1
|
Pinto-Silva C, Correia-Costa A, Moura C, Mota C, Guerra A, Areias JC, Schaefer F, Afonso AC, Wühl E, Azevedo A, Correia-Costa L. Cardiovascular rhythmicity in overweight and obese children. J Bras Nefrol 2023; 45:449-457. [PMID: 37527530 PMCID: PMC10726656 DOI: 10.1590/2175-8239-jbn-2022-0138en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/17/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts. METHODS We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms. RESULTS Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms. DISCUSSION The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications.
Collapse
Affiliation(s)
- Catarina Pinto-Silva
- Centro Hospitalar Universitário de Coimbra, Divisão de Pediatria, Coimbra, Portugal
| | - Ana Correia-Costa
- Universidade do Porto, Faculdade de Medicina da Universidade do Porto, Divisão de Pediatria, Porto, Portugal
- Centro Hospitalar e Universitário de São João, Divisão de Cardiologia Pediátrica, Porto, Portugal
| | - Cláudia Moura
- Universidade do Porto, Faculdade de Medicina da Universidade do Porto, Divisão de Pediatria, Porto, Portugal
- Centro Hospitalar e Universitário de São João, Divisão de Cardiologia Pediátrica, Porto, Portugal
| | - Cláudia Mota
- Universidade do Porto, Faculdade de Medicina da Universidade do Porto, Divisão de Pediatria, Porto, Portugal
| | - António Guerra
- Centro Hospitalar e Universitário de São João, Divisão de Cardiologia Pediátrica, Porto, Portugal
- Centro Hospitalar Universitário de São João, Serviço de Pediatria, Unidade de Nutrição Pediátrica, Porto, Portugal
| | - José Carlos Areias
- Universidade do Porto, Faculdade de Medicina da Universidade do Porto, Divisão de Pediatria, Porto, Portugal
- Centro Hospitalar e Universitário de São João, Divisão de Cardiologia Pediátrica, Porto, Portugal
| | - Franz Schaefer
- Universidade de Heidelberg, Centro de Pediatria e Medicina do Adolescente, Divisão de Nefrologia Pediátrica, Heidelberg, Alemanha
| | - Alberto Caldas Afonso
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal
- Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Universidade do Porto, Instituto de Saúde Pública, Unidade de Investigação em Epidemiologia, Porto, Portugal
| | - Elke Wühl
- Universidade de Heidelberg, Centro de Pediatria e Medicina do Adolescente, Divisão de Nefrologia Pediátrica, Heidelberg, Alemanha
| | - Ana Azevedo
- Universidade do Porto, Instituto de Saúde Pública, Unidade de Investigação em Epidemiologia, Porto, Portugal
- Universidade do Porto, Faculdade de Medicina, Saúde Pública e Ciências Forenses, Departamento de Educação Médica, Porto, Portugal
| | - Liane Correia-Costa
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal
- Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Universidade do Porto, Instituto de Saúde Pública, Unidade de Investigação em Epidemiologia, Porto, Portugal
| |
Collapse
|
2
|
Hemoglobin A1c and C-reactive protein are independently associated with blunted nocturnal blood pressure dipping in obesity-related prediabetes. Hypertens Res 2017; 41:33-38. [PMID: 29070829 DOI: 10.1038/hr.2017.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/11/2017] [Accepted: 06/07/2017] [Indexed: 12/12/2022]
Abstract
Blunted nocturnal dipping in blood pressure (BP) is associated with increased cardiovascular disease (CVD) risk in middle-aged/older adults. The prevalence of blunted nocturnal BP dipping is higher in persons with obesity and diabetes, conditions that are also associated with elevated aortic stiffness and inflammation. Therefore, we hypothesized that elevated glycemia, inflammation and aortic stiffness would be inversely associated with the magnitude of nocturnal systolic BP dipping among middle-aged/older adults with obesity at high CVD risk. Twenty-four hour ambulatory BP monitoring, aortic stiffness (carotid-femoral pulse wave velocity, CF-PWV), hemoglobin A1c (HbA1c) and inflammation (C-reactive protein, CRP) were measured in 86 middle-aged/older adults with obesity and at least one other CVD risk factor (age 40-74 years; 34 male/52 female; body mass index=36.7±0.5 kg m-2; HbA1c=5.7±0.04%). In the entire cohort, CRP (β=0.40±0.20, P=0.04), but not HbA1c or CF-PWV was independently associated with systolic BP dipping percent (Model R2=0.07, P=0.12). In stratified (that is, presence or absence of prediabetes) multiple linear regression analysis, HbA1c (β=6.24±2.6, P=0.02) and CRP (β=0.57±0.2, P=0.01), but not CF-PWV (β=0.14± 2.6, P=0.74), were independently associated with systolic BP dipping percent (Model R2=0.32, P<0.01) in obese adults with prediabetes but were absent in obese adults without prediabetes (Model R2=0.01 P=0.95). However, nocturnal systolic BP dipping percent (P=0.65), CF-PWV (P=0.68) and CRP (P=0.59) were similar between participants with and without prediabetes. These data suggest that impaired long-term glycemic control and higher inflammation may contribute partly to blunted BP dipping in middle-aged/older adults with obesity-related prediabetes.
Collapse
|
3
|
Harris KC, Benoit G, Dionne J, Feber J, Cloutier L, Zarnke KB, Padwal RS, Rabi DM, Fournier A. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension. Can J Cardiol 2016; 32:589-97. [DOI: 10.1016/j.cjca.2016.02.075] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 12/31/2022] Open
|
4
|
Correia-Costa L, Sousa T, Morato M, Cosme D, Afonso J, Moura C, Mota C, Areias JC, Guerra A, Schaefer F, Caldas Afonso A, Barros H, Albino-Teixeira A, Azevedo A. Association of myeloperoxidase levels with cardiometabolic factors and renal function in prepubertal children. Eur J Clin Invest 2016; 46:50-9. [PMID: 26541603 DOI: 10.1111/eci.12564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Myeloperoxidase (MPO), an enzyme linking obesity and cardiovascular (CV) risk in adults, has rarely been studied in young children and no studies assessed its association with renal function. We sought to explore a possible association between serum MPO levels, obesity, CV risk factors and renal function in prepubertal children. MATERIALS/METHODS Cross-sectional evaluation of 309 children aged 8-9 years (161 normal weight, 148 overweight/obese), members of the birth cohort Generation I (Portugal). Anthropometrics (body mass index (BMI), waist-to-height ratio (WHtR) and % body fat mass (%BFM) by bioelectrical impedance analysis), 24-h ambulatory blood pressure monitoring and pulse wave velocity (PWV) were measured. Insulin resistance was estimated by the HOMA index (considering serum fasting glucose and insulin determinations). Serum MPO levels were assessed by immunoenzymatic assay. RESULTS MPO levels were positively associated with obesity indices (BMI z-score, WHtR and %BFM). Higher MPO levels were associated with higher 24-h and night-time mean arterial pressure, with nondipping and with higher values of insulin resistance. In normal weight children, the endothelial function, as evaluated indirectly by PWV, was an independent predictor of MPO levels. In overweight/obese children, estimated glomerular filtration rate increased significantly across tertiles of MPO (Ptrend = 0·031) and this association held after adjustment for age, sex, neutrophil and monocyte counts and CV risk factors. CONCLUSIONS Our results reinforce the role of MPO as a risk marker in obesity and related CV morbidities in young children. MPO levels associate with the dipping pattern and PWV and, among overweight/obese children, an association exists between MPO and renal function.
Collapse
Affiliation(s)
- Liane Correia-Costa
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Division of Pediatric Nephrology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal
| | - Teresa Sousa
- Department of Pharmacology and Therapeutics, Faculty of Medicine of University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Manuela Morato
- Department of Pharmacology and Therapeutics, Faculty of Medicine of University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.,Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of Porto, REQUIMTE, University of Porto, Porto, Portugal
| | - Dina Cosme
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Pharmacology and Therapeutics, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Cláudia Moura
- Division of Pediatric Cardiology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal
| | - Cláudia Mota
- Division of Pediatric Cardiology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal
| | - José Carlos Areias
- Division of Pediatric Cardiology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal
| | - António Guerra
- Division of Pediatric Nutrition, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Alberto Caldas Afonso
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Division of Pediatric Nephrology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - António Albino-Teixeira
- Department of Pharmacology and Therapeutics, Faculty of Medicine of University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
6
|
Conkar S, Yılmaz E, Hacıkara Ş, Bozabalı S, Mir S. Is Daytime Systolic Load an Important Risk Factor for Target Organ Damage in Pediatric Hypertension? J Clin Hypertens (Greenwich) 2015; 17:760-6. [PMID: 26140344 PMCID: PMC8031531 DOI: 10.1111/jch.12608] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/13/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
The aim of this study was to compare ambulatory blood pressure (BP) monitoring (ABPM) data and determine which hypertension type is a risk factor in target organ damage. A total of 82 children (47 boys) with suspected hypertension based on office BP measurements and considered hypertensive by ABPM were studied. Target organ damage included the following: 35.3% hypertensive retinopathy, 25.6% microalbuminuria, 15.8% increased left ventricular mass index, 29.2% increased carotid intima-media thickness (cIMT), 24.3% high augmentation index (AIx), and 19.5% high pulse wave velocity (PWV). The association between BP load, PWV, and cIMT was statistically significant. There were significant correlations between daytime systolic BP load, PWV, AIx, and cIMT. A statistically significant difference was also detected between nighttime systolic BP load, PWV, and cIMT values and nighttime diastolic BP load levels and values of AIx and cIMT. There was also a statistically significant difference between the high level of nighttime diastolic BP load and cIMT. The authors found that target organ damage was seen more often in children with primary hypertension who had systolic loads.
Collapse
Affiliation(s)
- Seçil Conkar
- Department of Pediatric NephrologyEge University Medical FacultyIzmirTurkey
| | - Ebru Yılmaz
- Dr. Behcet Uz Children Diseases Teaching and Research Hospital Pediatric NephrologyIzmirTurkey
| | - Şükriye Hacıkara
- Department of Pediatric NephrologyEge University Medical FacultyIzmirTurkey
| | - Sibel Bozabalı
- Department of Pediatric CardiologyEge University Medical FacultyIzmirTurkey
| | - Sevgi Mir
- Department of Pediatric NephrologyEge University Medical FacultyIzmirTurkey
| |
Collapse
|
7
|
Normia J, Laitinen K, Isolauri E, Poussa T, Jaakkola J, Ojala T. Impact of intrauterine and post-natal nutritional determinants on blood pressure at 4 years of age. J Hum Nutr Diet 2013; 26:544-52. [DOI: 10.1111/jhn.12115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. Normia
- Department of Paediatrics; University of Turku and Turku University Hospital; Turku Finland
- Functional Foods Forum; University of Turku; Turku Finland
- Turku Health Centre; Turku Finland
| | - K. Laitinen
- Functional Foods Forum; University of Turku; Turku Finland
- Institute of Biomedicine; University of Turku; Turku Finland
| | - E. Isolauri
- Department of Paediatrics; University of Turku and Turku University Hospital; Turku Finland
| | | | - J. Jaakkola
- Department of Paediatrics; University of Turku and Turku University Hospital; Turku Finland
- Functional Foods Forum; University of Turku; Turku Finland
| | - T. Ojala
- Hospital for Children and Adolescents; University of Helsinki; Helsinki Finland
| |
Collapse
|