Adiposity, blood pressure, and carotid intima-media thickness in greek adolescents

Utility of waist-to-height ratio, waist circumference and body mass index in predicting clustered cardiometabolic risk factors and subclinical vascular phenotypes in children and adolescents: A pooled analysis of individual data from 14 countries

AIMS

The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV).

METHODS

We analyzed data from 34,224 youths (51.0 % boys, aged 6-18 years) with CMRFs, 5004 (49.5 % boys, aged 6-18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6-17 years) with PWV measurement from 20 pediatric samples across 14 countries.

RESULTS

WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75-0.78) to 0.78 (0.76-0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74-0.79) to 0.77 (0.74-0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64-0.71) to 0.70 (0.66-0.73) for high cIMT (≥P95 values) and from 0.60 (0.58-0.66) to 0.62 (0.58-0.66) for high PWV (≥P95 values).

CONCLUSIONS

Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings.

Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6-18 years

BACKGROUND

Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide.

METHODS

We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors.

RESULTS

Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA).

CONCLUSIONS

The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents

PURPOSE

To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents.

METHODS

Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5-17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies.

RESULTS

Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality.

CONCLUSION

While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.

Effectiveness of a body shape index in predicting pediatric high blood pressure

BACKGROUND

A body shape index (ABSI) is an emerging anthropometric indicator, challenging two traditional parameters: body mass index (BMI) and waist circumference (WC). We aimed to systematically compare and validate the capability of anthropometric indicators for determining pediatric high blood pressure (HBP).

METHODS

A total of 3150 participants aged 7-17 years were enrolled from Suzhou, China. Areas under the receiver operating characteristic curve (AUC) were obtained to evaluate the performance of anthropometric indicators in detecting HBP. DeLong's test was used to examine whether the AUCs of anthropometric indicators in contrast to BMI or original ABSI were statistically different. Furthermore, a meta-analysis was performed to combine results from this study and five similar articles from databases.

RESULTS

In Suzhou population, BMI exhibited the largest AUC (AUC = 0.705), followed by WC (AUC = 0.669) and original ABSI (AUC = 0.514). Modified ABSI (AUC: 0.537-0.681), although had slightly better performance than original ABSI, was still less valuable than BMI (P < 0.05), either in the total sample or in boys. The meta-analysis with 21108 children and adolescents subsequently confirms the results derived from Suzhou population.

CONCLUSIONS

In predicting pediatric HBP, original ABSI and modified ABSI underperform BMI and WC.

IMPACT

The current study is the first to evaluate whether original ABSI or modified ABSI is comparable to BMI and WC for screening HBP in children and adolescents. In predicting pediatric HBP, original ABSI and modified ABSI do not perform as well as traditional anthropometric indicators, such as BMI and WC. BMI remains the optimal indicator in pediatric HBP screening. This study provides a theoretical basis for the early identification of HBP in children and adolescents by adopting effective predictors.

Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review

The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.

The relation between increased carotid intima-media thickness with fibrin monomers in obese children

AIM

This study aimed to investigate the association between carotid intima-media changes that play a part in the atherosclerotic process in childhood obesity and fibrin monomers as an important indicator of fibrin plaque.

METHODS

This is a cross-sectional study of obese children and non-obese healthy control subjects. Height, weight, body mass index, waist/hip ratio, systolic/diastolic blood pressures were recorded, in addition, biochemistry, haemogram, fibrin monomers and d-dimer were measured in both groups. Right and left common carotid intima-media thicknesses were measured by ultrasonography and mean carotid intima-media thickness was calculated.

RESULTS

Obese children (n = 89, 46.1% girls, median age: 12.6 ± 2.3 years) and healthy control group (n = 40, 52.5% girls, median age: 13.2 ± 2.2 years) were comparable in terms of gender, age and puberty stage. Mean carotid intima-media thickness was higher in obese children than the healthy control group (P = .002). There was no difference between the two groups in terms of fibrin monomers and d-dimer levels. In obese children, there was a weak negative correlation between mean carotid intima-media thickness and fibrin monomers (P = .030, r = -0.233).

CONCLUSION

In obese children, mean carotid intima-media thickness was determined higher, as an early indicator of atherosclerosis. We want to emphasise that obese children are at risk for cardiovascular disease and should be evaluated in terms of atherosclerosis. This study investigates the relation between increased carotid intima-media thickness and fibrin monomers, in children, the first time in Literature.

Waist circumference change and risk of high carotid intima-media thickness in a cohort of Chinese children

OBJECTIVE

Previous cross-sectional studies showed a positive association between waist circumference (WC) and carotid intima-media thickness (cIMT) among children and adolescents. We examined the association between change in WC and cIMT in a cohort study of Chinese children with 2-year follow-up.

METHODS

A school-based cohort study named 'Huantai Childhood Cardiovascular Health Cohort Study' was conducted in Zibo City, Shandong Province, China. WC and cIMT were measured in 2017 and 2019. Change in WC was categorized into four groups: persistently low WC, WC loss, WC gain and persistently high WC. We examined the association between WC change and cIMT during a 2-year follow-up.

RESULTS

A total of 1183 children aged 6-11 years at baseline were included in this study. After adjustment for potential covariates, WC change was associated positively with cIMT change (linear regression coefficient = 5.92 μm/cm per 2 years, 95% confidence interval [CI]: 4.55-7.30). Among the 1072 children (out of 1183 children) with normal cIMT at baseline, compared with persistently low WC, WC gain (odds ratio [OR] = 3.23, 95% CI: 1.14-9.17) and persistently high WC (OR = 7.94, 95% CI: 3.81-16.51) were associated with high cIMT at the end of the follow-up period. In contrast, WC loss during follow-up was not associated with high cIMT (OR = 1.33, 95% CI:0.35-5.11).

CONCLUSION

In this cohort of children, WC gain and persistently high WC were associated with increased cIMT whereas WC loss was not. These findings emphasize the importance of maintaining a normal WC in childhood to promote vascular health.

The Effect of Long-Term Atorvastatin Therapy on Carotid Intima-Media Thickness of Children With Dyslipidemia

Carotid intima-media thickness (cIMT) has been proposed as an early marker of subclinical atherosclerosis in high risk children. Children with heterozygous familial hypercholesterolemia have greater cIMT than matched healthy controls or their unaffected siblings. Statin therapy may delay the progression of cIMT, although long-term studies in children are scarce. We evaluated the effect of atorvastatin treatment on cIMT in children with dyslipidemia. We studied 81 children/adolescents, 27 with severe dyslipidemia (low-density lipoprotein cholesterol [LDL-C] ≥190 mg/dL) and 54 sex- and age-matched healthy controls; LDL-C ≤ 130 mg/dL and lipoprotein (a), Lp(a), ≤30 mg/dL. In the children with dyslipidemia, cIMT was measured twice, before and on treatment (18.2 ± 7.7 months). Anthropometric data, a full lipid profile, liver, kidney, and thyroid function were evaluated. Males with dyslipidemia had a greater cIMT than male controls after adjustment for other factors (P = .049). In addition, a nonstatistically significant decrease in cIMT was observed after treatment (P = .261). Treatment with atorvastatin resulted in a significantly improved lipid profile. Females with dyslipidemia had a significantly thinner cIMT than males. Children with normal and high Lp(a) levels had similar cIMT values. In conclusion, treatment with atorvastatin had a beneficial effect on the lipid profile and cIMT progression in children with severe dyslipidemia.

Carotid Intima-Media Thickness in Healthy Children and Adolescents: Normative Data and Systematic Literature Review

Objectives: Early identification of children at risk of atherosclerosis is of paramount importance for implementing primary preventive measures addressing vascular health. Carotid intima-media thickness (cIMT) is a non-invasive biomarker of atherosclerosis. Semiautomatic radiofrequency-based software-guided technique quality intima-media thickness (RF-QIMT) was used to determine cIMT normative values in a healthy cohort of Caucasian children aged 6 to 18 years.

Study design: In a cross-sectional study, data on age, chronic illness, medication use, and pubertal status was acquired by a questioner. Anthropometric and blood pressure measurements were performed by standardized methods and trained medical personnel. cIMT of the right common carotid artery far wall (1 centimeter proximal to bifurcation) was determined using a multifrequency (3–13 MHz) electronic linear array transducer SL1543, a portable ultrasound device (MyLab Gamma Esaote, Genoa, Italy), and RF-QIMT software. A systematic review of the published normal cIMT in children was done using PRISMA methodology, and identified normative values were compared to those obtained in the presented study.

Results: 1137 non-obese normotensive children (males: n = 512; mean age 12.04 ± 3.52 years, females: n = 625, mean age 12.98 ± 3.83 years) were included. Gender-, age-, and height-specific mean cIMT percentile tables, percentile charts, and LMS tables for the RF-QIMT method were provided. They were comparable to the previously published data on mean cIMT gained by other validated ultrasound imaging techniques. cIMT increased with age, height, hip circumference, and BMI and was higher in males.

Conclusions: Gender-, age-, and height-specific normative cIMT values, using the semiautomatic software-guided RF-QIMT technique, in children aged 6 to 18 years were developed and validated in respect to the previously published pediatric normative cIMT data. It is suggested that the investigated method could be used for the estimation of atherosclerotic risk in children, especially in epidemiological studies.

Identifying early abdominal obesity risk in adolescents by telemedicine: A cross-sectional study in Greece

Obesity and thus, lipotoxicity, is a major health risk factor. Modern exposure to environmental chemicals has contributed significantly to the obesity epidemic. The purpose of this study was to assess, via telemedicine and using bioelectrical impedance analysis (BIA) in schools, the levels of adiposity and other body composition parameters of Greek adolescents in relation with their metabolic syndrome (MetS) characteristics. A representative sample (1575 adolescents, 14.4 ± 1.7 years-old) of the Attica region population, underwent body composition assessment of fat mass (FM), fat-free mass (FFM), and total body water (TBW) and was evaluated for anthropometric and MetS characteristics. Males demonstrated higher FFM% and TBW% but lower FM% than females. Adolescents with abdominal obesity/MetS (n = 149/n = 40) demonstrated significantly (P < 0.001) higher body mass index (BMI 27.8 ± 3.8 kg/m²/30.2 ± 4.2 kg/m²) and FM (33.6 ± 9.7%/35.0 ± 10.5%) but significantly (P < 0.001) lower FFM (34.2 ± 5.7%/33.8 ± 6.2%) and TBW (45.6 ± 6.7%/44.6 ± 7.2%) than adolescents without abdominal obesity/MetS (BMI 20.9 ± 2.8 kg/m²/21.3 ± 3.2 kg/m²; FM 19.2 ± 6.9%/20.2 ± 8.0%; FFM 41.3 ± 4.4%/40.8 ± 4.8%; TBW 55.5 ± 4.8%/54.8 ± 5.5%). Findings suggest that early "osteosarcopenic" elements of abdominal obesity/MetS may exist even in adolescence. The application of BIA, incorporated in the new approach methodology of telemedicine in schools, identified adolescents at risk for obesity complications.

Use of Static Cutoffs of Hypertension to Determine High cIMT in Children and Adolescents: An International Collaboration Study

BACKGROUND

Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents.

METHODS

Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs.

RESULTS

Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05).

CONCLUSION

Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.

Midlife women's health consequences associated with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common female endocrinopathies. Its symptoms may appear as early as adolescence and may include irregular menstrual periods, amenorrhea, hirsutism and obesity. Regardless of their phenotypic appearance, women with PCOS are metabolically obese. PCOS is associated with metabolic syndrome, type 2 diabetes, depression, cardiovascular disease and gynecological cancers. The metabolic disorders in obese women with PCOS are invariably due to insulin resistance, while inflammation, oxidative stress and possible interaction with environmental factors are among the features linking women with PCOS alone to metabolic disorders. The current review aims to highlight the relationship between PCOS and midlife women's health complications.

Subclinical Organ Damage in Children and Adolescents with Hypertension: Current Guidelines and Beyond

High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.

Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in Children and Adolescents: International Childhood Vascular Structure Evaluation Consortium

OBJECTIVE

It has been argued that metabolically healthy obesity (MHO) does not increase cardiovascular disease (CVD) risk. This study examines the association of MHO with carotid intima-media thickness (cIMT), a proxy of CVD risk, in children and adolescents.

RESEARCH DESIGN AND METHODS

Data were available for 3,497 children and adolescents aged 6-17 years from five population-based cross-sectional studies in Brazil, China, Greece, Italy, and Spain. Weight status categories (normal, overweight, and obese) were defined using BMI cutoffs from the International Obesity Task Force. Metabolic status (defined as "healthy" [no risk factors] or "unhealthy" [one or more risk factors]) was based on four CVD risk factors: elevated blood pressure, elevated triglyceride levels, reduced HDL cholesterol, and elevated fasting glucose. High cIMT was defined as cIMT ≥90th percentile for sex, age, and study population. Logistic regression model was used to examine the association of weight and metabolic status with high cIMT, with adjustment for sex, age, race/ethnicity, and study center.

RESULTS

In comparison with metabolically healthy normal weight, odds ratios (ORs) for high cIMT were 2.29 (95% CI 1.58-3.32) for metabolically healthy overweight and 3.91 (2.46-6.21) for MHO. ORs for high cIMT were 1.44 (1.03-2.02) for unhealthy normal weight, 3.49 (2.51-4.85) for unhealthy overweight, and 6.96 (5.05-9.61) for unhealthy obesity.

CONCLUSIONS

Among children and adolescents, cIMT was higher for both MHO and metabolically healthy overweight compared with metabolically healthy normal weight. Our findings reinforce the need for weight control in children and adolescents irrespective of their metabolic status.

Prevalence of Target Organ Damage in Chinese Hypertensive Children and Adolescents

Background: Subclinical target organ damage (TOD) has been common in hypertensive children, but there is limited data in the Chinese pediatric population. This study aimed to investigate the prevalence of subclinical TOD in the Chinese hypertensive children and adolescents. Methods: A cross-sectional study was performed in children and adolescents from four schools in Jinan, China between September 2012 and September 2014. The hypertensive status was confirmed based on elevated blood pressure across three different occasions. Those with hypertension were invited to participate in the evaluation of TOD (including heart, arteries, and kidney) and metabolic disorders. A total of 7,840 children and adolescents aged 6-17 years were recruited at baseline, of whom 373 were diagnosed as hypertensive after three separate visits, and 333 (89%) participated in evaluation of TOD. Results: Among 333 hypertensive children, 47.4% had elevated carotid intima-media thickness, 32.4% had left ventricular hypertrophy, 29.2% had dyslipidemia, 7.6% had liver dysfunction, and 4.1% had microalbuminuria. Cardiovascular damages were more prevalent in children aged 9-14 years than the other age groups (i.e., 6-8 and 15-17 years). Girls had higher proportion of microalbuminuria than boys (8.2 vs. 2.6%). No significant sex and age differences were observed for the prevalence of other TODs. Nearly all subclinical TODs were much more prevalent in hypertensive children who were overweight and obese than those with normal weight, except microalbuminuria. Conclusions: The subclinical TOD is prevalent in Chinese hypertensive children and adolescents. Effective measures should be taken to fight against subclinical TOD.

Overweight and obesity are not associated to high blood pressure in young people sport practitioners

The aim of this study was to analyze the association between overweight and obesity with high blood pressure (HBP) according to sports practice in young people. Took part in this study 636 young people aged 10 to 17 years of Londrina, Parana State, Brazil. Sex, age, parental education, sedentary behavior, sports practice, nutritional status and blood pressure were analysed. Poisson regression was used to estimate the prevalence ratio (PR) and 95% confidence intervals. Overweight and obesity young people showed higher prevalence of HBP compared to eutrophics when analysed the total sample (25,7 e 29,5 vs 15,2%) and non sport practitioners (29,7 e 33,3 vs 15,1%), which did not occur with sports practitioners (17,1 e 18,2 vs 15,5%). Positive associations were found between overweight and obesity with HBP in total sample (PR = 1,60, 1,02-2,52 and 1,93, 1,15-3,25) and on non sport practitioners (RP = 1,80, 1,05-3,14 and 2,15, 1,10-4,16). For young people sports practitioners were not found associations between overweight and obesity with HBP (PR = 1,01, 0,36-2,82 and 1,09, 0,48-2,48). Weight excess was not associated with HBP in young people sports practitioners, suggesting cardiovascular protection in young people with overweight and obesity.

Waist Circumference and Body Mass Index in Children with Chronic Kidney Disease and Metabolic, Cardiovascular, and Renal Outcomes

OBJECTIVE

To describe the prevalence of obesity as estimated by waist circumference (WC) and body mass index (BMI) and compare associations of WC and BMI with indicators of metabolic, cardiovascular, and renal health in children with chronic kidney disease (CKD).

STUDY DESIGN

Cross-sectional analysis stratified by CKD etiology (nonglomerular or glomerular) of 737 subjects. The kappa statistic was used to assess agreement between the 2 measures of obesity. Linear regression models were performed using WC and BMI as separate independent variables. Dependent variables included lipid measures, insulin resistance, blood pressure, left ventricular mass index, proteinuria, and estimated glomerular filtration rate. Associations were scaled to SD and interpreted as the change in dependent variable associated with a 1-SD change in WC or BMI.

RESULTS

There was good agreement (kappa statistic = 0.68) between WC and BMI in identifying obesity. Approximately 10% of subjects had obesity by 1 measure but not the other. BMI was more strongly associated with estimated glomerular filtration rate than WC. BMI was more strongly associated with left ventricular mass index in the nonglomerular CKD group compared with WC, but both had significant associations. The associations between WC and BMI with the remainder of the dependent variables were not significantly different.

CONCLUSIONS

Measurement of WC added limited information to BMI in this cohort. Further longitudinal study is needed to determine how WC and BMI compare in predicting outcomes, particularly for children with CKD identified as having obesity by 1 measure but not the other.

Risk factors of carotid plaque and carotid common artery intima-media thickening in a high-stroke-risk population

INTRODUCTION

To analyze the risk factors of carotid plaque (CP) and carotid common artery intima-media thickening (CCAIMT) and the association between the risk factors and CP numbers and the side of the CCAIMT in a high-stroke-risk population.

METHODS

Carotid ultrasonography was conducted in 2025 participants with high stroke risk. Participants were divided into different groups according to the results of the ultrasound. The risk factors and blood biochemical indices were recorded.

RESULTS

The presence of CP and CCAIMT were 38.9% and 24.8% respectively. Multivariate logistic regression indicated that the risk factors of CP were age, high LDL-C and FBG levels, male gender, stroke, diabetes, hypertension, and tobacco use. Compared with participants without CPs, the participants who were male, and older in age, with risk factors of tobacco use, diabetes, high LDL-C levels, and a family history of hypertension were likely to have a single CP, whereas the participants with risk factors of tobacco use, diabetes, hypertension, male gender, older age, high LDL-C levels, stroke and AF or valvulopathy were prone to have multiple CPs. The risk factors of CCAIMT were male gender, stroke, hypertension, diabetes, AF or valvulopathy, tobacco use and age. Compared with the N-CCAIMT subgroup, the risk factors of left CCAIMT were tobacco use, diabetes, male gender, and age. The risk factors of right CCAIMT were male gender, high FBG levels, age, AF or valvulopathy. The risk factors of dual CCAIMT were high frequency of drinking milk, tobacco use, male gender, age, stroke, and hypertension.

CONCLUSION

These findings revealed the risk factors of CP and CCAIMT, and an association between the risk factors and the CP numbers and the side of the CCAIMT.

The Relationship between Coronary Artery Disease Risk Factors and Carotid Intima-Media Thickness in Children

OBJECTIVE

To determine the number of coronary artery disease risk factors and the individual coronary artery disease risk factors that have a negative influence on carotid intima-media thickness in children.

STUDY DESIGN

One hundred and nineteen children (mean age 10.51 ± 0.52 years; 51% female) participated. Each subject was assessed for carotid intima-media thickness, total cholesterol, high-density lipoprotein cholesterol (HDL-C), glucose, body mass index (BMI), and resting blood pressure. Surveys assessed family history of cardiovascular disease, and physical activity. Ultrasound assessment was completed on the right and left common carotid arteries. Statistical analyses included the t test, χ² test, one-way ANOVA, and stepwise regression.

RESULTS

An increase in carotid intima-media thickness was observed with 2 vs 0 coronary artery disease risk factors for left carotid intima-media thickness (P < .001). With 3+ vs 0 coronary artery disease risk factors, increases in left (P < .001) and combined left and right carotid intima-media thickness (P < .05) were observed. BMI independently predicted carotid intima-media thickness (r = 0.410; P < .01), but HDL-C did not. However, HDL-C was significantly inversely related to BMI (r = -0.534; P < .01). Combining BMI and HDL-C provided the strongest prediction of carotid intima-media thickness (r = 0.451; adjusted R² = 0.190). Compared with children with a healthy and overweight BMI, children in the obese category had greater right (P < .00), left (P < .001), and combined right and left carotid intima-media thickness (P < .001).

CONCLUSIONS

Carotid intima-media thickness is negatively influenced by 2+ coronary artery disease risk factors. Weight status appears to have the greatest negative impact on carotid intima-media thickness in children. These findings support the need for strategies to lower BMI in children.

Association Between Short-Term Systolic Blood Pressure Variability and Carotid Intima-Media Thickness in ELSA-Brasil Baseline

BACKGROUND

Blood pressure (BP) is associated with carotid intima-media thickness (CIMT), but few studies have explored the association between BP variability and CIMT. We aimed to investigate this association in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline.

METHODS

We analyzed data from 7,215 participants (56.0% women) without overt cardiovascular disease (CVD) or antihypertensive use. We included 10 BP readings in varying positions during a 6-hour visit. We defined BP variability as the SD of these readings. We performed a 2-step analysis. We first linearly regressed the CIMT values on main and all-order interaction effects of the variables age, sex, body mass index, race, diabetes diagnosis, dyslipidemia diagnosis, family history of premature CVD, smoking status, and ELSA-Brasil site, and calculated the residuals (residual CIMT). We used partial least square path analysis to investigate whether residual CIMT was associated with BP central tendency and BP variability.

RESULTS

Systolic BP (SBP) variability was significantly associated with residual CIMT in models including the entire sample (path coefficient [PC]: 0.046; P < 0.001), and in women (PC: 0.046; P = 0.007) but not in men (PC: 0.037; P = 0.09). This loss of significance was probably due to the smaller subsample size, as PCs were not significantly different according to sex.

CONCLUSIONS

We found a small but significant association between SBP variability and CIMT values. This was additive to the association between SBP central tendency and CIMT values, supporting a role for high short-term SBP variability in atherosclerosis.

The association between blood pressure and carotid intima-media thickness in children: a systematic review

High blood pressure is a risk factor for atherosclerosis in adults, but whether the same is true in children and young people is not known. This is important to guide management of high blood pressure in children and young people. We aimed to investigate the association in children and young people between blood pressure and carotid intima-media thickness, a non-invasive marker of atherosclerosis, through a systematic review. Studies were retrieved from MEDLINE and EMBASE. Articles were eligible for inclusion if they included at least one measurement of blood pressure and at least one measurement of ultrasound-derived carotid intima-media thickness, both measured during childhood (0-19 years), and a measure of effect size or correlation between the two measurements. A total of 3748 studies were identified in the initial search, of which 28 studies were included in this review. The results were mixed, but the largest and highest-quality studies suggested an independent positive association between blood pressure and carotid intima-media thickness in children and young people, even after adjustment for other cardiovascular risk factors. There was no indication of a clear threshold level for the effect of blood pressure on carotid intima-media thickness, hence there are insufficient data to support a pharmacological treatment threshold for the treatment of high blood pressure in children and young people to prevent future cardiovascular disease. The studies included varied widely in terms of quality and design, and it was not possible to combine the data in a meta-analysis. There is likely to be an independent association between blood pressure and carotid intima-media thickness in childhood, but it is not clear at what point this should be treated.

Growth of Carotid Intima-Media Thickness in Black and White Young Adults

Background

There are few longitudinal studies that have comprehensively examined the intima‐media thickness (IMT) growth pattern and its determinants among racial population groups.

Methods and Results

Mean and maximum IMT were measured by B‐mode ultrasonography up to 3 times in 253 white and 268 black participants, aged 13 to 36 years (mean age±standard deviation 24±3.2 years old). The development of IMT was assessed using individual growth curve modeling. A total of 521 participants with 1015 IMT measurements were eligible for this study. We found higher IMT in both left and right sides in blacks compared to whites (P<0.001) in young adulthood. Both whites and blacks showed a strong linear increase in mean IMT with age. Body mass index and father's education level were associated with mean IMT, and only body mass index was associated with maximum IMT (P<0.05). We did not observe an interaction between age and race/ethnicity on the growth of IMT, suggesting that blacks and whites developed IMT in similar patterns. Interestingly, we found a faster increase in mean left‐side IMT than mean right‐side IMT (χ²=11.5, P<0.001) in both black and white subjects as well as in males and females.

Conclusions

Our findings provide compelling prospective evidence that blacks may have thicker IMT compared to whites as young adults. These racial differences could not be explained by traditional risk factors. This implies that differences in this precursor of atherosclerosis may explain racial disparity in cerebrovascular disease.

Relation between visceral fat and carotid intimal media thickness in Mexican postmenopausal women: a preliminary report

Aim of the study

To investigate the relationship between visceral fat and carotid IMT (intima media thickness) in Mexican postmenopausal women.

Material and methods

In 71 postmenopausal women divided in two groups: group 1, IMT > 1 mm and group 2, IMT ≤ 1 mm, blood pressure, body mass index (BMI), waist hip ratio (WHR), visceral and subcutaneous fats and carotid IMT were analyzed. Descriptive statistics were used and the comparison among those with abnormal and normal IMT was carried out using Mann-Whitney U test; also Spearman's correlation analysis was done.

Results

When comparing group 1 (n = 9, 12.7%) with group 2 (n = 62, 87.3%), it was found that the subcutaneous fat, visceral fat and systolic blood pressure were significantly greater in group 1 (p < 0.018, p < 0.001 and p < 0.006, respectively), and also in this group there was a correlation between BMI and subcutaneous fat (ρ = 0.686, p < 0.041) and between visceral fat and the systolic blood pressure (ρ = 0.712, p < 0.031). In group 2, there was a correlation between IMT and diastolic blood pressure (ρ = 0.251, p < 0.049).

Conclusion

Subcutaneous and visceral fat have an unfavorable effect in the carotid IMT and in blood pressure.

Effects of Thyroid Autoimmunity on Early Atherosclerosis in Euthyroid Girls with Hashimoto's Thyroiditis

OBJECTIVE

In the current study, we aimed to investigate whether thyroid autoimmunity (TA) had any effect on carotid intima-media thickness (cIMT) and enhanced the risk of cardiovascular disease (CVD) independent of thyroid function (TF) in pubertal girls with Hashimoto's thyroiditis (HT).

METHODS

Sixty-six newly diagnosed euthyroid girls with HT with a mean age of 14.4±2.4 years were included in the study. The control group consisted of 41 age- and body mass index (BMI)-matched healthy girls. At enrollment, all subjects underwent physical examination including blood pressure, standing height, weight, waist circumference (WC), and hip circumference measurements. The lipid profile, high-sensitivity C-reactive protein (hs-CRP), homocysteine, blood glucose, insulin, TF, and thyroid antibodies were measured, and thyroid ultrasound and cIMT were performed.

RESULTS

There were no significant differences in anthropometric variables between the two groups, but the patients with HT had significantly higher waist-to-hip ratio (WHR). Thyroid hormones, insulin, homocysteine, and homeostatic model assessment-insulin resistance were not different between the two groups. Serum hs-CRP levels were significantly higher in patients than controls (3.4 ng/mL vs. 2.03 ng/mL), (p<0.001). Patients were also characterized by significantly higher total cholesterol (166.4±27 mg/dL vs. 151±22 mg/dL), (p<0.01) and low-density cholesterol (95.8±24.4 mg/dL vs. 82.6±20.7 mg/dL), (p<0.01) levels. Patients, regardless of TF, had significantly increased cIMT compared with controls [0.28 mm vs. 0.25 mm, (p<0.001)], and cIMT was correlated with weight-standard deviation score (SDS), BMI-SDS, WC-SDS, and WHR. This increase in cIMT was associated independently with BMI-SDS and hs-CRP levels.

CONCLUSION

TA may be related to chronic inflammation, which may cause endothelial dysfunction, a promoter of atherosclerosis in girls with HT. cIMT is a good tool for the early detection and the monitoring of early atherosclerosis in euthyroid patients with HT. Early detection of risk factors of CVD, may be helpful for planning treatment and interventions, so as to prevent complications from the disease in adulthood.

Pressão arterial elevada em adolescentes e fatores associados: um estudo de base escolar em Uruguaiana, Rio Grande do Sul, 2011

Resumo Objetivos: identificar a prevalência de pressão arterial (PA) elevada e seus fatores associados em adolescentes de Uruguaiana (RS), 2011. Métodos: amostra probabilística composta por adolescentes de 10 a 17 anos de escolas públicas. A PA foi aferida pelo método auscultatório e classificada em normal ou elevada (PA acima do percentil 90). Fatores sociodemográficos, psicossociais, comportamentais, estado nutricional e aptidão física foram analisados. Foi realizada uma análise de regressão logística considerando um modelo teórico hierárquico. Resultados: participaram do estudo 1455 adolescentes (741 do sexo feminino). A prevalência de PA sistólica e PA diastólica elevadas foram de 16,4% (IC95%: 14,4-18,4) e de 18,5% (IC95%: 16,4-20,6), respectivamente. Permaneceram associados à PA sistólica e diastólica elevadas no modelo final: se perceber menos em forma que seus pares (sistólica OR: 2,27; IC95%: 1,22-4,23; diastólica OR: 2,99; IC95%: 1,34-6,70) e o sobrepeso e obesidade (sistólica OR: 9,29; IC95%: 4,89-17,69; diastólica OR: 4,70; IC95%: 2,61-8,45). Ainda, adolescentes do sexo feminino (OR: 1,39; IC95%: 1,02-1,90) e de maior nível socioeconômico (OR: 2,39; IC95%: 1,31- 4,36) têm mais chance de apresentarem PA sistólica elevada. Conclusões: a prevalência de PA elevada encontrada entre os adolescentes é alta. Para sua prevenção, programas de combate ao excesso de peso considerando características sociodemográficas como o sexo e nível socioeconômico devem ser elaboradas

Adiposity and carotid-intima media thickness in children and adolescents: a systematic review

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.

Prehypertension and Hypertension among Schoolchildren in Brazzaville, Congo

Background. To determine the prevalence and associated factors of prehypertension (pre-HT) and hypertension (HT) in schoolchildren at Brazzaville (Congo). Methods. This cross-sectional study was conducted from March to May 2011 in five representative urban schools in Brazzaville. American Pediatric Society's definition of pre-HT and HT was used. The measurement of blood pressure was obtained using auscultator method. Univariable and multivariable analyses were performed to establish associations between blood pressure levels and sociobiographical factors. Results. 603 children were included. The mean age was 11.8 ± 3.6 years (range 5-18 years). The prevalence of pre-HT was 20.7% (n = 125). Factors associated with pre-HT were secondary school (P = 0.02), private schools (P < 0.004), migrants (P = 0.03), the obese (P = 0.004), high socioeconomic level (P < 0.01), and overweight (P = 0.02). In logistic regression, the independent determinants of pre-HT were secondary school (P = 0.0001), migration (P = 0.04), obesity (P = 0.004), and overweight (P = 0.01). The prevalence of HT was 10.1% (n = 61) during the first screening and 3.3% (n = 20) in second screening. The independent determinants of HT were obesity (P = 0.0001) and overweight (P = 0.0001). Conclusion. Pre-HT and HT are emerging as a mass problem in Congolese schoolchildren with urban migration and overweight/obesity to be controlled and prevented.

Association between anthropometric measures of obesity and subclinical atherosclerosis in Bangladesh

BACKGROUND

Anthropometric measures such as waist-hip-ratio (WHR), waist-height-ratio (WHtR), waist circumference, Mid-upper arm circumference (MUAC), and upper thigh circumference, have been linked to the risk of cardiovascular disease (CVD). However, their relationships with subclinical atherosclerosis are unclear. Studies in normal-weight populations, especially in Asian countries where leanness is prevalent, are lacking.

METHODS

We conducted a cross-sectional study to assess the associations of WHR, WHtR, waist circumference, hip circumference, body mass index (BMI), MUAC and upper thigh circumference with carotid intima-media thickness (cIMT) among 562 middle-aged participants free of CVD in rural Bangladesh.

RESULTS

After adjusting for age and sex, WHR and waist circumference but not BMI showed a positive significant association with cIMT. In multivariate analysis, each standard deviation (SD) increase of WHR (0.08) or WHtR (0.07) was associated with an 8.96 μm (95% CI, 1.12-16.81) or 11.45 μm (95%CI, 0.86-22.04) difference in cIMT, respectively, after controlling for age, sex, BMI, smoking status, education level, and systolic blood pressure (SBP). The associations of WHR and WHtR with cIMT were independent of the influence of other anthropometric measures. The associations of other anthropometric measures and cIMT were not apparent.

CONCLUSIONS

In our relatively lean, healthy Asian population, WHR and WHtR appear to be better predictors of early atherosclerosis than other common surrogates of adiposity.