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Yu A, Jansen MAC, Dalmeijer GW, Bruijning-Verhagen P, van der Ent CK, Grobbee DE, Burgner DP, Uiterwaal CSPM. Childhood infection burden, recent antibiotic exposure and vascular phenotypes in preschool children. PLoS One 2023; 18:e0290633. [PMID: 37713433 PMCID: PMC10503770 DOI: 10.1371/journal.pone.0290633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Severe childhood infection has a dose-dependent association with adult cardiovascular events and with adverse cardiometabolic phenotypes. The relationship between cardiovascular outcomes and less severe childhood infections is unclear. AIM To investigate the relationship between common, non-hospitalised infections, antibiotic exposure, and preclinical vascular phenotypes in young children. DESIGN A Dutch prospective population-derived birth cohort study. METHODS Participants were from the Wheezing-Illnesses-Study-Leidsche-Rijn (WHISTLER) birth cohort. We collected data from birth to 5 years on antibiotic prescriptions, general practitioner (GP)-diagnosed infections, and monthly parent-reported febrile illnesses (0-1 years). At 5 years, carotid intima-media thickness (CIMT), carotid artery distensibility, and blood pressure (BP) were measured. General linear regression models were adjusted for age, sex, smoke exposure, birth weight z-score, body mass index, and socioeconomic status. RESULTS Recent antibiotic exposure was associated with adverse cardiovascular phenotypes; each antibiotic prescription in the 3 and 6 months prior to vascular assessment was associated with an 18.1 μm (95% confidence interval, 4.5-31.6, p = 0.01) and 10.7 μm (0.8-20.5, p = 0.03) increase in CIMT, respectively. Each additional antibiotic prescription in the preceding 6 months was associated with an 8.3 mPa-1 decrease in carotid distensibility (-15.6- -1.1, p = 0.02). Any parent-reported febrile episode (compared to none) showed weak evidence of association with diastolic BP (1.6 mmHg increase, 0.04-3.1, p = 0.04). GP-diagnosed infections were not associated with vascular phenotypes. CONCLUSIONS Recent antibiotics are associated with adverse vascular phenotypes in early childhood. Mechanistic studies may differentiate antibiotic-related from infection-related effects and inform preventative strategies.
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Affiliation(s)
- Angela Yu
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Maria A. C. Jansen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geertje W. Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David P. Burgner
- Department of Paediatrics, Monash University, Clayton, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, Melbourne University, Parkville, Australia
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Vascular Alterations Preceding Arterial Wall Thickening in Overweight and Obese Children. J Clin Med 2022; 11:jcm11123520. [PMID: 35743590 PMCID: PMC9224712 DOI: 10.3390/jcm11123520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Childhood obesity is linked to adverse cardiovascular outcomes in adulthood. This study aimed to assess the impact of childhood obesity on the vasculature and to investigate whether vascular alteration precedes arterial wall thickening in childhood. Methods: A total of 295 overweight (body mass index [BMI] 85th to 95th percentile, n = 30) and obese (BMI ≥ 95th percentile, n = 234) children aged 7–17 years and 31 normal-weight controls with similar age and gender were prospectively recruited. We assessed anthropometric data and laboratory findings, and measured the carotid intima–media thickness (IMT), carotid artery (CA) diameter, M-mode-derived arterial stiffness indices, and velocity vector imaging parameters, including the CA area, fractional area change, circumferential strain, and circumferential strain rate (SR). Results: The mean ± standard deviation age of the participants was 10.8 ± 2.1 years; 172 (58%) children were male. Regarding structural properties, there was no difference in the IMT between the three groups. The CA diameter was significantly increased in obese children, whereas the CA area showed a significant increase beginning in the overweight stage. Regarding functional properties, contrary to β stiffness and Young’s elastic modulus, which were not different between the three groups, the circumferential SR showed a significant decrease beginning in the overweight stage and was independently associated with BMI z-scores after adjusting for covariates. Conclusion: We have demonstrated that arterial stiffening and arterial enlargement precede arterial wall thickening, and that these vascular alterations begin at the overweight stage in middle childhood or early adolescence.
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Büschges J, Schaffrath Rosario A, Schienkiewitz A, Königstein K, Sarganas G, Schmidt-Trucksäss A, Neuhauser H. Vascular aging in the young: New carotid stiffness centiles and association with general and abdominal obesity – The KIGGS cohort. Atherosclerosis 2022; 355:60-67. [DOI: 10.1016/j.atherosclerosis.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/07/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
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Monasso GS, Silva CCV, Santos S, Goncalvez R, Gaillard R, Felix JF, Jaddoe VWV. Infant weight growth patterns, childhood BMI, and arterial health at age 10 years. Obesity (Silver Spring) 2022; 30:770-778. [PMID: 35142077 PMCID: PMC9302666 DOI: 10.1002/oby.23376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Associations of obesity with cardiovascular disease may originate in childhood. This study examined critical periods for BMI in relation to arterial health at school age. METHODS Among 4,731 children from a prospective cohort study, associations of infant peak weight velocity, both age and BMI at adiposity peak, and BMI trajectories with carotid artery intima-media thickness and carotid artery distensibility at 10 years were examined. RESULTS A 1-standard deviation score (SDS) higher peak weight velocity and BMI at adiposity peak were associated with higher intima-media thickness (0.10 SDS; 95% CI: 0.06 to 0.13 and 0.08 SDS; 95% CI: 0.05 to 0.12) and lower distensibility (-0.07 SDS; 95% CI: -0.10 to -0.03 and -0.07 SDS; 95% CI: -0.11 to -0.03) at 10 years. For distensibility, current BMI explained these associations. Children within the highest BMI tertile at ages 2 and 10 years had the lowest distensibility (p < 0.05), but similar intima-media thickness, compared with children constantly within the middle tertile. CONCLUSIONS Infant weight growth patterns and childhood BMI are associated with subtle differences in carotid intima-media thickness and carotid distensibility at school age. For distensibility, current BMI seems critical. Follow-up is needed to determine whether these associations lead to adult cardiovascular disease.
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Affiliation(s)
- Giulietta S. Monasso
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamthe Netherlands
| | - Carolina C. V. Silva
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamthe Netherlands
| | - Susana Santos
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamthe Netherlands
| | - Romy Goncalvez
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of Obstetrics and GynaecologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Romy Gaillard
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamthe Netherlands
| | - Janine F. Felix
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamthe Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study GroupErasmus University Medical CenterRotterdamthe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamthe Netherlands
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5
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Monasso GS, Jaddoe VWV, Küpers LK, Felix JF. Epigenetic age acceleration and cardiovascular outcomes in school-age children: The Generation R Study. Clin Epigenetics 2021; 13:205. [PMID: 34784966 PMCID: PMC8597298 DOI: 10.1186/s13148-021-01193-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/31/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertension and atherosclerosis may partly originate in early life. Altered epigenetic aging may be a mechanism underlying associations of early-life exposures and the development of cardiovascular risk factors in childhood. A discrepancy between chronological age and age predicted from neonatal DNA methylation data is referred to as age acceleration. It may either be positive, if DNA methylation age is older than clinical age, or negative, if DNA methylation age is younger than chronological age. We examined associations of age acceleration at birth ('gestational age acceleration'), and of age acceleration at school-age, with blood pressure and with intima-media thickness and distensibility of the common carotid artery, as markers of vascular structure and function, respectively, measured at age 10 years. RESULTS This study was embedded in the Generation R Study, a population-based prospective cohort study. We included 1115 children with information on cord blood DNA methylation and blood pressure, carotid intima-media thickness or carotid distensibility. Gestational age acceleration was calculated using the Bohlin epigenetic clock, which was developed specifically for cord blood DNA methylation data. It predicts gestational age based on methylation levels of 96 CpGs from HumanMethylation450 BeadChip. We observed no associations of gestational age acceleration with blood pressure, carotid intima-media thickness or carotid distensibility at age 10 years. In analyses among children with peripheral blood DNA methylation measured at age 6 (n = 470) and 10 (n = 449) years, we also observed no associations of age acceleration at these ages with the same cardiovascular outcomes, using the 'skin and blood clock,' which predicts age based on methylation levels at 391 CpGs from HumanMethylation450 BeadChip. CONCLUSIONS Our findings do not provide support for the hypothesis that altered epigenetic aging during the earliest phase of life is involved in the development of cardiovascular risk factors in childhood.
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Affiliation(s)
- Giulietta S Monasso
- The Generation R Study Group (Na-2918), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (Na-2918), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Leanne K Küpers
- The Generation R Study Group (Na-2918), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (Na-2918), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Maloberti A, Bombelli M, Vallerio P, Milani M, Cartella I, Tavecchia G, Tognola C, Grasso E, Sun J, De Chiara B, Riccobono S, Grassi G, Giannattasio C. Metabolic syndrome is related to vascular structural alterations but not to functional ones both in hypertensives and healthy subjects. Nutr Metab Cardiovasc Dis 2021; 31:1044-1052. [PMID: 33549437 DOI: 10.1016/j.numecd.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. In this paper we focused on the effects of MS on arterial carotid-femoral PWV and common carotid IMT in two different populations, one of hypertensive patients and one of healthy controls. METHODS AND RESULTS We enrolled 816 consecutive HT and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7 ± 1.9 vs 7.6 ± 1.1 m/s, p = 0.69), while IMT was higher in controls with than those without MS (0.64 ± 0.18 vs 0.57 ± 0.13 mm, p = 0.02). Hypertensives with MS were older (57.9 ± 12.2 vs 52.7 ± 14.1 years, p < 0.001) and showed higher PWV (9.0 ± 2.3 vs 8.4 ± 2.1 m/s, p = 0.001) and IMT (0.72 ± 0.22 vs 0.65 ± 0.17 mm, p < 0.001) than those without MS, however at the age-adjusted analysis only the difference in IMT was confirmed (p = 0.007). Regression models showed that MS was an independent determinant of IMT in both controls (β = 0.08, p = 0.03) and hypertensives (β = 0.08, p = 0.01), but not of PWV either in controls (β = 0.006, p = 0.886 and β = 0.04, p = 0.19, respectively). CONCLUSIONS the main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result have been confirmed both in hypertensive subjects and in healthy controls.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; Health Science Department, Milano-Bicocca University, Milan, Italy.
| | - Michele Bombelli
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Paola Vallerio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Martina Milani
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Iside Cartella
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | | | - Chiara Tognola
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Enzo Grasso
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Jinwei Sun
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Benedetta De Chiara
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Salvatore Riccobono
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Guido Grassi
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; Health Science Department, Milano-Bicocca University, Milan, Italy
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He H, Yang S, Qiu N, Qiao L, Ding Y, Luo J, Li Y, Luo Z, Huang Y, Pang H, Ji S, Zhang L, Guo X. Sex-Specific Differences in Related Indicators of Blood Pressure in School-Age Children With Overweight and Obesity: A Cross-Sectional Study. Front Pediatr 2021; 9:674504. [PMID: 34422716 PMCID: PMC8374442 DOI: 10.3389/fped.2021.674504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study is to further explore the difference between elevated blood pressure (EBP), elevated pulse pressure (EPP), and elevated mean arterial pressure (EMAP) and obesity in Chinese school-age children by sex. Methods: We performed a cross-sectional study of 935 children between 7 and 12 years old. Overweight and obesity were defined by body mass index and body composition. The multivariate logistic regression and the adjusted population attributable risk were used to assess the effects of obesity on pre-EBP/EBP, EPP, and EMAP. The interactions were used to identify the modification of obese on the relationship between related indicators of blood pressure and height or age. Results: The average age of the children included in the study was 10. Boys with overweight and obesity had higher pre-EBP/EBP, EPP, and EMAP (p < 0.05). The multivariate logistic regression analysis showed that overweight and obesity had a greater impact on BP and MAP than PP, especially in boys [odds ratio (OR) > 1]. Pre-EBP/EBP in 79% of boys and 76% of girls could be attributable to the visceral fat level. The interaction between BP, PP, MAP, and height or age was modestly increased in children with overweight and obesity, especially in boys. Conclusions: Independent of age and height, obesity not only increases blood pressure, it also increases mean arterial pressure and pulse pressure, and this effect is more pronounced in boys.
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Affiliation(s)
- Hongmei He
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Shujun Yang
- Department of Pediatrics, First Clinical College, Harbin Medical University, Harbin, China
| | - Na Qiu
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Ling Qiao
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Yong Ding
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Jiajia Luo
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Yuan Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Zengyou Luo
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Yingsa Huang
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Huishen Pang
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Shaoping Ji
- Department of Biochemistry and Molecular Biology, School of Basic Medical Science, Henan University, Kaifeng, China.,Kaifeng Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Center for Tumor Molecular Medicine, Kaifeng, China.,Bioinformatics Center, Institute of Biomedical Informatics, Henan University, Kaifeng, China
| | - Lu Zhang
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China.,Kaifeng Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Center for Tumor Molecular Medicine, Kaifeng, China.,Bioinformatics Center, Institute of Biomedical Informatics, Henan University, Kaifeng, China
| | - Xiangqian Guo
- Department of Preventive Medicine, School of Basic Medical Sciences, Henan University, Kaifeng, China.,Kaifeng Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Center for Tumor Molecular Medicine, Kaifeng, China.,Bioinformatics Center, Institute of Biomedical Informatics, Henan University, Kaifeng, China
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Botvin Moshe C, Haratz S, Ravona-Springer R, Heymann A, Hung-Mo L, Schnaider Beeri M, Tanne D. Long-term trajectories of BMI predict carotid stiffness and plaque volume in type 2 diabetes older adults: a cohort study. Cardiovasc Diabetol 2020; 19:138. [PMID: 32933542 PMCID: PMC7493137 DOI: 10.1186/s12933-020-01104-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND High body mass index (BMI) is a risk factor for type 2 diabetes and cardiovascular disease. However, its relationships with indices of carotid stiffness and plaque volume are unclear. We investigated associations of long-term measurements of BMI with indices of carotid stiffness and atherosclerosis among non-demented diabetes patients from the Israel Diabetes and Cognitive Decline (IDCD) study. METHODS Carotid ultrasound indices [carotid intima media thickness (cIMT), distensibility, elastography and plaque volume] were assessed in N = 471 participants. Mean BMI across all MHS diabetes registry measurements and trajectories of BMI were calculated. BMI was categorized into three trajectory groups representing: a relatively stable normal weight (n = 185, 44%), overweight trajectory (n = 188, 44.8%) and a trajectory of obesity (n = 47, 11.2%). Linear and logistic regressions estimated associations of carotid indices with mean BMI and BMI trajectories. RESULTS Compared to the normal weight trajectory, an obesity trajectory was associated with carotid distensibility (β = - 3.078, p = 0.037), cIMT (β = 0.095, p = 0.004), and carotid elastography (β = 0.181, p = 0.004) but not with plaque volume (β = 0.066, p = 0.858). Compared with the normal weight trajectory, an obesity trajectory was associated with increased odds for impaired carotid distensibility (OR = 2.790, p = 0.033), impaired cIMT (OR = 5.277, p = 0.001) and large carotid plaque volume (OR = 8.456, p = 0.013) but not with carotid elastography (OR = 1.956, p = 0.140). Mean BMI was linearly associated with Distensibility (β = - 0.275, p = 0.005) and cIMT (β = 0.005, p = 0.026). CONCLUSIONS Long-term measurements of adiposity are associated with indices of carotid stiffness and plaque volume among older type 2 diabetes adults.
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Affiliation(s)
- Chen Botvin Moshe
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Harimon 9, POB 365, 4295400 Nordia, Israel
| | | | - Ramit Ravona-Springer
- Memory and Geriatric Psychiatry Clinic, Sheba Medical center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Anthony Heymann
- Maccabi Health Services, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Lin Hung-Mo
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Ga, Israel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David Tanne
- Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel
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Posod A, Pechlaner R, Yin X, Burnap SA, Kiechl SJ, Willeit J, Witztum JL, Mayr M, Kiechl S, Kiechl-Kohlendorfer U. Apolipoprotein Profiles in Very Preterm and Term-Born Preschool Children. J Am Heart Assoc 2020; 8:e011199. [PMID: 30968745 PMCID: PMC6507182 DOI: 10.1161/jaha.118.011199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Little is known about plasma apolipoprotein profiles in very preterm‐born and term‐born preschool children compared with the adult population. This is of particular interest because apolipoprotein composition might contribute to cardiometabolic outcome in later life. Methods and Results Children aged 5 to 7 years born at term or with <32 weeks of gestation were included. Apolipoprotein concentrations were measured in plasma collected after an overnight fast using multiple‐reaction monitoring‐based mass spectrometry. Twelve apolipoproteins were measured in 26 former term and 38 former very preterm infants. Key findings were confirmed by assessing apolipoprotein levels using antibody‐based assays. Comparing children born term and preterm, apolipoprotein A‐I, A‐IV, C‐II, and C‐III were significantly higher in the latter group. Term‐born children showed plasma levels of apolipoprotein C‐II and C‐III quantitatively similar to the adult range (Bruneck study). Hierarchical clustering analyses suggested that a higher proportion of apolipoprotein C‐III and C‐II reside on high‐density lipoprotein particles in children than in adults given the marked correlations of apolipoprotein C‐III and C‐II with high‐density lipoprotein cholesterol and apolipoprotein A‐I in children but not adults. High‐density lipoprotein cholesterol concentrations were similar in children and adults but the pattern of high‐density lipoprotein cholesterol–associated apolipoproteins was different (lower apolipoprotein A‐I and C‐I but higher A‐II, A‐IV, and M). Conclusions Our study defines apolipoprotein profiles in preschoolers and reports potential effects of prematurity. Further large‐scale studies are required to provide evidence whether this apolipoprotein signature of prematurity, including high apolipoprotein C‐II and C‐III levels, might translate into adverse cardiometabolic outcome in later life.
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Affiliation(s)
- Anna Posod
- 1 Pediatrics II (Neonatology) Department of Pediatrics Medical University of Innsbruck Austria
| | | | - Xiaoke Yin
- 3 King's British Heart Foundation Centre King's College London London United Kingdom
| | - Sean Anthony Burnap
- 3 King's British Heart Foundation Centre King's College London London United Kingdom
| | | | - Johann Willeit
- 2 Department of Neurology Medical University of Innsbruck Austria
| | | | - Manuel Mayr
- 3 King's British Heart Foundation Centre King's College London London United Kingdom
| | - Stefan Kiechl
- 2 Department of Neurology Medical University of Innsbruck Austria
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Madhloum N, Luyten LJ, Provost EB, De Boever P, Dockx Y, Sleurs H, Plusquin M, Roodt JO, Vrijens K, Nawrot TS. Establishing reference values for macro- and microvascular measurements in 4-to-5 year-old children of the ENVIRONAGE prospective birth cohort. Sci Rep 2020; 10:5107. [PMID: 32198402 PMCID: PMC7083909 DOI: 10.1038/s41598-020-61987-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular risk factors are usually better tolerated, and can therefore be perceived as less harmful, at a young age. However, over time the effects of these adverse factors may persist or accumulate and lead to excess morbidity and mortality from cardiovascular diseases later in life. Until now, reference values for the basic cardiovascular health characteristics of 4-to-6 year-old children are lacking. Within a follow-up study of the ENVIRONAGE (ENVIRonmental influence ON early AGE) birth cohort we assessed various cardiovascular measurements in 288 children aged 4–5 years. For the macrovasculature, we measured their blood pressure and examined the intima-media thickness of the carotid artery (CIMT), the arterial elasticity (including the pulse-wave velocity (PWV), carotid distensibility (DC) and compliance (CC) coefficients), the carotid β stiffness index (SIβ) and Young’s Elastic Modulus (YEM). Retinal microvascular traits included the Central Retinal Arteriolar Equivalent (CRAE) and Central Retinal Venular Equivalent (CRVE). Age of the study population averaged (±SD) 4.2 (±0.4 years. Mean systolic and diastolic blood pressure were 97.9 (±8.1) mmHg and 54.7(±7.6) mmHg, respectively. CIMT for the total population averaged 487.1 (±68.1) µm. The average stiffness values for DC, CC, SIβ, and PWV were 78.7 (±34.2) 10−³/kPa, 1.61 (±0.59) mm2/kPa and 4.4 (±2.4), and 3.7 m/s (±0.9) respectively. The mean determined for YEM was 163.2 kPa (±79.9). Concerning the microvasculature, the average CRAE was 180.9 (±14.2) µm and the corresponding value for CRVE was 251.0 (±19.7) µm. In contrast to the macrovasculature, a significant gender-related difference existed for the microvasculature: in boys, both the CRAE (178.8 µm vs 182.6 µm; p = 0.03) and CRVE (247.9 µm vs 254.0 µm; p = 0.01) were narrower than in girls. We have provided reference values for young children to understand changes in the early cardiovascular health trajectory. Establishing these reference values of cardiovascular phenotypes at this young age is necessary to develop targeted health promotion strategies as well as for better understanding of the life course changes of both small and large blood vessels.
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Affiliation(s)
- Narjes Madhloum
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Leen J Luyten
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Unité de Recherche en Biologie Cellulaire (URBC) - Namur Research Institute for Life Sciences (Narilis), Namur University, Namur, Belgium
| | - Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Yinthe Dockx
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Jos Op't Roodt
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Karen Vrijens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium. .,Department of Public Health & Primary Care, Occupational and Environmental Medicine, Leuven University, Leuven, Belgium.
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11
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López-Bermejo A, Prats-Puig A, Osiniri I, Martínez-Calcerrada JM, Bassols J. Perirenal and epicardial fat and their association with carotid intima-media thickness in children. Ann Pediatr Endocrinol Metab 2019; 24:220-225. [PMID: 31905440 PMCID: PMC6944860 DOI: 10.6065/apem.2019.24.4.220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
Recent data suggest that subclinical atherosclerosis is more related to visceral adipose tissue distribution than to overall fat mass. Both perirenal fat and epicardial fat are visceral fat depots surrounding the kidneys and the myocardium, respectively, which can be easily assessed by ultrasound. Their clinical relevance in children is largely unknown. This review describes studies relating perirenal and epicardial fat to cardiovascular disease or carotid intima-media thickness (cIMT), a well-established surrogate for subclinical atherosclerosis, and discusses this in context with our own data from children. In adults, both perirenal and epicardial fat are useful biological markers of visceral obesity. The former has been related to hypertension in overweight subjects and with atherosclerosis in patients with human immunodeficiency virus. The latter was associated with several metabolic syndrome components and with calcification of the carotid artery. In healthy prepubertal children, both epicardial and perirenal fat thickness, rather than total body fat mass, were related to cIMT. Ultrasonography measures of perirenal and epicardial fat are related to atherosclerosis in adults and may be convenient tools for the assessment of cardiometabolic risk in children.
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Affiliation(s)
- Abel López-Bermejo
- Pediatric Endocrinology, Girona Institute for Biomedical Research, Girona, Spain,Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain,Address for correspondence: Abel López-Bermejo, MD Pediatric Endocrinology, Girona Institute for Biomedical Research, Av. França s/n, 17007 Girona, Spain Tel: +34-972- 940200 (Ext. 2810) Fax: +34-972-940270 E-mail:
| | - Anna Prats-Puig
- Department of Physical Therapy, EUSES University School, University of Girona, Salt, Spain
| | | | | | - Judit Bassols
- Maternal & Fetal Metabolic Research, Girona Institute for Biomedical Research, Salt, Spain
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12
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Zanini JLSS, Rodrigues TMB, Barra CB, Filgueiras MFTF, Silva IN. INTIMA-MEDIA THICKNESS OF THE CAROTID ARTERIES IS AFFECTED BY PUBERTAL MATURATION IN HEALTHY ADOLESCENTS. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2019; 37:428-434. [PMID: 31291443 PMCID: PMC6821474 DOI: 10.1590/1984-0462/;2019;37;4;00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/24/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To contribute to the assessment of normal parameters of carotid intima-media thickness (CIMT) in healthy adolescents. METHODS A cross-sectional study was conducted through clinical, laboratory and ultrasound evaluation in 61 healthy adolescents. The inclusion criteria consisted of being in good health. The exclusion criteria were: presence or history of any chronic disease; being obese or overweight according to the World Health Organization (WHO) established criterion; continuous use of medication; or presenting a febrile condition or requiring medication within 48-hours prior to assessment. The pubertal stages were evaluated using the Tanner criteria. The high-resolution B-mode ultrasound examinations were performed according to the recommendations of the Consensus Statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. RESULTS Adolescents were 14±2.6 years old, 62.3% female, 19 (31%) at early puberty (Tanner II and III), and 38 (62%) at late puberty (Tanner IV and V). They presented normal clinical and laboratorial parameters. CIMT values were 0.46±0.04 to 0.55±0.04 mm on the right and 0.48±0.02 to 0.53±0.04 mm on the left, according to pubertal maturation. CIMT values increased significantly on the right and left sides, according to pubertal stage (p<0.001 and p=0.016), and maximum internal diameters of the common carotid artery (p<0.025 and p<0.003). It was higher in males compared to females. CONCLUSIONS An increase in CIMT in the healthy adolescents group, according to both age, and the degree of pubertal maturation should be considered when evaluating adolescents in diagnostic procedures.
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13
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Sebastiani G, García-Beltran C, Pie S, Guerra A, López-Bermejo A, de Toledo JS, de Zegher F, Rosés F, Ibáñez L. The sequence of prenatal growth restraint and postnatal catch-up growth: normal heart but thicker intima-media and more pre-peritoneal fat in late infancy. Pediatr Obes 2019; 14:e12476. [PMID: 30362284 DOI: 10.1111/ijpo.12476] [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: 07/09/2018] [Revised: 08/17/2018] [Accepted: 08/31/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The sequence of prenatal growth restraint and postnatal catch-up growth leads to a thicker intima-media and more pre-peritoneal fat by age 3-6 years. OBJECTIVES To study whether carotid intima-media thickness (cIMT) and pre-peritoneal fat differ already between catch-up small-for-gestational-age (SGA) infants and appropriate-for-gestational-age (AGA) controls in late infancy (ages 1 and 2 years) and whether such differences - if any - are accompanied by differences in cardiac morphology and function. METHODS Longitudinal assessments included body height and weight; fasting glucose, insulin, Insulin-like growth factor (IGF-I), high-molecular-weight adiponectin; body composition (by absorptiometry); cIMT, aortic IMT, pre-peritoneal fat partitioning (by ultrasound); cardiac morphometry and function (by echocardiography) in AGA and SGA infants at birth, at age 1 year (N = 87), and again at age 2 years (N = 68). RESULTS Catch-up SGA infants had already a thicker cIMT than AGA controls at ages 1 and 2 years, and more pre-peritoneal fat by age 2 years (all p values between <0.01 and <0.0001); all cardiac and endocrine-metabolic results were similar in AGA and SGA infants at ages 1 and 2 years. CONCLUSIONS From late infancy onwards, catch-up SGA infants have a thicker cIMT and more pre-peritoneal fat than AGA controls, but their cardiac morphology and function remain reassuringly similar.
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Affiliation(s)
- G Sebastiani
- Endocrinology Unit, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Esplugues, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Health Institute Carlos III, Madrid, Spain
| | - C García-Beltran
- Endocrinology Unit, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Esplugues, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Health Institute Carlos III, Madrid, Spain
| | - S Pie
- Pediatric Cardiology Department, Hospital Materno-Infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - A Guerra
- Pediatric Cardiology Department, Hospital Materno-Infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - A López-Bermejo
- Department of Pediatrics, Dr. Josep Trueta Hospital, Girona Institute for Biomedical Research, Girona, Spain
| | - J S de Toledo
- Cardiology Department, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Esplugues, Spain
| | - F de Zegher
- Pediatric and Adolescent Endocrinology, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - F Rosés
- Pediatric Cardiology Department, Hospital Materno-Infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.,Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - L Ibáñez
- Endocrinology Unit, Pediatric Research Institute Sant Joan de Déu, University of Barcelona, Esplugues, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Health Institute Carlos III, Madrid, Spain
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14
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Abstract
Blood pressure (BP) tracks from childhood to adulthood, and early BP trajectories predict cardiovascular disease risk later in life. Excess postnatal weight gain is associated with vascular changes early in life. However, to what extent it is associated with children's BP is largely unknown. In 853 healthy 5-year-old children of the Wheezing-Illnesses-Study-Leidsche-Rijn (WHISTLER) birth cohort, systolic (SBP) and diastolic BP (DBP) were measured, and z scores of individual weight gain rates adjusted for length gain rates were calculated using at least two weight and length measurements from birth until 3 months of age. Linear regression analyses were conducted to investigate the association between weight gain rates adjusted for length gain rates and BP adjusted for sex and ethnicity. Each standard deviation increase in weight gain rates adjusted for length gain rates was associated with 0.9 mmHg (95% CI 0.3, 1.5) higher sitting SBP after adjustment for confounders. Particularly in children in the lowest birth size decile, high excess weight gain was associated with higher sitting SBP values compared to children with low weight gain rates adjusted for length gain rates. BMI and visceral adipose tissue partly explained the association between excess weight gain and sitting SBP (β 0.5 mmHg, 95% CI -0.3, 1.3). Weight gain rates adjusted for length gain rates were not associated with supine SBP or DBP. Children with excess weight gain, properly adjusted for length gain, in the first three months of life, particularly those with a small birth size, showed higher sitting systolic BP at the age of 5 years.
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15
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Staiano AE, Beyl RA, Guan W, Hendrick CA, Hsia DS, Newton RL. Home-based exergaming among children with overweight and obesity: a randomized clinical trial. Pediatr Obes 2018; 13:724-733. [PMID: 30027607 PMCID: PMC6203598 DOI: 10.1111/ijpo.12438] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/30/2018] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given children's low levels of physical activity and high prevalence of obesity, there is an urgent need to identify innovative physical activity options. OBJECTIVE This study aims to test the effectiveness of exergaming (video gaming that involves physical activity) to reduce children's adiposity and improve cardiometabolic health. METHODS This randomized controlled trial assigned 46 children with overweight/obesity to a 24-week exergaming or control condition. Intervention participants were provided a gaming console with exergames, a gameplay curriculum (1 h per session, three times a week) and video chat sessions with a fitness coach (telehealth coaching). Control participants were provided the exergames following final clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic health metrics. RESULTS Half of the participants were girls, and 57% were African-American. Intervention adherence was 94.4%, and children's ratings of acceptability and enjoyment were high. The intervention group significantly reduced BMI z-score excluding one control outlier (intervention [standard error] vs. control [standard error]: -0.06 [0.03] vs. 0.03 [0.03], p = 0.016) with a marginal difference in intent-to-treat analysis (-0.06 [0.03] vs. 0.02 [0.03], p = 0.065). Compared with control, the intervention group improved systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein-cholesterol and moderate-to-vigorous physical activity (all p values <0.05). CONCLUSIONS Exergaming at home elicited high adherence and improved children's BMI z-score, cardiometabolic health and physical activity levels. Exergaming with social support may be promoted as an exercise option for children.
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Affiliation(s)
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Win Guan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L. Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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16
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Wilde MAD, Eising JB, Gunning MN, Koster MPH, Evelein AMV, Dalmeijer GW, Uiterwaal CSPM, Eijkemans MJC, Ent CKVD, Meijboom FJ, Fauser BCJM. Cardiovascular and Metabolic Health of 74 Children From Women Previously Diagnosed With Polycystic Ovary Syndrome in Comparison With a Population-Based Reference Cohort. Reprod Sci 2018; 25:1492-1500. [PMID: 29320957 DOI: 10.1177/1933719117749761] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) have compromised cardiovascular health profiles and an increased risk of pregnancy complications. In order to evaluate potential consequences, we aim to compare the cardiovascular and metabolic health of the children from women with PCOS with a population-based reference cohort. We included children from women with PCOS between the age of 2.5 to 4 years (n = 42) and 6 to 8 years (n = 32). The reference groups consisted of 168 (3-4 years old) and 130 children (7-8 years old). In an extensive cardiovascular screening program, we measured anthropometrics and blood pressure (all children), heart function and vascular rigidity (young children), metabolic laboratory assessment and carotid intima thickness (old age-group). Results showed that young PCOS offspring have a significantly lower diastolic blood pressure (β = 2.3 [95% confidence interval, CI: 0.5-4.0]) and higher aortic pulse pressure (β = -1.4 [95% CI: -2.5 to -0.2]), compared to the reference population. Furthermore, a higher left ventricle internal diameter but a lower tissue Doppler imaging of the right wall in systole compared to the reference group was found. Older offspring of women with PCOS presented with a significantly lower breast and abdominal circumference, but higher triglycerides (β = -0.1 [95% CI: -0.2 to -0.1]), LDL-cholesterol (β = -0.4 [95% CI: -0.6 to -0.1]), and higher carotid intima-media thickness (β = -31.7 [95% CI: -46.6 to -16.9]) compared to the reference group. In conclusion, we observe subtle but distinct cardiovascular and metabolic abnormalities already at an early age in PCOS offspring compared to a population-based reference group, despite a lower diastolic blood pressure, breast, and abdominal circumference. These preliminary findings require confirmation in independent data sets.
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Affiliation(s)
- Marlieke A de Wilde
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jacobien B Eising
- 2 Department of Paediatric Pulmonology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlise N Gunning
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maria P H Koster
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annemieke M V Evelein
- 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geertje W Dalmeijer
- 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- 2 Department of Paediatric Pulmonology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert J Meijboom
- 4 Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bart C J M Fauser
- 1 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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17
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Perirenal fat is related to carotid intima-media thickness in children. Int J Obes (Lond) 2017; 42:641-647. [PMID: 29064476 DOI: 10.1038/ijo.2017.236] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/30/2017] [Accepted: 09/17/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES It is well known that increased abdominal fat is associated with cardiovascular (CV) risk. Perirenal fat has been recently associated with CV risk in adults. However, studies with children are lacking. We investigated the relationship of perirenal fat and other abdominal fat depots (including preperitoneal, intra-abdominal and subcutaneous fat) with carotid intima-media thickness (cIMT-a surrogate marker of CV risk) in prepubertal children, so as to identify novel markers that can be easily assessed and used in the early prevention of cardiovascular disease. SUBJECTS/METHODS Subjects were 702 asymptomatic prepubertal Caucasian children (418 lean, 142 overweight and 142 obese) who were recruited in a primary care setting. Ultrasound measurements (perirenal, preperitoneal, intra-abdominal and subcutaneous fat and cIMT), clinical (body mass index (BMI) and systolic blood pressure) and metabolic parameters (insulin resistance (HOMA-IR), high molecular weight (HMW) adiponectin and serum lipids) were assessed. RESULTS Perirenal fat was associated with diverse metabolic and CV risk factors in all the studied subjects. However, in overweight and obese children, perirenal fat was mostly associated with cIMT (P<0.001) and was the only fat depot that showed independent associations with cIMT in multivariate analyses (overweight chidren: β=0.250, P=0.003, r2=12.8%; obese children: β=0.254, P=0.002, r2=15.5%) after adjusting for BMI, gender, age and metabolic parameters. Perirenal fat was also the only fat depot that showed independent associations with HMW-adiponectin in obese children (β=-0.263, P=0.006, r2=22.8%). CONCLUSIONS Perirenal fat is the main abdominal fat depot associated with cIMT, especially in overweight and obese children, and may thus represent a helpful parameter for assessing CV risk in the pediatric population.
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Affiliation(s)
- Leonardo Roever
- 1 Department of Clinical Research, Federal University of Uberlândia, Brazil
| | - João L O'Connell
- 2 Department of Cardiology, Federal University of Uberlândia, Brazil
| | - Antonio Cp Chagas
- 3 Heart Institute (InCor), HCFMUSP, University of São Paulo Medical School, Brazil.,4 Department of Cardiology, Faculty of Medicine ABC, Brazil
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Jansen MAC, Dalmeijer GW, Visseren FLJ, van der Ent CK, Leusink M, Onland-Moret NC, Maitland-van der Zee AH, Grobbee DE, Uiterwaal CSPM. Adult derived genetic blood pressure scores and blood pressure measured in different body postures in young children. Eur J Prev Cardiol 2016; 24:320-327. [DOI: 10.1177/2047487316679526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Maria AC Jansen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Geertje W Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Frank LJ Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, the Netherlands
| | - Maarten Leusink
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, the Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Cuno SPM Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
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20
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Daan NMP, Koster MPH, de Wilde MA, Dalmeijer GW, Evelein AMV, Fauser BCJM, de Jager W. Biomarker Profiles in Women with PCOS and PCOS Offspring; A Pilot Study. PLoS One 2016; 11:e0165033. [PMID: 27806063 PMCID: PMC5091782 DOI: 10.1371/journal.pone.0165033] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To study metabolic/inflammatory biomarker risk profiles in women with PCOS and PCOS offspring. Design Cross-sectional comparison of serum biomarkers. Setting University Medical Center Utrecht. Patients Hyperandrogenic PCOS women (HA-PCOS, n = 34), normoandrogenic PCOS women (NA-PCOS, n = 34), non-PCOS reference population (n = 32), PCOS offspring (n = 14, age 6–8 years), and a paedriatic reference population (n = 30). Main Outcome Measure(s) Clustering profile of adipocytokines (IL-1b, IL-6, IL-13, IL-17, IL-18, TNF-α, adiponectin, adipsin, leptin, chemerin, resistin, RBP4, DPP-IV/sCD26, CCL2/MCP-1), growth factors (PIGF, VEGF, sVEGF-R1), soluble cell adhesion molecules (sICAM-1/sCD54, sVCAM-1/sCD106), and other inflammatory related proteases (MMP-9, S100A8, Cathepsin S). Differences in median biomarker concentrations between groups, and associations with the free androgen index (FAI; Testosterone/SHBG x100). Results The cluster analysis identified leptin, RBP-4, DPP-IV and adiponectin as potential discriminative markers for HA-PCOS with a specifically strong correlation in cases with increased BMI. Leptin (R2 = 0.219) and adiponectin (R2 = 0.182) showed the strongest correlation with the FAI. When comparing median protein concentrations adult PCOS women with or without hyperandrogenemia, the most profound differences were observed for leptin (P < 0.001), DPP-IV (P = 0.005), and adiponectin (P < 0.001). Adjusting for age, BMI and multiple testing attenuated all differences. In PCOS offspring, MMP-9 (P = 0.001) and S100A8 (P < 0.001) concentrations were significantly higher compared to a healthy matched reference population, even after correcting for age and BMI and adjustment for multiple testing. Conclusion In this preliminary investigation we observed significant differences in adipocytokines between women with or without hyperandrogenic PCOS and non-PCOS controls, mostly influenced by BMI. Leptin and adiponectin showed the strongest correlation with the FAI in adult women with PCOS. In PCOS offspring other inflammatory biomarkers (MMP-9, S100A8) were increased, suggesting that these children may exhibit increased chronic low-grade inflammation. Additional research is required to confirm results of the current exploratory investigation.
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Affiliation(s)
- Nadine M. P. Daan
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Maria P. H. Koster
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marlieke A. de Wilde
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerdien W. Dalmeijer
- Julius Centre for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke M. V. Evelein
- Julius Centre for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart C. J. M. Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilco de Jager
- Laboratory of Translational Immunology, Division of Pediatrics, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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22
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Sebastiani G, Díaz M, Bassols J, Aragonés G, López-Bermejo A, de Zegher F, Ibáñez L. The sequence of prenatal growth restraint and post-natal catch-up growth leads to a thicker intima-media and more pre-peritoneal and hepatic fat by age 3-6 years. Pediatr Obes 2016; 11:251-7. [PMID: 26132470 DOI: 10.1111/ijpo.12053] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/04/2015] [Accepted: 05/29/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Infants born small-for-gestational-age (SGA) who develop post-natal weight catch-up are at risk for insulin resistance, central adiposity and cardiovascular disease in later life, even in the absence of overweight. OBJECTIVE In young (age 3-6 years) non-obese SGA children, we assessed arterial health (as judged by intima-media thickness [IMT]) and abdominal fat distribution (subcutaneous, visceral, preperitoneal and hepatic components by magnetic resonance imaging [MRI] and/or ultrasound [US]) besides a selection of endocrine markers. METHODS Comparisons of measures in SGA (n = 27) vs. appropriate-for-GA (AGA) children (n = 19) of similar height, weight and body mass index. Longitudinal outcomes (age 3-6 years) were carotid IMT (cIMT); fasting glucose, circulating insulin, IGF-I and high-molecular-weight (HMW) adiponectin; abdominal fat partitioning by US. Cross-sectional outcomes (age 6 years) were aortic IMT (aIMT) and abdominal fat partitioning by MRI. RESULTS At 3 and 6 years, cIMT and IGF-I results were higher and HMW adiponectin lower in SGA than AGA children; at 6 years, SGA subjects had also a thicker aIMT and more pre-peritoneal and hepatic fat, and were less insulin sensitive (all P values between <0.05 and <0.0001). cIMT correlated positively with pre-peritoneal fat, particularly at 6 years. Post-SGA status and weight gain in early childhood (between 3 and 6 years) were independent predictors of cIMT at 6 years, explaining 48 % of its variance. CONCLUSION SGA children aged 3-6 years were found to have a thicker intima- media and more pre-peritoneal and hepatic fat than AGA children of comparable size.
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Affiliation(s)
- G Sebastiani
- Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - M Díaz
- Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - J Bassols
- Department of Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
| | - G Aragonés
- Grupo de Estudio de Enfermedades Metabólicas Asociadas a Resistencia a la Insulina (GEMMAIR), Department of Medicine and Surgery, Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - A López-Bermejo
- Department of Pediatrics, Dr. Josep Trueta Hospital, Girona, Spain
| | - F de Zegher
- Pediatric Endocrinology, University of Leuven, Leuven, Belgium
| | - L Ibáñez
- Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
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23
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Melo X, Santa-Clara H, Santos DA, Pimenta NM, Pinto R, Minderico CS, Fernhall B, Sardinha LB. Single and combined effects of body composition phenotypes on carotid intima-media thickness. Pediatr Obes 2016. [PMID: 26199046 DOI: 10.1111/ijpo.12056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Central fatness might be a more sensitive predictor of atherosclerotic changes in children than are total body fat measures. However, it is unclear whether a total body fat measure coupled with an estimate of a more central pattern of fat accumulation predicts increased carotid intima-media-thickness (cIMT) better than either measure alone. OBJECTIVE The objective of the study is to identify the ability of a combination of simple anthropometric screening tools or a combination of objective measures of body composition to predict cIMT. METHODS cIMT was assessed on the common carotid artery in 349 children aged 11-12 years old (183 girls). Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) were dichotomized according to established criteria and indices of total body (TBFI) and abdominal (ABFMI) fat were assessed by dual-energy X-ray absorptiometry and categorized (increased risk ≥85%). Single and combined associations among anthropometric and laboratorial measures with the risk of having increased cIMT (≥85%) and discriminatory performance were tested with logistic regression analysis and Receiver Operator Curve analysis. RESULTS Children with higher total fatness (BMI and TBFI) or higher central pattern of fat accumulation (WC, WHtR and BFMI) were in higher risk for increased cIMT [odds ratio (OR): 2.08-3.24). The risk for increased cIMT was not higher among children who coupled high total and high central fatness (OR: 2.27-3.10). CONCLUSIONS Combination of total and central measures of fat does not improve the prediction of increased cIMT in children. Simple surrogate measures of fatness can be used to predict increased cIMT urging special attention to those children who exhibit increased abdominal fat.
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Affiliation(s)
- X Melo
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - H Santa-Clara
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - D A Santos
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - N M Pimenta
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Health and Fitness, Sport Sciences School of Rio Maior - Polytechnic Institute of Santarem, Rio Maior, Portugal
| | - R Pinto
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - C S Minderico
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - B Fernhall
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - L B Sardinha
- Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
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24
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Engelen L, Bossuyt J, Ferreira I, van Bortel LM, Reesink KD, Segers P, Stehouwer CD, Laurent S, Boutouyrie P. Reference values for local arterial stiffness. Part A: carotid artery. J Hypertens 2016; 33:1981-96. [PMID: 26431185 DOI: 10.1097/hjh.0000000000000654] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Non-invasive measures of common carotid artery properties, such as diameter and distension, and pulse pressure, have been widely used to determine carotid artery distensibility coefficient - a measure of carotid stiffness (stiffness ∼1/distensibility coefficient). Carotid stiffness has been associated with incident cardiovascular disease (CVD) and may therefore be a useful intermediate marker for CVD. We aimed to establish age and sex-specific reference intervals of carotid stiffness. METHODS We combined data on 22 708 individuals (age range 15-99 years, 54% men) from 24 research centres worldwide. Individuals without CVD and established cardiovascular risk factors constituted a healthy sub-population (n = 3601, 48% men) and were used to establish sex-specific equations for percentiles of carotid distensibility coefficient across age. RESULTS In the sub-population without CVD and treatment (n = 12 906, 52% men), carotid distensibility coefficient Z-scores based on these percentile equations were independently and negatively associated, in men and women, respectively, with diabetes {-0.28 [95% confidence interval (CI) -0.41; -0.15] and -0.27 (-0.43; -0.12)}, mean arterial pressure [-0.26 (-0.29; -0.24) and -0.32 (-0.35; -0.29)], total-to-high-density lipoprotein cholesterol ratio [-0.05 (-0.09; -0.02) and -0.05 (-0.11; 0.01)] and BMI [-0.06 (-0.09; -0.04) and -0.05 (-0.08; -0.02)], whereas these were positively associated with smoking [0.30 (0.24; 0.36) and 0.24 (0.18; 0.31)]. CONCLUSIONS We estimated age and sex-specific percentiles of carotid stiffness in a healthy population and assessed the association between cardiovascular risk factors and carotid distensibility coefficient Z-scores, which enables comparison of carotid stiffness values between (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures.
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Affiliation(s)
- Lian Engelen
- aDepartment of Internal Medicine bCARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht cTop Institute Food and Nutrition, Wageningen, the Netherlands dHeymans Institute of Pharmacology, Research Unit of Clinical Pharmacology, Ghent University, Ghent, Belgium eDepartment of Clinical Epidemiology and Medical Technology Assessment (KEMTA) fDepartment of Biomedical Engineering, Maastricht University Medical Centre, Maastricht, the Netherlands gInstitute Biomedical Technology, iMinds Medical IT, Ghent University, Ghent, Belgium hDepartment of Pharmacology and INSERM U970, Hôpital Européen Georges Pompidou, Paris, France *A complete author list is included in the Appendix (Table A1, http://links.lww.com/HJH/A498)
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25
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Qanitha A, de Mol BA, Pabittei DR, Mappangara I, van der Graaf Y, Dalmeijer GW, Burgner DP, Uiterwaal CS. Infections in early life and premature acute coronary syndrome: A case-control study. Eur J Prev Cardiol 2016; 23:1640-8. [PMID: 27006417 DOI: 10.1177/2047487316640656] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infections in young children may affect the vasculature and initiate early atherosclerosis. Whether infections experienced in childhood play a part in adult clinical cardiovascular disease remains unclear. We investigated the association between infections in early life and the occurrence of premature coronary heart disease. METHODS We conducted a population-based case-control study of 153 patients with a first acute coronary syndrome before the age of 56 years and 153 age- and sex-matched controls. Any history of severe infections in childhood and adolescence was obtained, together with clinical and laboratory measurements and other cardiovascular risk factors. We developed an infection score for the overall burden of early life infections. Conditional logistic regression was used to assess the associations. RESULTS Infections experienced in early life increased the risk of acquiring acute coronary syndrome at a young age with an odds ratio (OR) of 2.67 (95% confidence interval (CI) 1.47-4.83, p = 0.001). After adjustments for traditional risk factors, lifestyle, dietary patterns, socio-economic status and parental history of cardiovascular events, these associations remained significant and changed only slightly. There was an indication for an interaction between infections in early life and current cardiovascular risk (Framingham Risk Score (FRS); p-interaction = 0.052). Within participants with a low FRS (<10%), the OR of early life infection for acute coronary syndrome was 1.49 (95% CI 0.72-3.08, p = 0.283); within participants with an intermediate FRS (10-20%), the OR was 4.35 (95% CI 1.60-11.84, p = 0.004); and within participants with a high FRS (>20%), the OR 10.00 (95% CI 1.21-82.51, p = 0.032). CONCLUSION Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus Ajm de Mol
- Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Dara R Pabittei
- Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Idar Mappangara
- Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Yolanda van der Graaf
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - Geertje W Dalmeijer
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - David P Burgner
- Department of Paediatrics, University of Melbourne, Australia
| | - Cuno Spm Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
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26
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Idris NS, Grobbee DE, Burgner D, Cheung MMH, Kurniati N, Uiterwaal CSPM. Effects of paediatric HIV infection on childhood vasculature. Eur Heart J 2016; 37:3610-3616. [PMID: 26746627 DOI: 10.1093/eurheartj/ehv702] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/24/2015] [Accepted: 12/01/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Human immunodeficiency virus (HIV) infection may alter childhood vascular properties and influence future cardiovascular risk. Whether vascular changes are associated with HIV infection per se or antiretroviral therapy (ART) is unknown. We investigated the effects of ART-naive or ART-exposed HIV infection in children on childhood vascular characteristics. METHODS AND RESULTS We performed vascular ultrasound to measure carotid intima media thickness (cIMT), distensibility, and elastic modulus on 114 children with vertically acquired HIV infection (56 ART-naive, 58 ART treated) and 51 healthy children in Jakarta, Indonesia. Children also underwent clinical and blood examinations. We used general linear modelling to estimate associations between HIV infection/treatment status and vascular characteristics with adjustment for confounders or possible mediators. Vascular measurements were successful in 42 ART-naive HIV-infected [median age 4.0 years (min 0.4-max 11.5)]; 53 ART-treated HIV infected [5.7 years (0.6-12.2), median ART duration 2.4 years (0.1-9.9)]; and 48 healthy children, 6.5 years (2.4-14.0). The ART-naive HIV infected had thicker cIMT (difference 70.4 µm, 95% CI 32.1-108.7, P < 0.001), adjusted for age, sex, socioeconomic status, parental smoking, body mass index, systolic and diastolic blood pressure, LDL cholesterol, and HbA1c. Addition of high-sensitivity C-reactive protein (hs-CRP) level to the model did not affect the results (71.6 µm, 31.9-111.2, P = 0.001). The ART-exposed children had similar cIMT dimensions to healthy children. Distensibility was not significantly different between HIV infected, either ART-naive or -exposed, and healthy children, but adjusted analysis including only ART-exposed children with controlled HIV (CD4+ ≥200/mm3 or CD4+ ≥15%) showed that the ART-exposed had an increased elastic modulus (difference 37.9 kPa, 95% CI 6.5-69.3, P = 0.02), and following adjustment for hs-CRP (35.5 kPa, 95% CI 4.2-66.8, P = 0.03). CONCLUSION ART-naive HIV infection in children is associated with increased cIMT. Children with ART-controlled HIV may have increased arterial stiffness, although further confirmation is required.
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Affiliation(s)
- Nikmah S Idris
- Department of Child Health, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia .,Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands.,Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Diederick E Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands
| | - David Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Michael M H Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Nia Kurniati
- Department of Child Health, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo National General Hospital, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia.,Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, The University Medical Centre Utrecht, Utrecht, The Netherlands
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27
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Eikendal ALM, Evelein AMV, Uiterwaal CSPM, van der Ent CK, Visseren FLJ, Bots ML, Hoefer IE, den Ruijter HM, Dalmeijer GW. Relation Between Circulating Inflammatory Chemokines and Vascular Characteristics in Healthy, Young Children. J Am Heart Assoc 2015; 4:e002346. [PMID: 26675251 PMCID: PMC4845277 DOI: 10.1161/jaha.115.002346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/07/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Atherosclerosis begins in childhood with the occurrence of inflammatory vascular wall alterations that are detectable with B-mode ultrasound. Chemokines appear to be involved in the development of these alterations given that they occur early in the atherosclerotic pathway as mediators of vascular inflammation. However, this has not extensively been investigated. Therefore, we studied in healthy young children whether chemokines monocyte chemotactic protein 1 (MCP-1), regulated on activation normal T-cell expressed and secreted (RANTES), and vascular and intercellular adhesion molecules (VCAM and ICAM) related to vascular characteristics of the carotid artery. METHODS AND RESULTS We obtained demography, anthropometry, and overnight fasting plasma of 139 eight-year-old children of the Wheezing Illnesses Study Leidsche Rijn birth cohort. Carotid intima-media thickness (CIMT), distensibility, and Young's Elastic Modulus (YEM) of the common carotid artery were measured sonographically. Chemokine plasma levels were assessed using a multiplex assay. We studied the relation between the chemokines and vascular characteristics using multivariable linear regression analyses with adjustments for sex, systolic blood pressure, homeostasis model assessment of insulin resistance, triglycerides, low-density lipoprotein- and high-density lipoprotein-cholesterol. Of the studied chemokines, RANTES related to common carotid distensibility and YEM. One standard deviation increase in RANTES level related to a 5.45-MPA(-1) (95% confidence interval [CI], -9.43, -1.39; P=0.01) decrease in distensibility and to a 5.55-kPa increase in YEM (95% CI, 0.40, 10.85; P=0.03). RANTES did not relate to CIMT. MCP-1, VCAM, and ICAM did not relate to any of the studied vascular characteristics. CONCLUSION RANTES appears to be involved in the development of preatherosclerotic inflammatory vascular alterations already in healthy, young children. This may provide further insight into the early-life origins of atherosclerosis.
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Affiliation(s)
| | - Annemieke M. V. Evelein
- Department of PediatricsWilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Cornelis K. van der Ent
- Department of PediatricsWilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Frank L. J. Visseren
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Imo E. Hoefer
- Laboratory of Experimental CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Hester M. den Ruijter
- Laboratory of Experimental CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Geertje W. Dalmeijer
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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28
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Gao Z, Khoury PR, McCoy CE, Shah AS, Kimball TR, Dolan LM, Urbina EM. Adiposity has no direct effect on carotid intima-media thickness in adolescents and young adults: Use of structural equation modeling to elucidate indirect & direct pathways. Atherosclerosis 2015; 246:29-35. [PMID: 26752690 DOI: 10.1016/j.atherosclerosis.2015.11.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/04/2015] [Accepted: 11/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carotid intima-media thickness (cIMT) is associated with CV events in adults. Thicker cIMT is found in youth with CV risk factors including obesity. Which risk factors have the most effect upon cIMT in youth and whether obesity has direct or indirect effects is not known. We used structural equation modeling to elucidate direct and indirect pathways through which obesity and other risk factors were associated with cIMT. METHODS We collected demographics, anthropometrics and laboratory data on 784 subjects age 10-24 years (mean 18.0 ± 3.3 years). Common, bulb and internal carotid cIMT were measured by ultrasound. Multivariable regression analysis was performed to assess independent determinants of cIMT. Analyses were repeated with structural equation modeling to determine direct and indirect effects. RESULTS Multivariable regression models explained 11%-22% of variation of cIMT. Age, sex and systolic blood pressure (BP) z-score were significant determinants of all cIMT segments. Body mass index (BMI) z-score, race, presence of type 2 diabetes mellitus (T2DM), hemoglobin A1c (HbA1c) and non-HDL were significant for some segments (all p = 0.05). The largest direct effect on cIMT was age (0.312) followed by BP (0.228), Blood glucose control (0.108) and non-HDL (0.134). BMI only had a significant indirect effect through blood glucose control, BP & non-HDL. High sensitivity C-reactive protein (CRP) had a small indirect effect through blood glucose control (all p = 0.05). CONCLUSIONS Age and BP are the major factors with direct effect on cIMT. Glucose and non-HDL were also important in this cohort with a high prevalence of T2DM. BMI only has indirect effects, through other risk factors. Traditional CV risk factors have important direct effects on cIMT in the young, but adiposity exerts its influence only through other CV risk factors.
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Affiliation(s)
- Zhiqian Gao
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Philip R Khoury
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Connie E McCoy
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Amy S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Thomas R Kimball
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Lawrence M Dolan
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA.
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29
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Park MH, Skow Á, De Matteis S, Kessel AS, Saxena S, Viner RM, Kinra S. Adiposity and carotid-intima media thickness in children and adolescents: a systematic review. BMC Pediatr 2015; 15:161. [PMID: 26475608 PMCID: PMC4609088 DOI: 10.1186/s12887-015-0478-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/06/2015] [Indexed: 12/12/2022] Open
Abstract
Background Adiposity in childhood is associated with later cardiovascular disease (CVD), but it is unclear whether this relationship is independent of other risk factors experienced in later life, such as smoking and hypertension. Carotid-intima media thickness (cIMT) is a measure of subclinical atherosclerosis that may be used to assess CVD risk in young people. The aim of this study was to examine the relationship between adiposity and cIMT in children and adolescents. Methods We searched Medline, Embase, Global Health, and CINAHL Plus electronic databases (1980–2014). Population-based observational studies that reported a measure of association between objectively-measured adiposity and cIMT in childhood were included in this review. Results Twenty-two cross-sectional studies were included (n = 7,366 children and adolescents). Thirteen of nineteen studies conducted in adolescent populations (mean age ≥12 years, n = 5,986) reported positive associations between cIMT and adiposity measures (correlation coefficients 0.13 to 0.59). Three studies of pre-adolescent populations (n = 1,380) reported mixed evidence, two studies finding no evidence of a correlation, and one an inverse relationship between skinfolds and cIMT. Included studies did not report an adiposity threshold for subclinical atherosclerosis. Conclusions Based on studies conducted mostly in Western Europe and the US, adiposity does not appear to be associated with cIMT in pre-adolescents, but may be associated in adolescents. If further studies confirm these findings, a focus on cardiovascular disease prevention efforts in pre-adolescence, before arterial changes have emerged, may be justified. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0478-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Hae Park
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Áine Skow
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sara De Matteis
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Department of Respiratory Epidemiology, Occupational Medicine and Public Health, NHLI, Imperial College London, London, UK.
| | - Anthony S Kessel
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK.
| | - Russell M Viner
- Department of General and Adolescent Paediatrics, Institute of Child Health, University College London, London, UK.
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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30
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Devlin AM, Panagiotopoulos C. Metabolic side effects and pharmacogenetics of second-generation antipsychotics in children. Pharmacogenomics 2015; 16:981-96. [DOI: 10.2217/pgs.15.55] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Second-generation antipsychotics (SGAs) are increasingly being used to treat children for a range of mental health conditions, for example, anxiety disorder, attention deficit hyperactivity disorder and bipolar disorder. SGA treatment is associated with weight gain and cardiometabolic side effects such as dyslipidemia, insulin resistance and elevated blood pressure, in some, but not all children. This review provides an overview of the potential role of pharmacogenomics in predisposing a child to unhealthy weight gain and cardiometabolic side effects with SGA treatment. Specifically, the review includes a synopsis of the evidence for cardiometabolic side effects in SGA-treated children, illustrating the extent and depth of the problem; summarizes the potential long-term consequences of developing cardiometabolic risk during childhood and highlights genetic variants that may be useful in predicting cardiometabolic side effects in SGA-treated children.
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Affiliation(s)
- Angela M Devlin
- Department of Pediatrics, University of British Columbia, Child & Family Research Institute, 272–950 West 28th Avenue, Vancouver, V5Z 4H4, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, University of British Columbia, Child & Family Research Institute, 272–950 West 28th Avenue, Vancouver, V5Z 4H4, Canada
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31
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Evelein AMV, Visseren FLJ, van der Ent CK, Grobbee DE, Uiterwaal CSPM. Allergies are associated with arterial changes in young children. Eur J Prev Cardiol 2014; 22:1480-7. [PMID: 25301873 DOI: 10.1177/2047487314554863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inflammation is important in atherosclerosis development. Whether common causes of inflammation, such as allergies and infections, already exert this influence in early childhood is unknown. The objective of this study was to investigate the association between both allergies and infections with children's vasculature. DESIGN This was a longitudinal study in a general population cohort. METHODS In 390 five-year-olds of the WHISTLER (Wheezing-Illnesses-Study-LEidsche-Rijn) birth cohort, carotid intima-media thickness (CIMT) and arterial stiffness were obtained ultrasonographically. Physician-diagnosed allergies and infections and recent prescriptions of systemic antihistamines and antibiotics were obtained, as well as parental history of allergies. General linear regression was performed with vascular characteristics as dependent variables and measures of inflammation as independent variables. RESULTS Having both a positive parental history of allergy and an allergy diagnosis showed 15.0 µm (95% confidence interval (CI): 2.3-27.8, p = 0.02) larger CIMT than not having such history and diagnosis. Having a positive parental history of allergy only showed 11.9 µm (0.87-23.0, p = 0.04) larger CIMT. Recent use of antihistamines and antibiotics showed 18.8 µm (1.6-35.9, p = 0.03) and 16.1 µm (4.5-27.7, p = 0.01) larger CIMT, respectively. Childhood infections were not clearly related to vascular parameters. Neither allergy nor infections were associated with arterial stiffness. CONCLUSION An allergic predisposition is already associated with thicker arterial walls in early childhood.
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Affiliation(s)
- Annemieke M V Evelein
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
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Canepa M, AlGhatrif M, Pestelli G, Kankaria R, Makrogiannis S, Strait JB, Brunelli C, Lakatta EG, Ferrucci L. Impact of central obesity on the estimation of carotid-femoral pulse wave velocity. Am J Hypertens 2014; 27:1209-17. [PMID: 24637912 DOI: 10.1093/ajh/hpu038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies have found that central obesity is associated with higher carotid-femoral pulse wave velocity (PWV). However, traveled distance (TD) measured over the body surface can be substantially overestimated with wider waist circumference (WC). We sought to investigate whether central obesity biases the estimation of PWV and whether this bias explains the association between PWV and different measures of adiposity. METHODS Seven hundred eleven participants (49.5% men) from the Baltimore Longitudinal Study of Aging with PWV, anthropometrics, and quantification of different fat depots by computed tomography and dual x-ray absorptiometry were included. TD and relative PWV were estimated with a tape measure over the body surface or linear distances taken from radiological images, unaffected by obesity. RESULTS A significant association was found between wider WC and a greater difference between the 2 TD measurements and their respective PWV in both sexes (r ≥ 0.34; P < 0.001). This overestimation bias appeared to be generally higher in women than men (0.27 m/sec for each unit increase in WC; P < 0.0001). When TD estimated over the body surface was used to calculate PWV, greater WC, total body fat, subcutaneous fat, and visceral fat were all associated with higher PWV (P < 0.05 for all). However, when PWV was calculated using TD estimated from radiological images or body height, only the association with visceral fat held significant. CONCLUSIONS When TD is measured over the body surface, the role of obesity on PWV is substantially overestimated. After accounting for this bias, PWV was still independently associated with visceral fat but not with other measures of adiposity, confirming its contribution to arterial stiffening.
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Affiliation(s)
| | - Majd AlGhatrif
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Gabriele Pestelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Rohan Kankaria
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - Sokratis Makrogiannis
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - James B Strait
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - Claudio Brunelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Edward G Lakatta
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
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Eikendal ALM, den Ruijter HM, Uiterwaal CSPM, Pasterkamp G, Hoefer IE, de Kleijn DPV, Schoneveld AH, Leiner T, Bots ML, Visseren FLJ, Evelein AMV. Extracellular vesicle protein CD14 relates to common carotid intima-media thickness in eight-year-old children. Atherosclerosis 2014; 236:270-6. [PMID: 25108076 DOI: 10.1016/j.atherosclerosis.2014.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Atherosclerosis is a process that begins in childhood, develops over decades and underlies the majority of cardiovascular events in adulthood. Previously, we demonstrated in adults with cardiovascular disease that levels of extracellular vesicle (EV) proteins CD14, Serpin F2 and cystatin C predict vascular outcome. Here, we study for the first time whether these EV proteins are related to vascular characteristics in healthy, young children. METHODS AND RESULTS In 141 eight-year old children of the Wheezing-Illnesses-Studie-LEidsche-Rijn birth cohort, anthropometrics and blood pressure were measured. In addition, common carotid intima-media thickness, carotid distensibility and carotid Young's elastic modulus were obtained non-invasively using ultrasound imaging. A fasting lipid spectrum was obtained and EVs were isolated from plasma. Levels of EV proteins CD14, Serpin F2 and cystatin C were measured using a multiplex assay. In a multivariable linear regression model we assessed the relation between these EV proteins and the selected vascular characteristics. Of the studied EV proteins, CD14 levels were positively related to common carotid intima-media thickness (log transformed, beta = 7.31 ln(mm)/(ng/mg) (1.24, 13.38), p = 0.02). EV proteins Serpin F2 and cystatin C were not related to common carotid intima-media thickness. In addition, we found no relation between all three EV proteins and carotid distensibility or carotid Young's elastic modulus. CONCLUSION In healthy eight-year old children, extracellular vesicle protein CD14 levels seem positively related to common carotid intima-media thickness. This would point towards inflammatory vascular alterations inflicted by extracellular vesicle protein CD14 already in early life and warrants further investigation.
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Affiliation(s)
- Anouk L M Eikendal
- Department of Radiology, E.01.132, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Hester M den Ruijter
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands; Laboratory of Experimental Cardiology, G02.523, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, G02.523, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Imo E Hoefer
- Laboratory of Experimental Cardiology, G02.523, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Dominique P V de Kleijn
- Laboratory of Experimental Cardiology, G02.523, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Department of Surgery, National University Singapore & Cardiovascular Research Institute, National University Health System, Singapore.
| | - Arjan H Schoneveld
- Laboratory of Experimental Cardiology, G02.523, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Tim Leiner
- Department of Radiology, E.01.132, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Frank L J Visseren
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands; Department of Internal Medicine, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Annemieke M V Evelein
- Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
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Melo X, Santa-Clara H, Pimenta NM, Carrolo M, Martins SS, Minderico CS, Fernhall B, Sardinha LB. Body composition phenotypes and carotid intima-media thickness in 11-13-year-old children. Eur J Pediatr 2014; 173:345-52. [PMID: 24096519 DOI: 10.1007/s00431-013-2164-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 09/16/2013] [Accepted: 09/20/2013] [Indexed: 12/18/2022]
Abstract
UNLABELLED Early detection of impairment in vascular structure is an important clinical pursuit. However, it is unknown which measure of body composition best predicts vascular wall changes. We assess the differences in body composition among intima-media thickness (IMT) tertiles and determined which measures of body composition are associated with IMT in 385 children aged 11-13 years (196 girls). In this cross-sectional study, body mass index (BMI), waist circumference (WC), body fat mass (BFM), and trunk fat mass (TFM) from dual-energy radiographic absorptiometry and IMT through high-resolution ultrasonography were collected. Differences in body composition measures among IMT tertiles [low IMT (LIMT), ≤ 0.46 mm; middle IMT, 0.46-0.53 mm; higher IMT (HIMT), ≥0.53 mm] were assessed with ANOVA/ANCOVA after categorization. Regression analysis was used to assess the relationships between body composition and IMT. The groups were similar for sex, age, and maturity (p > 0.05). As compared with LIMT group, subjects with HIMT had higher mean values of BMI, BFM, TFM, and WC (p < 0.05). Significant differences were found for WC even when controlling for BMI (p < 0.05). Combining all subjects, IMT was significantly correlated to BMI, BFM, TFM, and WC (p < 0.05). In multiple regression, WC was the only predictor of IMT (β = 0.22, p < 0.001). CONCLUSION Differences exist in body composition variables among IMT tertiles. In the overall model, WC was the only obesity-related predictor of increased IMT in 11-13-year-old children.
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Affiliation(s)
- Xavier Melo
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Lisbon, Portugal,
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Dratva J, Breton CV, Hodis HN, Mack WJ, Salam MT, Zemp E, Gilliland F, Kuenzli N, Avol E. Birth weight and carotid artery intima-media thickness. J Pediatr 2013; 162:906-11.e1-2. [PMID: 23260106 PMCID: PMC4030536 DOI: 10.1016/j.jpeds.2012.10.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/25/2012] [Accepted: 10/31/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To determine the association between birth weight and carotid artery intima-media thickness (CIMT), a measure of atherogenesis, in a population of 11-year-old children. STUDY DESIGN CIMT measured by high-resolution ultrasound, and birth registry data were available for 670 children of the Southern California Children's Health Study. Multivariate regression analyses were performed to investigate the association between birth weight and CIMT, with adjustment for child's health status and lifestyle, pregnancy information, and parental health. RESULTS Mean CIMT was 0.57 mm (SD 0.04). We found a nonlinear association between birth weight and CIMT, with an increase in CIMT of 0.014 mm in the fifth (P value .01) compared with the third birth weight quintile. These associations were robust in subsample analyses in children considered normal-weight by gestational age or in term-born children. No significant association with CIMT was found for the lowest quintile. CONCLUSIONS Greater birth weight was significantly associated with increased CIMT at age 11 years. No evidence for an impact of lower birth weight was found. The predictive value of childhood CIMT on future cardiovascular outcomes is largely unknown, but strong associations between childhood cardiovascular disease risk factors and adult vascular disease suggest that increased CIMT in childhood may be clinically important.
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Affiliation(s)
- Julia Dratva
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Carrie V. Breton
- Division of Environmental Health, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Howard N. Hodis
- Division of Environmental Health, Department of Preventive Medicine, University of Southern California, Los Angeles, CA,Atherosclerosis Research Unit, Health Sciences Campus, University of Southern California, Los Angeles, CA
| | - Wendy J. Mack
- Division of Environmental Health, Department of Preventive Medicine, University of Southern California, Los Angeles, CA,Atherosclerosis Research Unit, Health Sciences Campus, University of Southern California, Los Angeles, CA
| | - Muhammad T. Salam
- Division of Environmental Health, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Frank Gilliland
- Division of Environmental Health, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Nino Kuenzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Ed Avol
- Division of Environmental Health, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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Engelen L, Ferreira I, Stehouwer CD, Boutouyrie P, Laurent S. Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. Eur Heart J 2012. [PMID: 23186808 DOI: 10.1093/eurheartj/ehs380] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. METHODS AND RESULTS We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15-101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n = 4234) used to establish sex-specific equations for percentiles of CCIMT across age. With these equations, we generated CCIMT Z-scores in different reference sub-populations, thereby allowing for a standardized comparison between observed and predicted ('normal') values from individuals of the same age and sex. In the sub-population without CVD and treatment (n = 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized βs 0.19 (95% CI: 0.16-0.22) and 0.18 (0.15-0.21)], smoking [0.25 (0.19-0.31) and 0.11 (0.04-0.18)], diabetes [0.19 (0.05-0.33) and 0.19 (0.02-0.36)], total-to-HDL cholesterol ratio [0.07 (0.04-0.10) and 0.05 (0.02-0.09)], and body mass index [0.14 (0.12-0.17) and 0.07 (0.04-0.10)]. CONCLUSION We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CV-RFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.
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Affiliation(s)
- Lian Engelen
- Department of Pharmacology and INSERM U970, Hôpital Européen Georges Pompidou, Paris, France
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Bots ML, Sutton-Tyrrell K. Lessons from the past and promises for the future for carotid intima-media thickness. J Am Coll Cardiol 2012; 60:1599-604. [PMID: 22999720 DOI: 10.1016/j.jacc.2011.12.061] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 12/06/2011] [Accepted: 12/17/2011] [Indexed: 11/30/2022]
Abstract
Carotid intima-media thickness (CIMT) measurements have been used in cardiovascular research for more than 2 decades. There is a wealth of evidence showing that CIMT can be assessed in a reproducible manner and that increased CIMT relates to unfavorable risk factor levels and atherosclerosis elsewhere in the arterial system and to the risk of vascular events. Change in CIMT over time can be readily assessed, and trials showed that the rate of change is modifiable by treatment. Several issues important for the cardiovascular research community and its application in clinical practice are still outstanding. Promising future areas for CIMT measurements are: 1) application in studies among children and adolescents; 2) use of CIMT trials positioned decisively before the start of a morbidity and mortality trial; and 3) the use of CIMT measurement in risk stratification in those with an intermediate 10-year risk estimate.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Parental blood pressure is related to vascular properties of their 5-year-old offspring. Am J Hypertens 2012; 25:907-13. [PMID: 22673016 DOI: 10.1038/ajh.2012.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescent offspring of hypertensive parents have increased carotid intima media thickness (CIMT) and arterial stiffness compared with offspring of normotensives. We assessed whether systolic blood pressure (SBP) of both parents is associated with the vasculature of their offspring as early as in childhood. METHODS In the first 306 5-year-old children of the Wheezing-Illnesses-Study-Leidsche-Rijn birth cohort, CIMT, distensibility, and elastic modulus (EM) were obtained ultrasonographically. In 204 of 306 (67%) children, complete data on both maternal and paternal SBP were obtained from the linked database of the Utrecht Health Project. RESULTS CIMT of the children was 0.58 µm (95% confidence interval (CI): 0.14, 1.0) greater with every 1-mm Hg higher maternal SBP. Maternal SBP and children's distensibility and EM were more strongly associated, negative and positive respectively, with increasing paternal SBP and vice versa (P value-for-interaction: 0.003 and 0.001, respectively). CIMT of children of whom both parents were in the highest SBP tertile was 17.9 µm (95% CI: 4.0, 31.9) greater compared with the CIMT of children of whom neither one of the parents had a SBP in the highest tertile. For EM and distensibility, these estimates were 20.1 kPa (95% CI: 1.1, 39.2) and -11.6 1/Mpa (95%-CI: -22.9, -0.31), respectively. CONCLUSIONS Higher maternal SBP is related to thicker arterial walls in their 5-year-old offspring. If both parents have higher SBP, the arterial wall of their offspring is thicker and stiffer.
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Evelein AMV, Visseren FLJ, van der Ent CK, Grobbee DE, Uiterwaal CSPM. Excess early postnatal weight gain leads to increased abdominal fat in young children. Int J Pediatr 2012; 2012:141656. [PMID: 22649461 PMCID: PMC3357526 DOI: 10.1155/2012/141656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 02/01/2012] [Accepted: 02/23/2012] [Indexed: 01/16/2023] Open
Abstract
Background. Increased childhood weight gain has been associated with later adiposity. Whether excess early postnatal weight gain plays a role in childhood abdominal fat is unknown. Design. In the ongoing Wheezing Illnesses Study Leidsche Rijn (WHISTLER), birth cohort weight and length from birth to age 3 months were obtained. In the first 316 five-year-olds, intra-abdominal and subcutaneous fat were measured ultrasonographically. Individual weight and length gain rates were assessed in each child. Internal Z-scores of weight for length gain (WLG) were calculated. Multiple imputation was used to deal with missing covariates. Results. Per-1-unit increase in Z-score WLG from birth to 3 months, BMI, waist circumference, and subcutaneous fat were significantly higher; 0.51 kg/m(2), 0.84 cm, and 0.50 mm, respectively. After multiple imputation, a trend towards significance was observed for intra-abdominal fat as well (0.51 mm/SD). In the associations with 5-year adiposity, no interaction between postnatal Z-score WLG and birth size was found. Conclusion. Excess early postnatal weight gain is associated with increased general and central adiposity, characterized by more subcutaneous and likely more intra-abdominal fat at 5 years of age.
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Affiliation(s)
- Annemieke M. V. Evelein
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85060, Utrecht, The Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85060, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85060, Utrecht, The Netherlands
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