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Abstract
PURPOSE OF REVIEW Anthracyclines have markedly improved the survival rates of children with cancer. However, anthracycline-related cardiotoxicity is also well recognized and can compromise the long-term outcome in some patients. The challenge remains of how to balance the chemotherapeutic effects of anthracycline treatment with its potentially serious cardiovascular complications. Here, we review the pathophysiology, risk factors, clinical manifestations, prevention, and treatment of anthracycline-related cardiotoxicity. RECENT FINDINGS Some risk factors and biomarkers associated with an increased probability of anthracycline-related cardiotoxicity have been identified. Modifying the structural forms and dosages of anthracyclines and coadministering cardioprotective agents may prevent some of these cardiotoxic effects. Cardiovascular complications have also been treated with angiotensin-converting enzyme inhibitors, β-blockers, and growth hormone replacement therapy. Cardiac transplantation remains the treatment of last resort. SUMMARY Despite major advances in cancer treatment, anthracycline-related cardiotoxicity remains a major cause of morbidity and mortality in survivors of childhood cancer. Promising areas of research include: use of biomarkers for early recognition of cardiac injury in children receiving chemotherapy, development and application of cardioprotective agents for prevention of cardiotoxicity, and advancements in therapies for cardiac dysfunction in children after anthracycline treatment.
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102
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Savant JD, Furth SL, Meyers KE. Arterial Stiffness in Children: Pediatric Measurement and Considerations. Pulse (Basel) 2014; 2:69-80. [PMID: 26587447 PMCID: PMC4646130 DOI: 10.1159/000374095] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arterial stiffness is a natural consequence of aging, accelerated in certain chronic conditions, and predictive of cardiovascular events in adults. Emerging research suggests the importance of arterial stiffness in pediatric populations. METHODS There are different indices of arterial stiffness. The present manuscript focuses on carotid-femoral pulse wave velocity and pulse wave analysis, although other methodologies are discussed. Also reviewed are specific measurement considerations for pediatric populations and the literature describing arterial stiffness in children with certain chronic conditions (primary hypertension, obesity, diabetes, chronic kidney disease, hypercholesterolemia, genetic syndromes involving vasculopathy, and solid organ transplant recipients). CONCLUSIONS The measurement of arterial stiffness in children is feasible and, under controlled conditions, can give accurate information about the underlying state of the arteries. This potentially adds valuable information about the functionality of the cardiovascular system in children with a variety of chronic diseases well beyond that of the brachial artery blood pressure.
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Affiliation(s)
- Jonathan D. Savant
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
| | - Susan L. Furth
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
- Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa., USA
| | - Kevin E.C. Meyers
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Pa., USA
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103
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Zhang YX, Cheng Y, Xu JH, Xie L. Blood pressure of general and abdominal obese children and adolescents in Shandong, China. Int J Cardiol 2014; 172:e461-2. [PMID: 24485601 DOI: 10.1016/j.ijcard.2014.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ying-xiu Zhang
- Shandong Center for Disease Control and Prevention, Shandong, China.
| | - Yan Cheng
- Shandong blood center, Shandong, China
| | | | - Li Xie
- Shandong Center for Disease Control and Prevention, Shandong, China
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104
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Blood pressure level profiles among children and adolescents with various types of obesity: study in a large population in Shandong, China. Clin Res Cardiol 2014; 103:553-9. [DOI: 10.1007/s00392-014-0683-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/29/2014] [Indexed: 12/17/2022]
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105
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Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy. Surg Obes Relat Dis 2014; 10:842-50. [PMID: 25439000 DOI: 10.1016/j.soard.2014.01.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents. METHODS Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions. RESULTS The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively. CONCLUSION LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.
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106
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Silva LR, Cavaglieri C, Lopes WA, Pizzi J, Coelho-e-Silva MJC, Leite N. Endothelial wall thickness, cardiorespiratory fitness and inflammatory markers in obese and non-obese adolescents. Braz J Phys Ther 2014; 18:47-55. [PMID: 24675912 PMCID: PMC4183237 DOI: 10.1590/s1413-35552012005000133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 09/06/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Increased carotid intima-media thickness (c-IMT) is considered a marker of early-onset atherosclerosis and it has been found in obese children and adolescents, but the risk factors associated with this population remain to be elucidated. OBJECTIVE To compare and verify the relationship between c-IMT, metabolic profile, inflammatory markers, and cardiorespiratory fitness in obese and non-obese children and adolescents. METHOD Thirty-five obese subjects (19 boys) and 18 non-obese subjects (9 boys), aged 10-16 years, were included. Anthropometry, body composition, blood pressure, maximal oxygen consumption (VO2max), and basal metabolic rate were evaluated. Serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, C-reactive protein (CRP), and adiponectin were assessed. c-IMT was measured by ultrasound. RESULTS The results showed that c-IMT, triglycerides, insulin, HOMA-IR, and CRP values were significantly higher in the obese group than in the non-obese group, and high-density lipoprotein cholesterol (HDL-c), adiponectin, and VO2max values were significantly lower in the obese group than in the non-obese group. The c-IMT was directly correlated with body weight, waist circumference, % body fat, and HOMA-IR and inversely correlated with % free fat mass, HDL-c, and VO2max. CONCLUSIONS Our findings show that c-IMT correlates not only with body composition, lipids, insulin resistance, and inflammation but also with low VO2max values in children and adolescents.
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Affiliation(s)
- Larissa R Silva
- Department of Physical Education, Universidade Federal do Parana, Curitiba, PR, Brazil
| | - Cláudia Cavaglieri
- Faculty of Physical Education, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Wendell A Lopes
- Faculty of Physical Education, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Juliana Pizzi
- Department of Physical Education, Universidade do Parana, Francisco Beltrao, PR, Brazil
| | | | - Neiva Leite
- Department of Physical Education, Universidade Federal do Parana, Curitiba, PR, Brazil
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107
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Boodai SA, Cherry LM, Sattar NA, Reilly JJ. Prevalence of cardiometabolic risk factors and metabolic syndrome in obese Kuwaiti adolescents. Diabetes Metab Syndr Obes 2014; 7:505-11. [PMID: 25368527 PMCID: PMC4216021 DOI: 10.2147/dmso.s66156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Childhood and adolescent obesity is associated with insulin resistance, abnormal glucose metabolism, hypertension, dyslipidemia, inflammation, liver disease, and compromised vascular function. The purpose of this pilot study was to determine the prevalence of cardiometabolic risk factor abnormalities and metabolic syndrome (MetS) in a sample of obese Kuwaiti adolescents, as prevalence data might be helpful in improving engagement with obesity treatment in future. METHODS Eighty obese Kuwaiti adolescents (40 males) with a mean (standard deviation) age of 12.3 years (1.1 years) participated in the present study. All participants had a detailed clinical examination and anthropometry, blood pressure taken, and assessment of fasting levels of C-reactive protein, intracellular adhesion molecule, interleukin-6, fasting blood glucose, insulin, liver function tests (alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase), lipid profile (cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides), insulin resistance by homeostasis model assessment, and adiponectin. MetS was assessed using two recognized criteria modified for use in younger individuals. RESULTS The cardiometabolic risk factors with highest prevalence of abnormal values included aspartate aminotransferase (88.7% of the sample) and insulin resistance by homeostasis model assessment (67.5%), intracellular adhesion molecule (66.5%), fasting insulin (43.5%), C-reactive protein (42.5%), low-density lipoprotein cholesterol (35.0%), total cholesterol (33.5%), and systolic blood pressure (30.0%). Of all participants, 96.3% (77/80) had at least one impaired cardiometabolic risk factor as well as obesity. Prevalence of MetS was 21.3% according to the International Diabetes Federation definition and 30% using the Third Adult Treatment Panel definition. CONCLUSION The present study suggests that obese Kuwaiti adolescents have multiple cardiometabolic risk factor abnormalities. Future studies are needed to test the benefits of intervention in this high-risk group. They also suggest that prevention of obesity in children and adults should be a major public health goal in Kuwait.
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Affiliation(s)
- Shurooq A Boodai
- University of Glasgow School of Medicine, Yorkhill Hospitals, Glasgow, Scotland
- Correspondence: Shurooq A Boodai, University of Glasgow School of Medicine, Yorkhill Hospitals, Glasgow, G3 8SJ Scotland, Email
| | - Lynne M Cherry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Naveed A Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - John J Reilly
- University of Strathclyde Physical Activity for Health Group, School of Psychological Sciences and Health, Glasgow, Scotland
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108
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Djordjevic J, Lawlor DA, Zhurov AI, Toma AM, Playle R, Richmond S. A population-based cross-sectional study of the association between facial morphology and cardiometabolic risk factors in adolescence. BMJ Open 2013; 3:bmjopen-2013-002910. [PMID: 23793675 PMCID: PMC3657674 DOI: 10.1136/bmjopen-2013-002910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine whether facial morphology is associated with fasting insulin, glucose and lipids independent of body mass index (BMI) in adolescents. DESIGN Population-based cross-sectional study. SETTING Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England. PARTICIPANTS From the ALSPAC database of 4747 three-dimensional facial laser scans, collected during a follow-up clinic at the age of 15, 2348 white British adolescents (1127 males and 1221 females) were selected on the basis of complete data on cardiometabolic parameters, BMI and Tanner's pubertal stage. MAIN OUTCOME MEASURES Fasting insulin, glucose and lipids (triglycerides, high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc)). RESULTS On the basis of the collection of 63 x, y and z coordinates of 21 anthropometric landmarks, 14 facial principal components (PCs) were identified. These components explained 82% of the variation in facial morphology and were used as exposure variables. With adjustment for age, gender and pubertal stage, seven PCs were associated with fasting insulin, none with glucose, three with triglycerides, three with HDLc and four with LDLc. After additional adjustment for BMI, four PCs remained associated with fasting insulin, one with triglycerides and two with LDLc. None of these associations withstood adjustment for multiple comparisons. CONCLUSIONS These initial hypotheses generating analyses provide no evidence that facial morphology is importantly related to cardiometabolic outcomes. Further examination might be warranted. Facial morphology assessment may have value in identifying other areas of disease risk.
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Affiliation(s)
- Jelena Djordjevic
- Department of Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Debbie A Lawlor
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alexei I Zhurov
- Department of Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Arshed M Toma
- Department of Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Rebecca Playle
- Department of Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Stephen Richmond
- Department of Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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109
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Schwiebbe L, Talma H, van Mil EG, Fetter WPF, Hirasing RA, Renders CM. Diagnostic procedures and treatment of childhood obesity by pediatricians: 'The Dutch approach'. Health Policy 2013; 111:110-5. [PMID: 23683472 DOI: 10.1016/j.healthpol.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 03/22/2013] [Accepted: 04/09/2013] [Indexed: 11/24/2022]
Abstract
Child Public Health professionals in the Netherlands refer obese children to a pediatrician to check for underlying causes and comorbidity. What happens to these children in terms of diagnostics and treatment when they visit a pediatrician? To get an overview of the diagnostic procedures and treatment methods a questionnaire was developed and sent to all 583 pediatricians in the Netherlands. Data was obtained of 290 pediatricians from 85% of the general hospitals and all (8) academic hospitals. To define childhood obesity Dutch pediatricians most often use the adult Body Mass Index, only 34% use the sex and age specific IOTF-BMI-criteria. 11% of the (non-obese) overweight children visiting a pediatrician have already comorbidities. All pediatricians perform at least weight and height measurements. Waist circumference is measured by only 42%, ninety-five percent measure blood pressure. To treat obese children without comorbidity thirty different intervention programs were reported. A large variation in diagnostics and interventions of childhood obesity exist. Guidelines in pediatric obesity for diagnostics and treatment are urgently needed.
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Affiliation(s)
- Luuk Schwiebbe
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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