Marcadores de aterosclerosis temprana y síndrome metabólico en niños

[Improvement in adherence to Mediterranean diet in children attending preschool centers]

Introduction

Background: the Mediterranean diet has been associated with a lower prevalence of obesity and metabolic syndrome, and with healthier lifestyles in adults and children, but data is scarce in younger ages. The Mediterranean-type ecosystem of the central region of Chile as well as its traditional gastronomy would facilitate the adoption of this dietary pattern. Objectives: to assess the adherence to Mediterranean diet in preschoolers and their parents, and to evaluate the impact of a nutrition education intervention and diet implementation. Methods: prospective cohort study. The KidMed index was applied to children older than 18 months, and the Mediterranean Dietary Index in Chile (Chilean-MDI) to their parents, before and after a remote educational intervention. Results: one hundred and thirty-nine families participated, with 95 preschoolers; 56 % were girls, aged 26.2 ± 8.7 months. The basal mean KidMed score was 7.4 ± 1.9 and increased to 7.9 ± 1.9 after the intervention (p = 0.1). The Chilean-MDI score was 6.9 ± 1.8 and 7.1 ± 1.7, respectively (p = 0.09). When separated by categories, there was improvement from low and moderate adherence to optimal adherence in both children and their parents (Chi2, p = 0.009 y p = 0.04). In 58 dyads, there was a positive correlation between the KidMed and the Chilean-MDI index, pre- and post-intervention (Pearson R = 0.3 y 0.34; p = 0.004 y 0.003, respectively). Conclusions: most of these sample of preschoolers and their parents had a moderate adherence to Mediterranean diet, with an improvement after an educational intervention.

Increased C-Reactive Protein in Brazilian Children: Association with Cardiometabolic Risk and Metabolic Syndrome Components (PASE Study)

C-reactive protein (CRP) is a marker of subclinical inflammation that has been found to be associated with cardiovascular disease risk. However, few studies have investigated the relationship between CRP and cardiometabolic markers in a representative sample of prepubescent children. The objective was to evaluate the high-sensitive CRP (hs-CRP) and its association with traditional and nontraditional cardiometabolic risk factors, as well as metabolic syndrome (MetS) components in Brazilian children. This is a cross-sectional representative study, with participants of the Schoolchildren Health Assessment Survey (PASE). Children from 8 to 9 years old (n=350) enrolled in public and private schools in the municipality of Viçosa, Minas Gerais, Brazil, were evaluated. Sociodemographic evaluation was performed through a semistructured questionnaire. Anthropometric, body composition, clinical, and biochemical measures were analyzed for cardiometabolic risk assessment. The total mean of serum hs-CRP concentration was 0.62 (±1.44) mg/L. hs-CRP was significantly correlated with several anthropometric, biochemical, and clinical parameters in this population (P < 0.05). hs-CRP was positively associated with the accumulation of cardiometabolic risk factors and MetS components (P < 0.05). Children with excessive weight; abdominal obesity; increased gynoid and android body fat; low HDL-c; hyperglycemia; and elevated uric acid, homocysteine, and apoB had higher chances of presenting increased hs-CRP (P < 0.05). In this study, Brazilian children with cardiometabolic risk already presented elevated serum hs-CRP concentration. hs-CRP was associated with the increase of traditional and nontraditional cardiometabolic risk factors, as well as the accumulation of MetS components.

Perinatal inflammation and childhood adiposity - a gender effect?

Background: To determine the association of maternal and fetal inflammatory factors with gender-specific infant adiposity, independent of leptin.Methods: Analysis of anthropometry from 265 mother-infant pairs at birth and 280 pairs at 6 months from the randomised control trial of low glycaemic index diet in pregnancy (ROLO) study (Randomised control trial of low glycaemic index diet) and their association with Maternal TNF-alpha, interleukin 6 and leptin as measured in early and late pregnancy and fetal levels in cord blood.Results: No associations were noted in the male cohort. On multiple regression amongst the female neonatal cohort late pregnancy IL-6 was inversely associated with sum of skinfolds (p ≤ .001); at 6 months infant sum of skinfolds were positively associated with early pregnancy IL-6 (p = .046) and central adiposity positively associated with early pregnancy TNF alpha (p = .018) independent of leptin.Conclusion: Although maternal inflammatory cytokines were not associated with neonatal adiposity independent of leptin (as this association is known), both IL-6 and TNF-α were associated with female infant anthropometry at 6 months of age independent of leptin. These results suggest inflammatory cytokines may exert an in-utero influence on later infant adiposity with a tendency to influence female adiposity more than male. Further research is required to ascertain whether these cytokines may be used as reliable early predictors of infant adiposity.

C-reactive protein in Brazilian adolescents: distribution and association with metabolic syndrome in ERICA survey

BACKGROUND/OBJECTIVES

C-reactive protein (CRP) is a marker of inflammation that has been shown to be predictive of cardiovascular diseases in adults. To evaluate the distribution of CRP as well as its association with metabolic syndrome and its components.

SUBJECTS/METHODS

This is a cross-sectional study on adolescents aged 12-17, participants in the Study of Cardiovascular Risk in Adolescents (ERICA). Anthropometric, biochemical and blood pressure data were collected from 6316 adolescents, selected from a random sample of students in the cities of Brasilia, Fortaleza, João Pessoa, Manaus, Porto Alegre and Rio de Janeiro. Metabolic syndrome was defined by the criteria proposed by International Diabetes Federation for adolescent. Poisson regression model with robust variance, taking into consideration the study's complex sampling design, was used to determine multivariate-adjusted prevalence rate ratios expressing the relationship of metabolic syndrome with CRP.

RESULTS

In adolescents with metabolic syndrome, CRP concentrations were five times higher (1.01 mg/l; interquartile range (IQR): 0.54-3.47) compared with those without metabolic syndrome (0.19 mg/l; IQR: 0.10-0.78). In multivariate Poisson regression analysis adjusted by sex, age and skin color, the prevalence of elevated CRP (>3.0 mg/l) was almost three times higher in adolescents with metabolic syndrome than in those without this condition (prevalence ratio (PR): 2.9; 95%CI: 2.0-4.3; P<0.001). Of the metabolic syndrome components, elevated waist circumference, low high-density lipoprotein-cholesterol and high triglycerides were significantly related to CRP in a graded (dose-response) manner.

CONCLUSIONS

The association of CRP with metabolic syndrome and its components suggests that inflammation may be useful in assessing cardiovascular risk in adolescents.

Endothelial and Metabolic Function Interactions in Overweight/Obese Children

AIM

Although the underlined mechanisms are still unknown, metabolic/coagulation alterations related to childhood obesity can induce vascular impairments. The aim of this study was to investigate the relationship between metabolic/coagulation parameters and endothelial function/vascular morphology in overweight/obese children.

METHODS

Thirty-five obese/overweight children (22 pre-pubertal, mean age: 9.52±3.35 years) were enrolled. Body mass index (BMI), homeostasis model assessment index (HOMAIR), metabolic and coagulation parameters, [adiponectin, fibrinogen, high molecular weight adiponectin (HMW), endothelin-1, and vonWillebrand factor antigen] ultrasound early markers of atherosclerosis [flow-mediated dilatation (FMD), common carotid intima-media thickness (C-IMT), and anteroposterior diameter of infra-renal abdominal aorta (APAO)] were assessed.

RESULTS

APAO was related to anthropometric (age: r=0.520, p=0.001; height: r=0.679, p＜0.001; weight: r=0.548, p=0.001; BMI: r=0.607, p＜0.001; SBP: r=0.377, p=0.026) and metabolic (HOMAIR: r=0.357, p=0.035; HMW: r=－0.355, p=0.036) parameters. Age, height, and systolic blood pressure were positively related to increased C-IMT (r=0.352, p=0.038; r=0.356, p=0.036; r=0.346, p=0.042, respectively). FMD was not related to any clinical and biochemical characteristics of the pediatric population. Age, HOMAIR, fasting glucose levels, and HMW were independent predictors for APAO increase. Each unit decrease in HMW concentrations (1 μg/ml) induced a 0.065 mm increase in APAO.

CONCLUSION

High molecular weight adiponectin is related to cardiovascular risk in overweight/obese children.

[Relationship between subclinical atherosclerosis, blood pressure, and lipid profile in obese children and adolescents: a systematic review]

The present study aimed to systematically review the literature about intima-media thickness (IMT), blood pressure (BP), and lipid profile (LP) in obese and non-obese children and adolescents. The search was carried out in electronic databases (PubMed, Bireme, and Elsevier ScienceDirect) between 2000-2010. The following keywords, in English, were used: "obesity", "adolescents", "atherosclerosis" and "child", using two combinations: obesity+child+atherosclerosis and obesity+adolescents+atherosclerosis. The electronic search resulted in 3,211 manuscripts. After analysis of the inclusion criteria, 13 papers were selected. Of these, two studies showed significant correlation between IMT and the variables BP, LDL, and triglycerides. In other studies, no significant correlations were found. There is a wide methodological variability across the studies. However, obese children and adolescents had higher values of IMT, BP, and LP.

Hypertension in adolescents

In adults, hypertension has long been perceived as a public health problem. By contrast, its impact in childhood is far less appreciated. In fact, quite often, high blood pressure in children is not even diagnosed. Blood pressure is a vital sign that is routinely obtained during a physical examination of adults, but only very seldom in children. The diagnosis of hypertension in children is complicated because 'normal' blood pressure values vary with age, sex and height. As a consequence, almost 75% of the cases of arterial hypertension and 90% of the cases of prehypertension in children and adolescents are currently undiagnosed. Furthermore, adolescence hypertension is increasing in prevalence as the prevalence of pediatric obesity has increased. Ambulatory blood pressure monitoring is a useful method for risk evaluation in adolescents. In addition to being viewed as an important cardiovascular risk factor in adolescents, elevated blood pressure should prompt a thorough search for other modifiable risk factors that, if treated, might reduce teenagers' risk of developing cardiovascular disease in adulthood. Thus, assessing blood pressure values in children represents one of the most important measurable markers of cardiovascular risk later in life and a major step in preventive medicine.