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Abstract
The cardiometabolic syndrome is highly prevalent among overweight youth. The risk of developing the cardiometabolic syndrome is likely triggered or exacerbated by concurrent obesity, unhealthy lifestyle/eating habits, and hormonal changes (puberty). Current screening recommendations include measurement of blood pressure, fasting insulin and glucose, and total cholesterol. However, limiting assessments to these measures underestimates cardiometabolic risk in overweight youth, particularly minorities. Early identification of cardiometabolic risk in its incipient stages may justify early and more aggressive intervention to prevent progression and complications. This review provides rationale for additional assessments to determine cardiometabolic risk in overweight youth and recommends treatment options.
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Affiliation(s)
- Pedro Velasquez-Mieyer
- Dept. of Pediatrics LeBonheur Children's Medical Center 50 North Dunlap Memphis, TN 38103
| | | | - Ramfis Nieto
- Department of Physiology, Universidad Centro-Occidental “Lisandro Alvarado” (UCLA). Barquisimeto, Venezuela
| | - Patricia A. Cowan
- Department of Nursing, University of Tennessee Health Science Center, Memphis, TN 38103, USA
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Dathan-stumpf A, Vogel M, Hiemisch A, Thiery J, Burkhardt R, Kratzsch J, Kiess W. Pediatric reference data of serum lipids and prevalence of dyslipidemia: Results from a population-based cohort in Germany. Clin Biochem 2016; 49:740-9. [DOI: 10.1016/j.clinbiochem.2016.02.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/13/2016] [Accepted: 02/26/2016] [Indexed: 11/22/2022]
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Watabe Y, Arisaka O, Miyake N, Ichikawa G, Koyama S, Shimura N. Estimation of LDL Particle Size Using Lipid Indices: A Population-Based Study of 1578 Schoolchildren. Metab Syndr Relat Disord 2015; 13:465-9. [PMID: 26469303 DOI: 10.1089/met.2015.0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low-density lipoprotein (LDL) is atherogenic and LDL particles are reduced in diameter in the presence of insulin resistance, forming small, dense LDL. This study was conducted to assess the relationship between commonly used lipid indices and LDL particle size and furthermore to clarify the best surrogate lipid markers that could conveniently be used to estimate LDL particle size in children. METHODS We determined LDL particle diameter by gradient gel electrophoresis in 1578 children aged 10-12 years. At the fasting state, the relationships between measured LDL particle size and lipid variables [total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), atherogenic index [(TC-HDL-C)/HDL-C, TG/HDL-C, LDL-C/HDL-C, and LDL-C/apolipoprotein B (Apo B) and non-HDL-C (TC-HDL-C)] were analyzed. RESULTS The LDL particle diameter was 26.64 (mean) ± 0.48 (SD) nm in boys (n = 820) and 26.66 ± 0.49 nm in girls (n = 758); there was not a statistically significant difference. There were statistically significant correlations between LDL particle size and TG or HDL-C concentrations (r = 0.28∼0.37), but the correlations with LDL-C and ApoB were very weak. The combined lipid measures, such as atherogenic index, TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C showed moderate correlations (r = 0.33∼0.38) with LDL particle size; however, the correlation of non-HDL-C with LDL particle size was weak (r = 0.18∼0.19). Simple HDL-C measure appeared to be of comparable value to combined lipid measures. CONCLUSIONS Our data indicate that various lipid indices are not superior to HDL-C levels alone as a clinical tool for estimating LDL particle size. Non-HDL-C was less valuable in this aspect.
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Affiliation(s)
- Yaeko Watabe
- 1 Department of Pediatrics, Dokkyo Medical University , Mibu, Kitakobayashi, Japan
| | - Osamu Arisaka
- 1 Department of Pediatrics, Dokkyo Medical University , Mibu, Kitakobayashi, Japan
| | - Noriko Miyake
- 2 Department of Clinical Pathology, Juntendo Nerima Hospital , Tokyo, Japan
| | - Go Ichikawa
- 1 Department of Pediatrics, Dokkyo Medical University , Mibu, Kitakobayashi, Japan
| | - Satomi Koyama
- 1 Department of Pediatrics, Dokkyo Medical University , Mibu, Kitakobayashi, Japan
| | - Naoto Shimura
- 1 Department of Pediatrics, Dokkyo Medical University , Mibu, Kitakobayashi, Japan
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Ryder JR, Vega-López S, Ortega R, Konopken Y, Shaibi GQ. Lifestyle intervention improves lipoprotein particle size and distribution without weight loss in obese Latino adolescents. Pediatr Obes 2013; 8:e59-63. [PMID: 23576420 PMCID: PMC3898800 DOI: 10.1111/j.2047-6310.2013.00162.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/15/2013] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
Childhood obesity is associated with a pro-atherogenic phenotype contributing to increased cardiovascular disease (CVD) risk. This single-arm pilot study examined the effects of a lifestyle intervention on lipoprotein particle size and cholesterol distribution in obese Latino adolescents. Fifteen obese Latino adolescents (15.0 ± 1.0 years) completed a 12-week nutrition education and exercise intervention. Low-density lipoprotein (LDL) particle size and distribution of cholesterol in lipoprotein subclasses were determined via polyacrylamide gel electrophoresis. The intervention resulted in increases in mean LDL particle size (269.3 ± 3.4 to 271.6 ± 2.9 Å, P = 0.0003) and cholesterol in large high-density lipoprotein (HDL) subfractions (22.4 ± 11.2 to 26.8 ± 10.6% area, P = 0.007) along with decreases of cholesterol in small LDL (1.6 ± 2.0 to 0.6 ± 1.2% area, P < 0.01) and HDL subfractions (23.2 ± 9.4 to 19.0 ± 6.7% area, P = 0.05). These improvements were observed independent of changes in weight (90.7 ± 26.2 to 89.9 ± 27.8 kg, P > 0.05) and suggest that lifestyle modification in obese youth may reduce cardiovascular risk by shifting lipoprotein particle size and cholesterol distribution to a less atherogenic phenotype.
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Affiliation(s)
- Justin R. Ryder
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ
| | - Sonia Vega-López
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ,Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ
| | - Rocio Ortega
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ,College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Yolanda Konopken
- St. Vincent de Paul Virginia G. Piper Medical and Dental Clinic, Phoenix, AZ
| | - Gabriel Q. Shaibi
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ,Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ,College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
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Arisaka O, Kariya K, Ichikawa G. Fasting non-high-density lipoprotein cholesterol and low-density lipoprotein particle size. J Pediatr 2012; 160:531-2; author reply 532. [PMID: 22217472 DOI: 10.1016/j.jpeds.2011.11.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/22/2011] [Indexed: 11/21/2022]
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Gutin B, Harris RA, Howe CA, Johnson MH, Zhu H, Dong Y. Cardiometabolic biomarkers in young black girls: relations to body fatness and aerobic fitness, and effects of a randomized physical activity trial. Int J Pediatr 2011; 2011:219268. [PMID: 22007244 DOI: 10.1155/2011/219268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/08/2011] [Indexed: 01/27/2023] Open
Abstract
There is little evidence from randomized trials showing that physical activity alone influences biomarker profiles in youths. This study tested two hypotheses: (i) that elevated body fatness and poor fitness would be associated with unfavorable levels of cardiometabolic biomarkers in 8–12-y-old black girls (n = 242) and (ii) that a 10-mo PA intervention would have favorable effects on the fatness-related cardiometabolic biomarkers. At baseline, all fatness indices (i.e., percent body fat, visceral adipose tissue, BMI, and waist circumference) were significantly (P < 0.05) associated with unfavorable levels of insulin, glucose, systolic BP, diastolic BP, triglycerides, C-reactive protein (CRP), and fibrinogen. Aerobic fitness was significantly (P < 0.05) associated with favorable levels of insulin, CRP, fibrinogen, and HDL2. The PA intervention had significant and favorable effects on fitness, fatness, and two biomarkers—resting heart rate and LDL cholesterol. More research is needed to clarify what types of interventions can enhance the cardiometabolic health of youths.
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Arisaka O, Ichikawa G, Koyama S, Shimura N. Relation between low-density lipoprotein particle size and insulin and diabetes mellitus. J Pediatr 2009; 155:600. [PMID: 19773013 DOI: 10.1016/j.jpeds.2009.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 04/14/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Miyamoto K, Tsuboi T, Suzumura H, Arisaka O. Relationship between Aortic Intima-media Thickening, Serum IGF-I and Low-density Lipoprotein Particle Diameter in Newborns with Intrauterine Growth Restriction. Clin Pediatr Endocrinol 2009; 18:55-64. [PMID: 24790381 PMCID: PMC4004904 DOI: 10.1297/cpe.18.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 12/01/2008] [Indexed: 11/14/2022] Open
Abstract
Much epidemiological evidence has linked low birth weight with late
cardiovascular risk. In order to investigate the effect of intrauterine growth restriction
(IUGR) on early atherosclerosis in the fetus, we measured aortic wall thickness (abdominal
aortic intima-media thickness: aIMT) by ultrasonography in 15 neonates with IUGR and in 31
neonates considered to be appropriate for gestational age (AGA). Furthermore, we evaluated
the relationship between aIMT, serum insulin-like growth factor-I (IGF-I) and low-density
lipoprotein (LDL) particle size to investigate the possible effect of these
atherosclerosis-related factors on the early atherosclerosis process. The results showed
that the mean aIMT was significantly greater in the IUGR neonates than in the AGA neonates
(least squares mean ± SE, 537 ± 24.8 vs. 471 ± 17.0 µm, p=0.037). The serum IGF-I levels
were lower in the IUGR neonates than in the AGA neonates (27.9 ± 4.3 vs. 42.7 ± 2.9 ng/ml,
p=0.009). A significant negative correlation was observed between aIMT and IGF-I in the
IUGR neonates (r=–0.646, p=0.009); however, a positive correlation was observed between
aIMT and IGF-I (r=0.416, p=0.020) in the AGA neonates. There appeared to be no
relationship between aIMT and LDL particle diameter. Atherogenic small, dense LDL was not
detected in the IUGR infants. In conclusion, neonates with IUGR have significant aortic
thickening with decreased IGF-I, suggesting that prenatal events might predispose them to
later cardiovascular risk.
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Affiliation(s)
- Kenji Miyamoto
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi-ken, Japan
| | - Tatsuo Tsuboi
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi-ken, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi-ken, Japan
| | - Osamu Arisaka
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi-ken, Japan
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Kaitosaari T, Simell O, Viikari J, Raitakari O, Siltala M, Hakanen M, Leino A, Jokinen E, Rönnemaa T. Tracking and determinants of LDL particle size in healthy children from 7 to 11 years of age: the STRIP Study. Eur J Pediatr 2009; 168:531-9. [PMID: 18604555 DOI: 10.1007/s00431-008-0780-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 05/30/2008] [Accepted: 06/02/2008] [Indexed: 11/25/2022]
Abstract
Serum low-density lipoprotein (LDL) particle composition varies according to lifestyle and age. To analyze its long-term tracking, we studied LDL particle size consecutively in 100 children at the ages of 7, 9 and 11 years using a high-resolution 3% polyacrylamide gel tube, electrophoresis method, searching also for long-term determinants of the particle size. The mean LDL particle sizes at 7 and 9 years, and at 7 and 11 years correlated directly (r=0.72 and 0.39, respectively). The probability that children would remain in the same LDL particle size tertile between 7 and 11 years of age was 48% (p=0.008). Longitudinally, total, high-density lipoprotein (HDL) and LDL cholesterol concentrations and body mass index (BMI) associated directly with mean LDL particle size, and triglyceride concentration and triglyceride/HDL cholesterol ratio correlated inversely. A shift from pre-puberty to puberty was associated with an increase in LDL particle size. Sex, serum insulin concentration, or energy nutrient intakes did not associate with LDL particle size. In conclusion, although mean LDL particle size tracks in 7- to 11-year-old healthy children, changes in serum triglycerides, HDL, LDL, and total cholesterol concentration, BMI, and pubertal status all modify LDL particle size.
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Affiliation(s)
- Tuuli Kaitosaari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland.
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Arisaka O, Ichikawa G, Yamazaki Y, Shimura N. Cardiovascular risk markers in adolescent girls with anorexia nervosa. J Pediatr 2007; 151:e16; author reply e16. [PMID: 17889059 DOI: 10.1016/j.jpeds.2007.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
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Azadbakht L, Mirmiran P, Hedayati M, Esmaillzadeh A, Shiva N, Azizi F. Particle size of LDL is affected by the National Cholesterol Education Program (NCEP) step II diet in dyslipidaemic adolescents. Br J Nutr 2007; 98:134-9. [PMID: 17445337 DOI: 10.1017/s0007114507657857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective was to determine the effects of the National Cholesterol Education Program (NCEP) step II diet on LDL and HDL particle size in dyslipidaemic adolescents. Forty-four dyslipidaemic adolescents, aged 10–18 years, participated in this case-control study. The control diet was a diet similar to what most Tehranian adolescents eat. NCEP step II diet was a diet with 30 % of energy as total fat, less than 7 % saturated fat, less than 200 mg cholesterol/d, less than 15 % of energy as MUFA and less than 10 % as PUFA. Lipoprotein particle size was the major outcome variable, which was measured after 3 months of intervention. Comparison was made by the repeated measurement ANOVA. The mean BMI was 26·3 (sd4·2) kg/m2. There were no significant changes in weight or physical activity in the two groups during the study. The NCEP diet resulted in higher reduction in total cholesterol ( − 13 (sd4)v.− 2 (sd0·3) mg/dl,P < 0·001) and LDL ( − 9 (sd2)v.3 (sd0·6) mg/dl,P < 0·01), and higher increase in size of the LDL (1·7 (sd0·4)v.0·1 (sd0·4) nanometer,P < 0·001). HDL particle size did not change significantly. NCEP step II diet had a favourable effect on the LDL particle size. The related mechanism needs to be studied in future experimental designs.
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Affiliation(s)
- Leila Azadbakht
- Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW This review discusses whether the relationship of small dense low-density lipoprotein to cardiovascular risk is direct, due to the atherogenic properties of the particle, or a reflection of concomitant abnormalities in high-density lipoprotein and plasma triglyceride. RECENT FINDINGS Recent studies have examined whether low-density lipoprotein size distribution or concentration of small low-density lipoprotein is related more strongly to risk. It appears that the latter is a better predictor in major surveys, although in smaller cohort studies particle size shows a strong association with atherosclerosis burden. While the main causes of the formation of small dense low-density lipoprotein are relatively well understood, novel metabolic factors may also play a role, and pharmacologic interventions such as glitazones may have a direct regulatory impact. SUMMARY Evidence links abnormalities in low-density lipoprotein structure to cardiovascular risk. The plasma concentration of small dense low-density lipoprotein is likely to be more informative than relative low-density lipoprotein particle size, and although methods are available for quantitation of this subfraction, there is considerable room for improvement. It is not yet clear how knowledge of the small dense low-density lipoprotein concentration may add to risk prediction.
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Affiliation(s)
- Chris J Packard
- Department of Vascular Biochemistry, University of Glasgow, Scotland, UK.
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