dichotomous definition of MetS.
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Affiliation(s)
- Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
| | - Sanith Cheriyan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Juha Koskinen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Russell Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michael R Skilton
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Leena Taittonen
- Department of Pediatrics, Vaasa Central Hospital, Vaasa, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
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Eyre ELJ, Duncan MJ, Birch SL, Cox V. Environmental and school influences on physical activity in South Asian children from low socio-economic backgrounds: A qualitative study. J Child Health Care 2015; 19:345-58. [PMID: 24270992 DOI: 10.1177/1367493513508845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
South Asian (SA) children are less active but have enhanced metabolic risk factors. Physical activity (PA) is a modifiable risk factor for metabolic disease. Evidence suggests that environmental factors and socio-economic status influence PA behaviour. The purpose of this study was to understand PA environments, barriers and facilitators of PA in deprived environments for children from SA backgrounds. Focus groups were conducted with 5 groups of children aged 7-9 years (n = 33; male = 16, female = 17; SA = 17, White = 8 and Black = 8) from two schools in deprived wards of Coventry, England. Thematic analysis was used to identify key themes and subthemes across all transcripts. From the results, emergent themes included school and home environment, outdoor activity, equipment, weather, parental constraints and safety. Ethnic differences were apparent for sources of beliefs and knowledge and religious practice as constraints for PA. The findings suggest that school provides a good foundation for PA attitude, knowledge and behaviour, especially for SA children. To increase PA, multi-component interventions are needed, which focus on changing the home environment (i.e. junk food and media time), encouraging outdoors activity, changing perceptions of safety and weather conditions, which provide parental constraints for children. Interventions also need to be considerate to religious practices that might constrain time.
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Abstract
Elevated serum lipoproteins in childhood and adolescence are associated with health consequences and poor outcomes in adulthood. Universal screening, recommended in recent guidelines from the National Heart, Blood, and Lung Institute and supported by the American Academy of Pediatrics, may help identify a significant number of children who would be missed by targeted screening.
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Hall MH, Lee L, Matthews KA. Sleep duration during the school week is associated with C-reactive protein risk groups in healthy adolescents. Sleep Med 2014; 16:73-8. [PMID: 25468623 DOI: 10.1016/j.sleep.2014.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/09/2014] [Accepted: 10/11/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence of short sleep duration in adolescence and the relevance of early risk factors to cardiovascular disease in adulthood suggest that adolescence is an opportune time to evaluate links between sleep duration and cardiovascular disease risk. We examined associations among actigraphy-assessed sleep duration and sleep debt with elevated C-reactive protein (CRP), a known risk factor for cardiovascular disease. METHODS Participants were 244 (56% Black, 48% male) healthy high school students, each of whom wore wrist actigraphs for one week and provided a fasting blood draw. CRP was examined as both a continuous and categorical outcome, with CRP >3 mg/L identifying a High Risk Group. RESULTS Sleep duration and sleep debt were significantly associated with CRP High Risk Group in covariate-adjusted analyses. Shorter sleep duration on school nights was associated with a greater likelihood of being in the High Risk CRP Group. Likelihood of being in the High Risk CRP Group was doubled in students who obtained an average of two or more hours of "catch up" sleep on weekend nights. CONCLUSIONS Reduced weekday sleep duration and sleep debt were both associated with CRP Risk Group in adolescence. That these relationships may be observed prior to the onset of clinical disease suggests that adolescence may provide an opportune period for disease prevention.
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Affiliation(s)
- Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Laisze Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Christofaro DGD, Fernandes RA, Oliveira AR, Freitas Júnior IF, Barros MVG, Ritti-Dias RM. The association between cardiovascular risk factors and high blood pressure in adolescents: a school-based study. Am J Hum Biol 2014; 26:518-22. [PMID: 24799284 DOI: 10.1002/ajhb.22555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/01/2014] [Accepted: 04/12/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Although previous studies have analyzed the association between cardiovascular risk factors and blood pressure in adolescents, few studies conducted in developing countries analyzed whether the aggregation of risk factors contributes to an increased risk of high blood pressure in adolescents. The objective of this study was to assess the association between cardiovascular risk factors (including general overweight, abdominal obesity, high consumption of foods rich in fats, and insufficient physical activity levels) and high blood pressure in adolescents. METHODS This study was carried out from 2007 to 2008 with 1021 adolescents (528 girls) from primary schools located in the city of Londrina- Brazil. Blood pressure was assessed using an oscillometric device. General overweight was obtained through body mass index, abdominal obesity was assessed using waist circumference, and the consumption of foods rich in fat and physical activity were assessed using a questionnaire. The sum of these risk factors was determined. RESULTS Adolescents with three or four aggregated risk factors were more likely to have higher values of systolic and diastolic blood pressure when compared with adolescents who did not have any cardiovascular risk factors (P = 0.001 for both). Logistic regression indicated that groups of adolescents with 2 (OR= 2.46 [1.11-5.42]; P = 0.026), 3 (OR= 4.97 [2.07-11.92]; P = 0.001) or 4 risk factors (OR= 6.79 [2.24-19.9]; P = 0.001) presented an increased likelihood of high blood pressure. CONCLUSIONS The number of cardiovascular risk factors was found to be related to high blood pressure in adolescents.
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Affiliation(s)
- Diego G D Christofaro
- Laboratory of Investigation in Exercise - LIVE, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
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Li P, Jiang R, Li L, Liu C, Yang F, Qiu Y. Prevalence and risk factors of metabolic syndrome in school adolescents of northeast China. J Pediatr Endocrinol Metab 2014; 27:525-32. [PMID: 24821873 DOI: 10.1515/jpem-2013-0336] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 11/22/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying adolescents with metabolic syndrome (MetS) is important in China, where diabetes and MetS is highly prevalent among adults. We aimed to estimate MetS prevalence and to determine risk factors for MetS in adolescents of northeast China. METHODS This cross-sectional study was conducted from December 2010 to March 2011. We recruited 1312 healthy students from 30 high school classes and 910 who met the inclusion criteria (13.80±1.44 years, 53.3% boys) were enrolled. All subjects underwent anthropometric and biochemical examinations. MetS was defined using the definition specific for children and adolescents proposed by the International Diabetes Federation in 2007. RESULTS Total prevalence of MetS was 7.6% and was higher in boys than in girls (10.9% vs. 3.8%, p<0.0001). The most frequent component of MetS was low high-density lipoprotein-cholesterol (46.8%), followed by central obesity (22.5%). More than one third of adolescents were overweight or obese. Insulin resistance, hyperuricemia, abnormal lipid profiles, increased aminotransferase, overweight, and obesity were all associated with MetS. Only overweight [odds ratio (OR)=9.29, 95% confidence interval (CI) 5.36-16.00] and obesity (OR=61.85, 95% CI 32.73-116.86) evaluated with body mass index (BMI) were independent predictors for MetS. Receiver operating characteristic curve analysis revealed that BMI had high diagnostic accuracy (area under curve value 0.914, 95% CI 0.882-0.947) and the cutoff point of 23.8 kg/m2 had maximum accuracy for determining the presence of MetS (sensitivity 92.8%, specificity 80.1%). CONCLUSIONS MetS is highly prevalent among adolescents in northeast China and obesity is the major indicator for this disorder. Early identification and lifestyle modifications are strongly recommended.
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Chao CY, Shih CC, Wang CJ, Wu JS, Lu FH, Chang CJ, Yang YC. Low socioeconomic status may increase the risk of central obesity in incoming university students in Taiwan. Obes Res Clin Pract 2014; 8:e201-98. [PMID: 24847662 DOI: 10.1016/j.orcp.2012.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 07/16/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
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When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood. Curr Opin Cardiol 2014; 28:561-8. [PMID: 23928921 DOI: 10.1097/hco.0b013e32836428f4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood. RECENT FINDINGS Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor. SUMMARY Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
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Moreira C, Moreira P, Abreu S, Santos PC, Moreira-Silva I, Póvoas S, Mota J, Santos R. Vitamin D intake and cardiometabolic risk factors in adolescents. Metab Syndr Relat Disord 2014; 12:171-7. [PMID: 24495166 DOI: 10.1089/met.2013.0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing body of research suggests that vitamin D might play an important role in overall health. No data exist on vitamin D intake for the Azorean adolescent population. The purpose of this study was to assess vitamin D intake and investigate a possible association between vitamin D intake and cardiometabolic risk factors in Azorean adolescents. METHODS A cross-sectional school-based study was conducted on 496 adolescents (288 girls) aged 15-18 years from the Azorean Islands, Portugal. Anthropometric measurements (waist circumference and height), blood pressure (systolic), and plasma biomarkers [fasting glucose, insulin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs)] were measured to assess metabolic risk. Homeostasis model assessment (HOMA), TC-to-HDL-C ratio, and waist-to-height ratio were calculated. For each of these variables, a Z-score was computed by age and sex. A metabolic risk score was constructed by summing the Z-scores of all individual risk factors. High risk was considered when the individual had ≥1 standard deviation (SD) of this score. Vitamin D intake was assessed with a semiquantitative food frequency questionnaire. Participants were classified into quartiles of vitamin D intake. Logistic regression was used to determine odds ratios for high cardiometabolic risk scores after adjusting for total energy intake, pubertal stage, fat mass percentage, and cardiorespiratory fitness. RESULTS Mean (SD) vitamin D intake was 5.8 (6.5) μg/day, and 9.1% of Azorean adolescents achieved the estimated average requirement of vitamin D (10 μg/day or 400 IU). Logistic regression showed that the odds ratio for a high cardiometabolic risk score was 3.35 [95% confidence interval (CI) 1.28-8.75] for adolescents in the lowest vitamin D intake quartile in comparison with those in the highest vitamin D intake quartile, even after adjustment for confounders. CONCLUSION A lower level of vitamin D intake was associated with worse metabolic profile among Azorean adolescents.
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Affiliation(s)
- Carla Moreira
- 1 Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto , Porto, Portugal
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What the Long Term Cohort Studies that Began in Childhood Have Taught Us about the Origins of Coronary Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0373-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hosseinpanah F, Asghari G, Barzin M, Ghareh S, Azizi F. Adolescence metabolic syndrome or adiposity and early adult metabolic syndrome. J Pediatr 2013; 163:1663-1669.e1. [PMID: 24011762 DOI: 10.1016/j.jpeds.2013.07.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/20/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the predictive role of adolescent metabolic syndrome (MetS) in development of early adult MetS, independent of adult body mass index (BMI). STUDY DESIGN 1424 adolescents (639 boys), participants of the Tehran Lipid and Glucose Study, followed for 10.4 years, were analyzed and logistic regression models were developed. Using the areas under the receiver operating characteristic curve, the discriminatory ability of adolescent MetS and overweight or obesity was evaluated. Net reclassification improvement was calculated to determine the accuracy of classification by adolescent MetS in place of overweight or obesity. RESULTS The mean ± SD of age and BMI were 14.6 ± 2.2 years and 20.3 ± 4.2 kg/m(2), respectively. The prevalence of MetS was 13.3% and 14.6% at baseline and after follow-up, respectively. The risk of developing early adult MetS among subjects who were overweight or obese in adolescence but nonobese as adults (OR: 1.65) was lower than the risk among subjects who were obese as adults but nonobese as adolescents (OR: 8.45). After adjustment for adult BMI, adolescent MetS and overweight or obesity did not show any association with the risk of adult MetS. Area under the receiver operating characteristic curve was higher for obesity (0.619) than MetS (0.589) and the net reclassification improvement value for MetS was 1.5% (P = .398). CONCLUSION Adolescent MetS or adiposity did not predict early adult MetS independent of adult BMI. The addition of adolescent MetS to obesity does not improve the predictive power for early adult MetS.
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Affiliation(s)
- Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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A high school-based voluntary cardiovascular risk screening program: issues of feasibility and correlates of electrocardiographic outcomes. Pediatr Cardiol 2013; 34:1612-9. [PMID: 23503948 DOI: 10.1007/s00246-013-0682-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
Abstract
Risk factors for adult cardiovascular events can be identified from the prenatal period through childhood. We performed a cardiovascular risk-screening program in students from grades 9-12 in 7 high schools in Hillsborough County, FL. We obtained blood pressure (BP) measurements and calculated body mass index (BMI) as risk factors for future cardiovascular events as well as obtained an electrocardiogram (ECG) for the purposes of detecting possible life-threatening arrhythmias. Of ~14,000 students contacted, 600 (4 %) participated in the screening. Of these, 517 (86 %) were diagnosed with normal, 71 (12 %) with borderline, and 12 (1 %) with abnormal ECGs. Although no participant had any cardiac history, two of the abnormal ECGs indicated a cardiac diagnosis associated with the potential for sudden cardiac death. Both systolic and diastolic BP increased as the ECG diagnosis moved from normal (115.6/73.8) through borderline (121.0/75.9) to an abnormal (125.0/80.7) diagnosis (all P ≤ .0016). An increase in BMI was only observed when an ECG diagnosis was abnormal (P = .0180). Boys had a greater prevalence (18.97 %) of borderline or abnormal ECGs compared with girls (6.75 %), whereas no discernible differences were seen in ECG diagnosis between white and nonwhite individuals (15.09 and 12.26 %, respectively). Although participation rates were low, a high school-based cardiovascular risk-screening program including ECG is feasible. Although ECG diagnosis tended to be related to other known cardiovascular risk factors (BP, BMI), the utility of an abnormal ECG in adolescence as a predictor of future cardiovascular risk will require further evaluation in more controlled settings.
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Jang HB, Lee HJ, Park JY, Kang JH, Song J. Association between serum vitamin d and metabolic risk factors in korean schoolgirls. Osong Public Health Res Perspect 2013; 4:179-86. [PMID: 24159553 PMCID: PMC3767105 DOI: 10.1016/j.phrp.2013.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/05/2013] [Accepted: 06/17/2013] [Indexed: 01/05/2023] Open
Abstract
Objectives Vitamin D, a key regulator of bone metabolism, has been recently been linked with energy homeostasis and metabolic disorders in western countries. However, few studies have focused on the association of vitamin D with metabolic risk factors among Asian children. We studied the prevalence of vitamin D insufficiency and the association of 25-hydroxyvitamin D [25(OH)D] with metabolic risk factors in Korean schoolgirls. Methods The sample consisted of 320 13-year-old girls recruited from two middle schools in the city of Gwacheon, Korea (latitude 37°N), in July 2011. Anthropometric and blood biochemistry data were obtained for this cross-sectional observational study. We also obtained lifestyle data from questionnaires and dietary data from 3-day food diaries. Results Vitamin D deficiency [25(OH)D < 20 ng/mL] was noted in 63.8% of participants. The mean 25(OH)D level was not significantly lower in the overweight group. Level of physical activity and vitamin D intake did not significantly affect 25(OH)D. However, 25(OH)D levels were positively correlated with milk intake and negatively correlated with soft drink intake. Serum 25(OH)D had a negative relationship with fasting glucose and insulin resistance index (homeostasis model assessment-insulin resistance; HOMA-IR) after adjustment for physical activity and body mass index z score (r = −0.144, p = 0.015), and with metabolic risk score similarly (r = −0.141, p = 0.012). Levels of insulin, HOMA-IR, and systolic blood pressure were higher in girls with deficient 25(OH)D levels than in those with sufficient levels. Conclusion We found that low 25(OH)D levels were associated with higher blood glucose and insulin resistance. Korean girls with low 25(OH)D levels could be at increased risk for metabolic disorders.
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Affiliation(s)
- Han Byul Jang
- Division of Metabolic Diseases, Korea National Institute of Health, Osong, Korea
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Suchday S, Bellehsen M, Friedberg JP, Almeida M, Kaplan E. Clustering of cardiac risk factors associated with the metabolic syndrome and associations with psychosocial distress in a young Asian Indian population. J Behav Med 2013; 37:725-35. [PMID: 23775637 DOI: 10.1007/s10865-013-9521-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 05/28/2013] [Indexed: 01/21/2023]
Abstract
The metabolic syndrome is a precursor for coronary heart disease. However, its pathophysiology is not clear, its phenotypic expression may vary by region; also, the phenotypic manifestation may be exacerbated by psychosocial distress and family history. The purpose of the current study was to assess the factor structure of the metabolic syndrome in young urban Asian Indians. Asian Indian youth (N = 112) were evaluated for body mass index (BMI), waist-hip ratio, blood pressure (systolic: SBP; diastolic: DBP), blood sugar, triglycerides, cholesterol, insulin, psychosocial distress and family health history. Factor analyses were computed on components of the metabolic syndrome. Three factors were identified for the entire sample: hemodynamic-obesity (SBP, DBP, waist-hip ratio), Lipid (cholesterol, triglyceride), and insulin-obesity (blood sugar, BMI, insulin). Similar to previous research with this population, three distinct factors with no overlap were identified. Factors did not correlate with psychosocial distress or family history. Lack of correlation with family history and psychosocial distress may be a function of the young age and demographics of the sample.
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Affiliation(s)
- Sonia Suchday
- Albert Einstein College of Medicine, Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA,
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Oikonen M, Laitinen TT, Magnussen CG, Steinberger J, Sinaiko AR, Dwyer T, Venn A, Smith KJ, Hutri-Kähönen N, Pahkala K, Mikkilä V, Prineas R, Viikari JSA, Morrison JA, Woo JG, Chen W, Nicklas T, Srinivasan SR, Berenson G, Juonala M, Raitakari OT. Ideal cardiovascular health in young adult populations from the United States, Finland, and Australia and its association with cIMT: the International Childhood Cardiovascular Cohort Consortium. J Am Heart Assoc 2013; 2:e000244. [PMID: 23782922 PMCID: PMC3698791 DOI: 10.1161/jaha.113.000244] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Goals for cardiovascular (CV) disease prevention were set by the American Heart Association in 2010 for the concept of CV health. Ideal CV health is defined by 7 CV health metrics: blood pressure, glucose, cholesterol, body mass index, and physical activity on recommended levels; nonsmoking; and a healthy diet. We studied the prevalence of ideal CV health and its associations with ultrasonographically measured carotid intima-media thickness (cIMT) cross-sectionally in 5 international populations. METHODS AND RESULTS Prevalence of ideal CV health was assessed among 5785 young adults (age, 36.6 ± 3.2 years) comprising 335 participants from the Minneapolis Childhood Cohort Studies (Minnesota), 723 from the Princeton Follow-up Study, 981 from the Bogalusa Heart Study (BHS), 1898 from the Cardiovascular Risk in Young Finns Study (YFS), and 1848 from the Childhood Determinants of Adult Health Study (CDAH). Only 1% of the participants had all 7 ideal CV health metrics. The number of ideal CV health metrics associated inversely with cIMT in the 4 cohorts in which cIMT was available: for each additional ideal CV health metric, cIMT was 12.7 μm thinner in Minnesota (P=0.0002), 9.1 μm thinner in BHS (P=0.05), 10.4 μm thinner in YFS (P<0.0001), and 3.4 μm thinner in CDAH (P=0.03). CONCLUSIONS The number of ideal CV health metrics was inversely associated with cIMT in the cohorts in which cIMT was available, indicating that ideal CV health metrics are associated with vascular health at the population level. Ideal CV health was rare in this large international sample of young adults, emphasizing the need for effective strategies for health promotion.
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Affiliation(s)
- Mervi Oikonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.
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Lim S, Jang HC, Park KS, Cho SI, Lee MG, Joung H, Mozumdar A, Liguori G. Changes in metabolic syndrome in American and Korean youth, 1997-2008. Pediatrics 2013; 131:e214-22. [PMID: 23209102 DOI: 10.1542/peds.2012-0761] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetSyn) in children and adolescence is increasing worldwide; however, its pattern may be different between Asians and Americans. We compare the prevalence and patterns of MetSyn between American and Korean children and adolescents between roughly 1998 and 2007. METHODS Data from the American and Korean versions of the NHANES (NHANES and KNHANES) were used for this study. The main outcome is prevalence and pattern of MetSyn among participants separately in each country. In each survey, stratified multistage probability sampling designs and weighting adjustments were conducted to represent the entire population. The revised National Cholesterol Education Program criteria were used to define MetSyn. RESULTS Totals of 934, 1781, and 1690 Americans aged 12 to 19 participated in NHANES 1988-1994, NHANES 1999-2002, and NHANES 2003-2006, respectively; and 1225, 976, 705, and 456 Koreans aged 12 to 19 have participated in KNHANES 1998, 2001, 2005, and 2007. The age-adjusted prevalence of MetSyn in American NHANES decreased from 7.3% to 6.7% and 6.5%, whereas in Korean NHANES there was an increase from 4.0% to 5.9%, 6.6%, and 7.8% in each country's respective study. Increases in dyslipidemia and abdominal obesity contributed to the increased prevalence in Korea, whereas in the United States, decreases in low high-density lipoprotein cholesterolemia and high blood pressure contributed to a decreased prevalence. CONCLUSIONS Considering different phenotype changes, different approaches should be conducted at the national level to reduce the burden and consequences of MetSyn between Korea and the United States.
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Affiliation(s)
- Soo Lim
- College of Medicine, Internal Medicine, Seoul National University, Seoul, Korea
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Tandon N, Garg MK, Singh Y, Marwaha RK. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR). J Pediatr Endocrinol Metab 2013; 26:1123-30. [PMID: 23751385 DOI: 10.1515/jpem-2013-0020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/14/2013] [Indexed: 01/29/2023]
Abstract
AIM To assess prevalence of metabolic syndrome (MS) in urban Indian adolescents. MS in adolescents is a forerunner of diabetes mellitus and cardiovascular disease in adults, therefore, its identification provides an opportunity to intervene with lifestyle changes to prevent disease progression into adulthood. We randomly selected 900 adolescents (300 for each group) to participate in the study from a total of 15,101 adolescents (10-18 years) who were grouped as normal, overweight, and obese (total population). METHODS From the 900 adolescents, 695 consented to participate in the study and underwent a detailed anthropometric and biochemical evaluation, therefore, these adolescents constituted the study population. MS was defined by criteria proposed by the International Diabetes Federation (MS-IDF) and the Adult Treatment Panel (MS-ATP). The prevalence of MS in the study population was used to calculate the prevalence of MS in the total population based on the distribution of the different BMI categories in this larger sample (n=15,101). RESULTS Calculated prevalence of MS in urban Indian adolescents was 4.3% and 3.0% in the total population using MS-ATP and MS-IDF criteria, respectively. Among the study population, MS was higher in girls than boys (MS-ATP, G: 22.3% vs. B: 16.6%, p=0.03; MS-IDF, G: 20.5% vs. B: 13.5%, p=0.006). The most common component of MS- ATP and MS-IDF was central obesity (89.8% vs. 100.0%, p<0.00001), followed by hypertriglyceridemia (83.0% vs. 82.2%, p=0.35), low high density lipoprotein-cholesterol (71.1% vs. 71.2%, p=0.48), hypertension (44.4% vs. 44.9%, p=0.025), and dysglycemia (40.0% vs. 34.7%, p=0.94). The mean serum insulin levels and HOMA-IR progressively increased with the increasing number of components present in an individual. CONCLUSIONS Metabolic syndrome is common in urban Indian overweight and obese adolescents.
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Magnussen CG, Koskinen J, Juonala M, Chen W, Srinivasan SR, Sabin MA, Thomson R, Schmidt MD, Nguyen QM, Xu JH, Skilton MR, Kähönen M, Laitinen T, Taittonen L, Lehtimäki T, Rönnemaa T, Viikari JS, Berenson GS, Raitakari OT. A Diagnosis of the Metabolic Syndrome in Youth That Resolves by Adult Life Is Associated With a Normalization of High Carotid Intima-Media Thickness and Type 2 Diabetes Mellitus Risk. J Am Coll Cardiol 2012; 60:1631-9. [DOI: 10.1016/j.jacc.2012.05.056] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 04/16/2012] [Accepted: 05/11/2012] [Indexed: 10/27/2022]
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Morrison JA, Glueck CJ, Woo JG, Wang P. Risk factors for cardiovascular disease and type 2 diabetes retained from childhood to adulthood predict adult outcomes: the Princeton LRC Follow-up Study. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2012; 2012:6. [PMID: 22507454 PMCID: PMC3466140 DOI: 10.1186/1687-9856-2012-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/19/2012] [Indexed: 12/27/2022]
Abstract
Background Pediatric risk factors predict adult cardiovascular disease (CVD) and type 2 diabetes (T2DM), but whether they predict events independently of adult risk factors is not fully known. Objective Assess whether risk factors for CVD and T2DM retained from childhood to adulthood predict CVD and T2DM in young adulthood. Study design 770 schoolchildren, ages 5–20 (mean age 12), 26-yr prospective follow-up. We categorized childhood and adult risk factors and 26-year changes (triglycerides [TG], LDL cholesterol, BMI, blood pressure [BP] and glucose ≥, and HDL cholesterol < pediatric and young adult cutoffs). These risk factors and race, cigarette smoking, and family history of CVD and T2DM were assessed as predictors of CVD and T2DM at mean age 38. Results Children who had high TG and retained high TG as adults had increased CVD events as adults (p = .0005). Children who had normal BMI and retained normal BMI as adults had reduced CVD events as adults (p = .02). Children who had high BP or high TG and retained these as adults had increased T2DM as adults (p = .0006, p = .003). Conclusions Risk factors for CVD and T2DM retained from childhood to adulthood predict CVD and T2DM in young adulthood and support universal childhood screening.
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Affiliation(s)
- John A Morrison
- From the Cholesterol and Metabolism Center, Jewish Hospital of Cincinnati, Cincinnati, USA.
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Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2012; 16:1296-305. [DOI: 10.1017/s1368980012000973] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo examine the association between breakfast consumption and CVD risk factors in European adolescents.DesignCross-sectional. Breakfast consumption was assessed by the statement ‘I often skip breakfast’ and categorized into ‘consumer’, ‘occasional consumer’ and ‘skipper’. Blood pressure, weight, height, waist circumference, skinfold thickness, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), TAG, insulin and glucose were measured and BMI, TC:HDL-C, LDL-C:HDL-C and homeostasis model assessment–insulin resistance index (HOMA-IR) were calculated.SettingThe European Union-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.SubjectsEuropean adolescents, aged 12·50–17·49 years, from ten cities within the HELENA study (n2929,n925 with blood sample, 53 % females).ResultsIn males, significant differences across breakfast consumption category (‘consumer’, ‘occasional consumer’ and ‘skipper’) were seen for age, BMI, skinfold thickness, waist circumference, cardiorespiratory fitness, systolic and diastolic blood pressures, TC:HDL-C, LDL-C:HDL-C, glucose, insulin, HOMA-IR and LDL-C; in females, for cardiorespiratory fitness, skinfold thickness, BMI, insulin and HOMA-IR. In overweight/obese males significant differences were also seen for TC and LDL-C, whereas no differences were observed in non-overweight males or in females regardless of weight status.ConclusionsOur findings among European adolescents confirm previous data indicating that adolescents who regularly consume breakfast have lower body fat content. The results also show that regular breakfast consumption is associated with higher cardiorespiratory fitness in adolescents, and with a healthier cardiovascular profile, especially in males. Eating breakfast regularly may also negate somewhat the effect of excess adiposity on TC and LDL-C, especially in male adolescents.
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Dogru T, Genc H, Tapan S, Ercin CN, Ors F, Aslan F, Kara M, Sertoglu E, Bagci S, Kurt I, Sonmez A. Elevated asymmetric dimethylarginine in plasma: an early marker for endothelial dysfunction in non-alcoholic fatty liver disease? Diabetes Res Clin Pract 2012; 96:47-52. [PMID: 22189171 DOI: 10.1016/j.diabres.2011.11.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/21/2011] [Accepted: 11/24/2011] [Indexed: 12/22/2022]
Abstract
AIMS Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease. Asymmetric dimethylarginine (ADMA) is a novel marker of endothelial dysfunction and atherosclerosis. We aimed to investigate circulating ADMA concentrations in biopsy proven NAFLD and also to search its association with carotid atherosclerosis. METHODS Sixty-seven nondiabetic and normotensive patients with NAFLD and 35 healthy controls were enrolled. Plasma ADMA was measured along with glucose, lipids and insulin levels. Insulin resistance (IR) was assessed by homeostasis model assessment-estimated insulin resistance (HOMA-IR) method. Carotid atherosclerosis was evaluated by carotid artery intima-media thickness (CIMT) using carotid ultrasonography. RESULTS ADMA levels and CIMT measurements were significantly higher in NAFLD group than the controls. However, the difference regarding the CIMT disappeared when the findings were adjusted according to the metabolic parameters and insulin sensitivity. In contrast, the difference for ADMA remained significant between two groups. No significant association was found between ADMA, CIMT and histopathological findings. CONCLUSIONS Plasma ADMA levels are increased in subjects with NAFLD. This increase seems to be independent from traditional cardiovascular risk factors, insulin resistance and liver histology. Circulating ADMA may be an earlier marker of vascular damage with respect to CIMT in subjects with NAFLD.
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Affiliation(s)
- Teoman Dogru
- Department of Gastroenterology, Gulhane Medical School, Ankara, Turkey
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Fulkerson JA, Farbakhsh K, Lytle L, Hearst MO, Dengel DR, Pasch KE, Kubik MY. Away-from-home family dinner sources and associations with weight status, body composition, and related biomarkers of chronic disease among adolescents and their parents. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2011; 111:1892-7. [PMID: 22117665 PMCID: PMC3230299 DOI: 10.1016/j.jada.2011.09.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2011] [Indexed: 10/15/2022]
Abstract
Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietetics practitioners. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and takeout foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006-2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly vs none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z score, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, triglycerides, fasting glucose, insulin, and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency, and demographic characteristics. The odds of overweight/obesity were considerably greater when families reported at least one away-from-home dinner purchase in the past week (odds ratio=1.2 to 2.6). Mean percent body fat, metabolic risk cluster z scores, and insulin levels were significantly greater with weekly purchases of family dinner from fast-food restaurants (P<0.05). Mean percent body fat, metabolic risk cluster z scores, and high-density lipoprotein levels were significantly higher for families who purchased weekly family dinner from takeout sources (P<0.05). Although frequent family dinners may be beneficial for adolescents, the source of dinners is likely as important in maintaining a healthy weight. Interventions should focus on encouragement of healthful family meals.
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Affiliation(s)
- Jayne A. Fulkerson
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455; phone: 612-624-4823; fax: 612-626-6606;
| | - Kian Farbakhsh
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South Second Street SE, Suite 300, Minneapolis, MN 55454; phone: 612-626-9090; fax: 612-624-0315;
| | - Leslie Lytle
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South Second Street SE, Suite 300, Minneapolis, MN 55454; phone: 612-624-3518; fax: 612-624-0315;
| | - Mary O. Hearst
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South Second Street SE, Suite 300, Minneapolis, MN 55454; phone: 612-624-5723; fax: 612-624-0315;
| | - Donald R. Dengel
- School of Kinesiology, University of Minnesota, Room 141B Mariucci Arena, 1901 4th Street SE, Minneapolis, MN 55414; phone: 612-626-9701; fax: 612-625-8867;
| | - Keryn E. Pasch
- Department of Kinesiology and Health Education, University of Texas, 1 University Station, D3700, Austin, TX 78712-0360; phone: 512-232-8295; fax: 512-471-3845;
| | - Martha Y. Kubik
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455; phone: 612-625-0606; fax: 612-626-6606;
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