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Repo O, Juonala M, Niinikoski H, Rovio S, Mykkänen J, Lagström H, Cheung CY, Yang D, Vaahtoranta-Lehtonen H, Jula A, Nevalainen J, Rönnemaa T, Viikari J, Raitakari O, Tapp R, Pahkala K. Randomized 20-year infancy-onset dietary intervention, life-long cardiovascular risk factors and retinal microvasculature. Eur Heart J 2024; 45:3072-3085. [PMID: 38995853 PMCID: PMC11365608 DOI: 10.1093/eurheartj/ehae423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/01/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND AND AIMS Retinal microvasculature characteristics predict cardiovascular morbidity and mortality. This study investigated associations of lifelong cardiovascular risk factors and effects of dietary intervention on retinal microvasculature in young adulthood. METHODS The cohort is derived from the longitudinal Special Turku Coronary Risk Factor Intervention Project study. The Special Turku Coronary Risk Factor Intervention Project is a 20-year infancy-onset randomized controlled dietary intervention study with frequent study visits and follow-up extending to age 26 years. The dietary intervention aimed at a heart-healthy diet. Fundus photographs were taken at the 26-year follow-up, and microvascular measures [arteriolar and venular diameters, tortuosity (simple and curvature) and fractal dimensions] were derived (n = 486). Cumulative exposure as the area under the curve for cardiovascular risk factors and dietary components was determined for the longest available time period (e.g. from age 7 months to 26 years). RESULTS The dietary intervention had a favourable effect on retinal microvasculature resulting in less tortuous arterioles and venules and increased arteriolar fractal dimension in the intervention group when compared with the control group. The intervention effects were found even when controlled for the cumulative cardiovascular risk factors. Reduced lifelong cumulative intake of saturated fats, main target of the intervention, was also associated with less tortuous venules. Several lifelong cumulative risk factors were independently associated with the retinal microvascular measures, e.g. cumulative systolic blood pressure with narrower arterioles. CONCLUSIONS Infancy-onset 20-year dietary intervention had favourable effects on the retinal microvasculature in young adulthood. Several lifelong cumulative cardiovascular risk factors were independently associated with retinal microvascular structure.
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Affiliation(s)
- Oskari Repo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Harri Niinikoski
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Suvi Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Juha Mykkänen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Hanna Lagström
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
- Department of Public Health, Turku University Hospital, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Jaakko Nevalainen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Robyn Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Research Institute for Health and Wellbeing, Coventry University, Coventry, United Kingdom
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
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2
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Chen Y, Liu Y, Cong L, Liu A, Song X, Liu W, Hua R, Shen Q, Shao Y, Xue Y, Yao Q, Zhang Y. Sleeve gastrectomy improved microvascular phenotypes from obesity cohort, detected with optical coherence tomography angiography. J Diabetes 2023; 15:313-324. [PMID: 36872300 PMCID: PMC10101840 DOI: 10.1111/1753-0407.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
AIMS To examine how metabolic status is associated with microvascular phenotype and to identify variables associated with vascular remodeling after bariatric surgery, using noninvasive optical coherence tomography angiography (OCTA). METHODS The study included 136 obese subjects scheduled for bariatric surgery and 52 normal-weight controls. Patients with obesity were divided into metabolically healthy obesity (MHO) and metabolic syndrome (MetS) groups according to the diagnosis criteria of the Chinese Diabetes Society. Retinal microvascular parameters were measured by OCTA, including superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities. Follow-ups were performed at the baseline and 6 months after bariatric surgery. RESULTS Fovea SCP, average DCP, fovea DCP, parafovea DCP, and perifovea DCP vessel densities were significantly lower in the MetS group, compared to controls (19.91% vs. 22.49%, 51.60% vs. 54.20%, 36.64% vs. 39.14%, 56.24% vs. 57.65% and 52.59% vs. 55.58%, respectively, all p < .05). Parafovea SCP, average DCP, parafovea DCP, and perifovea DCP vessel densities significantly improved in patients with obesity 6 months after surgery, compared to baseline (54.21% vs. 52.97%, 54.43% vs. 50.95%, 58.29% vs. 55.54% and 55.76% vs. 51.82%, respectively, all p < .05). Multivariable analyses showed that baseline blood pressure and insulin were independent predictors of vessel density changes 6 months after surgery. CONCLUSIONS Retinal microvascular impairment occurred mainly in MetS rather than MHO patients. Retinal microvascular phenotype improved 6 months after bariatric surgery and baseline blood pressure and insulin status may be key determinants. OCTA may be a reliable method to evaluate the microvascular complications associated with obesity.
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Affiliation(s)
- Yaying Chen
- Department of OphthalmologyHuadong Hospital, Fudan UniversityShanghaiChina
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yanyang Liu
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Lin Cong
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Ailin Liu
- Department of UltrasoundHuashan Hospital, Fudan UniversityShanghaiChina
| | - Xiangyuan Song
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Wenting Liu
- Department of OphthalmologyHuadong Hospital, Fudan UniversityShanghaiChina
| | - Rong Hua
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Qiwei Shen
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yikai Shao
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yiwen Xue
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Qiyuan Yao
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yuyan Zhang
- Department of OphthalmologyHuadong Hospital, Fudan UniversityShanghaiChina
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Hanssen H. Vascular biomarkers in the prevention of childhood cardiovascular risk: From concept to clinical implementation. Front Cardiovasc Med 2022; 9:935810. [PMID: 36072878 PMCID: PMC9441864 DOI: 10.3389/fcvm.2022.935810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
Vascular biomarkers allow for non-invasive assessment of vascular structure and function and have been shown to be surrogates for cardiovascular (CV) outcome in adults. They reflect the cumulative risk of a plethora of single CV risk factors, such as obesity and hypertension, on the arterial wall. The process of atherosclerosis oftentimes has its origin in childhood and tracks into adulthood. Obesity-related CV risk in childhood is a main determinant of manifest CV disease and adverse outcome in adulthood. To date, prevention strategies are directed toward the detection and reduction of CV disease in adulthood. This review updates and puts into perspective the potential use of vascular biomarkers in children. With reference to the concept of early vascular aging in adults, it elaborates on the role of vascular biomarkers for CV risk stratification in children. The concept of primordial vascular aging implies that young children be screened for vascular health, in an attempt to timely detect subclinical atherosclerosis and initiate treatment strategies to reverse vascular damage in a period of life with high probability for risk regression. The evidence for the validity of macro- and microvascular candidate biomarkers as screening tools of CV risk in children is reviewed, and limitations as well as remaining research gaps are highlighted. Furthermore, an overview on the effects of exercise treatment on vascular biomarkers is given. Vascular biomarkers susceptible to lifestyle or drug treatment have the potential to qualify as monitoring tools to guide clinicians. This review discusses evidence for vascular biomarkers to optimize screening of childhood CV risk from initial concepts to potential future clinical implementation in cardiovascular prevention.
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Hanssen H, Streese L, Vilser W. Retinal vessel diameters and function in cardiovascular risk and disease. Prog Retin Eye Res 2022; 91:101095. [PMID: 35760749 DOI: 10.1016/j.preteyeres.2022.101095] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular structure and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological essentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland.
| | - Lukas Streese
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany; Neonatology and Pediatric Intensive Care Unit, Department of Pediatrics, Jena University Hospital, Jena, Germany
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5
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Aydemir GA, Aydemir E, Asik A, Bolu S. Changes in ocular pulse amplitude and choroidal thickness in childhood obesity patients with and without insulin resistance. Eur J Ophthalmol 2021; 32:2018-2025. [PMID: 34382437 DOI: 10.1177/11206721211039337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare choroidal thickness (CT) and ocular pulse amplitude (OPA) in childhood obesity with insulin resistance (IR) and without IR. METHODS Seventy-three childhood obesity and 62 healthy children, who were both age-matched and gender-matched, comprised the study population in this prospective study. Obesity was determined as having a body mass index (BMI) - standard deviation (SD) score that was > 2 SD.Intraocular pressure (IOP) and OPA were measured using a dynamic contour tonometer. The CT measurements were performed using enhanced depth imaging optical coherence tomography at three locations, comprising at the fovea, at a position 500 µm nasal, and also at a position 500 µm temporal to the fovea. RESULTS Mean BMI value was 28.72 ± 4.85 in the patients with childhood obesity and 21.47 ± 1.14 in the control group. The mean IOP and OPA values were determined 15.90 ± 2.30 and 14.10 ± 2.16 mm Hg, 1.50 ± 0.28 and 1.74 ± 0.32 mm Hg in the patients with childhood obesity and the control group, respectively (p < 0.001, p < 0.001). The mean subfoveal CT value was 350.50 ± 81.51 μm in the eyes with childhood obesity and 390.02 ± 71.50 μm in those of the control group (p = 0.003). When the patient groups with and without IR were compared, no significant difference was found between CT, OPA and IOP values (p > 0.005). CONCLUSIONS Our results showed that both OPA and CT values were significantly decreased in childhood obesity patients. We suggest further studies to verify longitudinal changes in OPA and CT, as also the evaluation of these parameters in other populations.
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Affiliation(s)
- Gözde Aksoy Aydemir
- Ophthalmology Department, Adıyaman University Education and Research Hospital, Adıyaman, Turkey
| | - Emre Aydemir
- Ophthalmology Department, Adıyaman University Education and Research Hospital, Adıyaman, Turkey
| | - Abdulvahit Asik
- Department of Pediatrics, Adıyaman University Education and Research Hospital, Adıyaman, Turkey
| | - Semih Bolu
- Department of Pediatrics, Adıyaman University Education and Research Hospital, Adıyaman, Turkey
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6
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Ho A, Cheung CY, Wong JS, Zhang Y, Tang FY, Kam KW, Young AL, Chen LJ, Ip P, Wong TY, Pang CP, Tham CC, Yam JC. Independent and Synergistic Effects of High Blood Pressure and Obesity on Retinal Vasculature in Young Children: The Hong Kong Children Eye Study. J Am Heart Assoc 2021; 10:e018485. [PMID: 33496185 PMCID: PMC7955451 DOI: 10.1161/jaha.120.018485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High blood pressure (BP) and obesity are becoming increasingly prevalent among children globally. Although prior studies have shown their adverse impacts on macrovascular health, less is known about their effects on microvascular heath. This study aims to evaluate the independent and synergistic effects of hypertensive BP and obesity on retinal vasculature in young children. Method and Results 1006 children aged 6 to 8 years were recruited from the Hong Kong Children Eye Study. Quantitative retinal vascular parameters, including central retinal arteriolar and venular equivalents and retinal arteriolar and venular fractal dimensions, were measured from retinal photographs following a standardized protocol. BP and body mass index were categorized according to reference values from American Academy of Pediatrics and International Obesity Task Force guidelines respectively. Children with hypertensive systolic BP had the narrowest central retinal arteriolar equivalents compared with children with either elevated or normotensive systolic BP (162.4, 164.6, and 167.1 µm; P-trend <0.001). Increased standardized systolic BP was associated with narrower central retinal arteriolar equivalents (β=-2.276 µm, P<0.001), wider central retinal venular equivalents (1.177, P=0.007), and decreased arteriolar fractal dimensions (β=-0.004, P=0.034). Children with obesity had the smallest arteriolar fractal dimensions compared with children with overweightness and normal weight (1.211, 1.234, and 1.240; P-trend=0.004). Children with both hypertensive BP and either overweightness or obesity had the narrowest central retinal arteriolar equivalents and smallest arteriolar Df (P-trend<0.001 and P-trend=0.007). Conclusions Our findings demonstrate the potential synergistic or additive effects for both hypertensive BP and obesity on retinal vasculature in children.
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Affiliation(s)
- Agnes Ho
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China
| | - Jason S Wong
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China.,Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Hong Kong SAR China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China.,Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Hong Kong SAR China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China.,Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Hong Kong SAR China.,Hong Kong Hub of Paediatric Excellence The Chinese University of Hong Kong Hong Kong SAR China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine LKS Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Tien Y Wong
- Singapore Eye Research Institute Singapore National Eye Center Duke-NUS Medical SchoolNational University of Singapore Singapore
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China.,Hong Kong Hub of Paediatric Excellence The Chinese University of Hong Kong Hong Kong SAR China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China.,Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Hong Kong SAR China.,Hong Kong Hub of Paediatric Excellence The Chinese University of Hong Kong Hong Kong SAR China.,Hong Kong Eye Hospital Hong Kong SAR China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong Hong Kong SAR China.,Department of Ophthalmology and Visual Sciences Prince of Wales Hospital Hong Kong SAR China.,Hong Kong Hub of Paediatric Excellence The Chinese University of Hong Kong Hong Kong SAR China.,Hong Kong Eye Hospital Hong Kong SAR China.,Department of Ophthalmology Hong Kong Children's Hospital Hong Kong SAR China
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7
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Sousa‐Sá E, Zhang Z, Pereira JR, Wright IM, Okely AD, Santos R. Systematic review on retinal microvasculature, physical activity, sedentary behaviour and adiposity in children and adolescents. Acta Paediatr 2020; 109:1956-1973. [PMID: 31998981 DOI: 10.1111/apa.15204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/16/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
AIM As retinal microvasculature (RMV) can be assessed non-invasively, it presents an opportunity to examine the health and disease of the human microcirculation, as RMV alterations have been recognised as one of the earliest signs of cardiovascular risk. This review summarises current literature on the associations between physical activity (PA), sedentary behaviour (SB) and/or adiposity and RMV in children and adolescents aged 0-18 years. METHODS Six databases were searched (MEDLINE, Scopus, Web of Science, ScienceDirect, PsycINFO and CINAHL), through to December 11, 2019. English, Portuguese, French, Spanish or Dutch were the languages searched. Meta-analyses were performed using the meta-analyst software. RESULTS A total of 6796 studies were screened, and 26 studies were included, representing 24 448 participants, from 12 different countries. Studies reporting results on weight status were twenty-three, PA was assessed in six studies, and SB was assessed in three studies. Four studies examined weight status and PA/SB. Meta-analysis was performed for two studies and showed that children with obesity have smaller retinal arterioles (-2.38 µm difference, 95% CI 0.62, 4.15 µm) and larger retinal venules (2.74 µm difference, 95% CI -4.78, -0.72 µm) than children without obesity. CONCLUSION Results showed that adiposity was associated with microvascular alterations in children and adolescents. Increased adiposity, lack of PA and high levels of SB were negatively correlated with vessel width parameters.
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Affiliation(s)
- Eduarda Sousa‐Sá
- Early Start University of Wollongong Wollongong NSW Australia
- Illawarra Health and Medical Research Institute Wollongong NSW Australia
| | - Zhiguang Zhang
- Early Start University of Wollongong Wollongong NSW Australia
| | - João R. Pereira
- Early Start University of Wollongong Wollongong NSW Australia
- Research Unit for Sport and Physical Activity University of Coimbra Coimbra Portugal
| | - Ian M. Wright
- Illawarra Health and Medical Research Institute Wollongong NSW Australia
| | - Anthony D. Okely
- Early Start University of Wollongong Wollongong NSW Australia
- Illawarra Health and Medical Research Institute Wollongong NSW Australia
| | - Rute Santos
- Early Start University of Wollongong Wollongong NSW Australia
- Research Centre in Physical Activity, Health and Leisure University of Porto Porto Portugal
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8
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Li W, Baumbach J, Larsen MJ, Mohammadnejad A, Lund J, Christensen K, Christiansen L, Tan Q. Differential long noncoding RNA profiling of BMI in twins. Epigenomics 2020; 12:1531-1541. [PMID: 32901529 DOI: 10.2217/epi-2020-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Many efforts have been deployed to identify genetic variants associated with BMI. Alternatively, we explore epigenetic contribution to BMI variation by focusing on long noncoding RNAs (lncRNAs) which represents a key layer of epigenetic control. Materials & methods: We analyzed lncRNA expression in whole blood of 229 monozygotic twin pairs in association with BMI using generalized estimating equations. Results & conclusion: Six lncRNA probes were identified as significant (false discovery rate <0.05), with BMI showing causal effects on the expression of the significant lncRNAs. Functional annotation of differential profiles identified Gene ontology biological processes including kidney development, regulations of lipid biosynthetic process, circadian rhythm, notch signaling, etc. Whole blood lncRNAs are significantly expressed in response to BMI variation.
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Affiliation(s)
- Weilong Li
- Unit of Epidemiology, Biostatistics & Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jan Baumbach
- Computational BioMedicine, Department of Mathematics & Computer Science, University of Southern Denmark, Odense, Denmark.,Chair of Experimental Bioinformatics, TUM School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Martin J Larsen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Afsaneh Mohammadnejad
- Unit of Epidemiology, Biostatistics & Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Lund
- Unit of Epidemiology, Biostatistics & Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics & Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Christiansen
- Unit of Epidemiology, Biostatistics & Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Qihua Tan
- Unit of Epidemiology, Biostatistics & Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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9
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Liu M, Lycett K, Wong TY, Kerr JA, He M, Juonala M, Olds T, Dwyer T, Burgner D, Wake M. Do body mass index and waist-to-height ratio over the preceding decade predict retinal microvasculature in 11-12 year olds and midlife adults? Int J Obes (Lond) 2020; 44:1712-1722. [PMID: 32424266 DOI: 10.1038/s41366-020-0584-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Microvascular changes may contribute to obesity-associated cardiovascular disease. We examined whether body mass index (BMI) and waist-to-height ratio (WHtR) (1) at multiple earlier time points and (2) decade-long trajectories predicted retinal microvascular parameters in mid-childhood/adulthood. METHODS Participants/design: 1288 11-12 year olds (51% girls) and 1264 parents (87% mothers) in the population-based Child Health CheckPoint (CheckPoint) module within the Longitudinal Study of Australian Children (LSAC). LSAC exposure measures: biennial BMI z-score and WHtR for children at five time points from age 2-3 to 10-11 years and self-reported parent BMI at six time points from child age 0-1 years to 10-11 years. CheckPoint outcome measures: retinal arteriolar and venular caliber. ANALYSES BMI/WHtR trajectories were identified by group-based trajectory modeling; linear regression models estimated associations between BMI/WHtR at each time point/trajectories and later retinal vascular caliber, adjusted for age, sex, and family socioeconomic status. RESULTS In time point analyses, higher child BMI/WHtR from age 4 to 5 years was associated with narrower arteriolar caliber at the age of 11-12 years, but not venular caliber. For example, each standard deviation higher in BMI z-score at 4-5 years was associated with narrower arteriolar caliber at 11-12 years (standardized mean difference (SMD): -0.05, 95% confidence interval (CI): -0.10 to 0.01); by 10-11 years, associations had doubled to -0.10 (95% CI: -0.16 to -0.05). In adults, these finding were similar, except the magnitude of BMI and arteriolar associations were similar across all time points (SMD: -0.11 to -0.13). In child and adult BMI trajectory analyses, less favorable trajectories predicted narrower arteriolar (p-trend < 0.05), but not venular (p-trend > 0.1), caliber. Compared with those in the average BMI trajectory, SMDs in arterial caliber for children and adults in the highest trajectory were -0.25 (95% CI: -0.44 to -0.07) and -0.42 (95% CI: -0.73 to -0.10), respectively. Venular caliber showed late associations with child WHtR, but not with BMI in children or adults. CONCLUSIONS Associations of decade-long high BMI trajectories with narrowed retinal arteriolar caliber emerge in children, and are clearly evident by midlife. Adiposity appears to exert its early adverse life course impacts on the microcirculation more via arteriolar than venular mechanisms.
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Affiliation(s)
- Mengjiao Liu
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kate Lycett
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Social & Early Emotional Development, Deakin University, Melbourne, VIC, Australia
| | - Tien Yin Wong
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Jessica A Kerr
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mingguang He
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Tim Olds
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Terry Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - David Burgner
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Melissa Wake
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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10
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Köchli S, Endes K, Steiner R, Engler L, Infanger D, Schmidt-Trucksäss A, Zahner L, Hanssen H. Obesity, High Blood Pressure, and Physical Activity Determine Vascular Phenotype in Young Children. Hypertension 2019; 73:153-161. [PMID: 30571553 DOI: 10.1161/hypertensionaha.118.11872] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiovascular disease often develops during childhood, but the determinants of vascular health and disease in young children remain unclear. The study aimed to investigate the association of obesity and hypertension, as well as physical fitness with retinal microvascular health and large artery stiffness, in children. In this cross-sectional study, 1171 primary school children (aged 7.2±0.4 years) were screened for central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) diameters, pulse wave velocity (PWV), body mass index, blood pressure (BP), and cardiorespiratory fitness by standardized procedures for children. BP was categorized according to the reference values of the population-based German KiGGS study (Kinder- und Jugendgesundheitssurvey [Children- and Adolescents Health Survey]) and the American Academy of Pediatrics guidelines. Overweight (mean [95% CI]: CRAE, 200.5 [197.9-203.2] µm; CRVE, 231.4 [228.6-234.2] µm; PWV, 4.46 [4.41-4.52] m/s) and obese children (CRAE, 200.5 [196.4-204.7] µm; CRVE, 233.3 [229.0-237.7] µm; PWV, 4.51 [4.43-4.60] m/s) had narrower CRAE, wider CRVE, and higher PWV compared with normal-weight children (CRAE: 203.3 [202.5-204.1] µm, P<0.001; CRVE: 230.1 [229.1-230.9] µm, P=0.07; PWV: 4.33 [4.31-4.35] m/s, P<0.001). Children with high-normal BP (CRAE, 202.5 [200.0-205.0] µm; PWV, 4.44 [4.39-4.49] m/s) and BP in the hypertensive range (CRAE, 198.8 [196.7-201.0] µm; PWV, 4.56 [4.51-4.60] m/s) showed narrower CRAE, as well as higher PWV, compared with normotensive peers (CRAE: 203.7 [202.9-204.6] µm, P<0.001; PWV: 4.30 [4.28-4.32] m/s, P<0.001). With each unit increase of body mass index and systolic BP, CRAE decreased and PWV increased significantly. Children with the highest cardiorespiratory fitness had wider CRAE, narrower CRVE, and lower PWV compared with least fit children. Childhood obesity and hypertension, even at preclinical stages, are associated with microvascular and macrovascular impairments in young children. Primary prevention programs targeting physical activity behavior may have the potential to counteract development of small and large vessel disease early in life. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02853747.
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Affiliation(s)
- Sabrina Köchli
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Katharina Endes
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Ramona Steiner
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Luca Engler
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Denis Infanger
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
| | | | - Lukas Zahner
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Henner Hanssen
- From the Department of Sport, Exercise and Health, University of Basel, Switzerland
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11
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Bizzarri C, Pedicelli S, Romanzo A, Bocchini S, Bottaro G, Cianfarani S, Cappa M. The impact of IGF-I, puberty and obesity on early retinopathy in children: a cross-sectional study. Ital J Pediatr 2019; 45:52. [PMID: 31029141 PMCID: PMC6487055 DOI: 10.1186/s13052-019-0650-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
Background Childhood obesity has been correlated with coronary heart disease, but the correlation with microvascular disease remains unclear. The retinal microcirculation is affected early in the process of atherosclerosis and it offers the opportunity to indirectly study the effects of obesity on small brain vessels. Insulin-like growth factor 1 (IGF-I) is involved in angiogenesis and it has a crucial role in retinal vascularization. Methods A single-centre cross-sectional study was performed in 268 children and adolescents (116 males; mean age 13.03 ± 1.9 years,) with overweight/obesity, in order to identify risk factors for early retinopathy. Results Nine patients (3.3%) showed signs of retinopathy, defined as arteriovenous crossings and/or papilledema. Body mass index and fat mass, analysed by Dual X-ray Absorptiometry, were not different in patients with or without retinopathy. Patients with retinopathy were pubertal and showed higher waist circumference (107.78 ± 15.83 versus 99.46 ± 10.85 cm; p: 0.027), waist circumference/height ratio (0.66 ± 0.07 versus 0.62 ± 0.05; p: 0.04) and IGF-I SDS (0.03 ± 1.3 versus − 0.66 ± 0.9; p: 0.04). Multivariate analysis (after correction for sex, age, family history of type 2 diabetes mellitus, obesity, cardiovascular disease, hypertension and dyslipidaemia) showed that waist circumference/height ratio and IGF-I SDS were the only variables independently correlated with the presence of retinopathy. Conclusions Retinal vascular changes may become evident as an early complication of overweight and obesity, even during childhood and adolescence. Relatively high levels of IGF-I during this phase may act as an additional risk factor for microvascular damage. The screening for retinopathy should be proposed to all children and adolescents with overweight/obesity.
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Affiliation(s)
- Carla Bizzarri
- Unit of Endocrinology, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Stefania Pedicelli
- Unit of Endocrinology, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Antonino Romanzo
- Ophtalmology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Sarah Bocchini
- Unit of Endocrinology, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Giorgia Bottaro
- Unit of Endocrinology, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Stefano Cianfarani
- Unit of Diabetes, "Bambino Gesù" Children's Hospital, IRCCS-Tor Vergata University, Piazza S. Onofrio 4, 00165, Rome, Italy.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marco Cappa
- Unit of Endocrinology, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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12
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Siegrist M, Hanssen H, Lammel C, Haller B, Koch AM, Stemp P, Dandl E, Liestak R, Parhofer KG, Vogeser M, Halle M. Effects of a cluster-randomized school-based prevention program on physical activity and microvascular function (JuvenTUM 3). Atherosclerosis 2018; 278:73-81. [PMID: 30261471 DOI: 10.1016/j.atherosclerosis.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/30/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS It is unknown whether a school-based prevention program has the potential to improve microvascular health in children. This study investigates the impact of the school-based lifestyle intervention program JuvenTUM 3 on physical activity, physical fitness, serum biomarkers and microvascular function. METHODS We studied 434 children (10-11 years) in a cluster-randomized setting (8 intervention schools, IG; 7 control schools, CG) over 18 months. The school-based prevention program included weekly lifestyle lessons for children with the aim to increase physical activity in and outside of school, physical fitness as well as health behavior. Anthropometric measurements and blood sampling were conducted using standard protocols, physical activity by use of a questionnaire and physical fitness by a 6-item-test battery. Central retinal arteriolar (CRAE) and venular (CRVE) vessel diameters as early marker of vascular dysfunction, as well as the arteriolar-to-venular diameter ratio (AVR), were investigated with a non-mydriatic vessel analyser. RESULTS School-based physical activity increased in 41% of children in IG (19% in CG, p = 0.038). Improvements in vascular parameters were observed for AVR (increase in 83% of children in IG versus 50% in CG; p < 0.001) and for CRVE (43% of children with retinal venular widening in IG versus 58% in CG, p = 0.019). These vascular improvements were also seen in overweight children for CRAE (p = 0.021) and AVR (p < 0.001). CONCLUSIONS The school-based prevention program JuvenTUM 3 increased physical activity at school inducing favourable effects on retinal microvasculature function. These findings underline the importance of early lifestyle interventions in children for primary prevention of cardiovascular disease.
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Affiliation(s)
- Monika Siegrist
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany.
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, University of Basel, Switzerland
| | - Christoph Lammel
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Anna-Maria Koch
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Pia Stemp
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Elke Dandl
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Roberta Liestak
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Klaus G Parhofer
- Department of Internal Medicine II, University of Munich, Großhadern Campus, Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
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13
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Topcu-Yilmaz P, Akyurek N, Erdogan E. The effect of obesity and insulin resistance on macular choroidal thickness in a pediatric population as assessed by enhanced depth imaging optical coherence tomography. J Pediatr Endocrinol Metab 2018; 31:855-860. [PMID: 29935116 DOI: 10.1515/jpem-2018-0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the macular choroidal thickness in obese children with and without insulin resistance (IR). METHODS Thirty-six patients with obesity and 26 healthy volunteers were included in this cross-sectional study. The choroidal thickness was measured with enhanced depth imaging optical coherence tomography (EDI-OCT) at the fovea and at positions 500 μm, 1000 μm, 1500 μm nasal and temporal to the fovea. The choroidal thickness measurements of the groups were compared and the correlation between the homeostasis model assessment of insulin resistance (HOMA-IR) and choroidal thickness values was evaluated. RESULTS The average choroidal thickness in the obese group was significantly lower than that of controls at locations 1000 μm (303.31±58.52 vs. 340.58±69.47, p=0.026) and 1500 μm (284.14±65.06 vs. 336.85±71.37, p=0.004) temporal to the fovea. A subgroup analysis depending on the presence of IR revealed that the choroidal thickness measurements at all positions were thinner in obese children without IR compared to children with IR and healthy controls. This thinning reached a statistical significance at locations 500 μm temporal, 1000 μm temporal and 1500 μm temporal to the fovea (p=0.03, p=0.009 and p=0.006; respectively). There was a moderate correlation between the choroidal thickness measurements and HOMA-IR values (r-values between 0.37 and 0.48; p<0.05). CONCLUSIONS Our results suggest that obesity and IR may have an influence on the choroidal thickness in children. Longitudinal studies will clarify whether these choroidal changes are progressive and are a sign of microvascular dysfunction in childhood obesity.
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Affiliation(s)
- Pinar Topcu-Yilmaz
- Konya Research and Training Hospital, Department of Ophthalmology, Konya, Turkey
| | - Nesibe Akyurek
- Konya Research and Training Hospital, Department of Pediatric Endocrinology, Konya, Turkey
| | - Erkan Erdogan
- Konya Research and Training Hospital, Department of Ophthalmology, Konya, Turkey
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14
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Köchli S, Endes K, Infanger D, Zahner L, Hanssen H. Obesity, Blood Pressure, and Retinal Vessels: A Meta-analysis. Pediatrics 2018; 141:peds.2017-4090. [PMID: 29743194 DOI: 10.1542/peds.2017-4090] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 01/30/2023] Open
Abstract
CONTEXT Retinal vessel imaging is a noninvasive diagnostic tool used to evaluate cardiovascular risk. Childhood obesity and elevated blood pressure (BP) are associated with retinal microvascular alterations. OBJECTIVE To systematically review and meta-analyze associations between obesity, BP, and physical activity with retinal vessel diameters in children. DATA SOURCES We conducted a literature search through the databases of PubMed, Embase, Ovid, Web of Science, and the Cochrane Register of Controlled Trials. STUDY SELECTION School- and population-based cross-sectional data. DATA EXTRACTION General information, study design, participants, exposure, and outcomes. RESULTS A total of 1751 studies were found, and 30 full-text articles were analyzed for eligibility. Twenty-two articles (18 865 children and adolescents) were used for further assessment and reflection. Eleven articles were finally included in the meta-analysis. We found that a higher BMI is associated with narrower retinal arteriolar (pooled estimate effect size -0.37 [95% confidence interval (CI): -0.50 to -0.24]) and wider venular diameters (0.35 [95% CI: 0.07 to 0.63]). Systolic and diastolic BP are associated with retinal arteriolar narrowing (systolic BP: -0.63 [95% CI: -0.92 to -0.34]; diastolic BP: -0.60 [95% CI -0.95 to -0.25]). Increased physical activity and fitness are associated with favorable retinal vessel diameters. LIMITATIONS Long-term studies are needed to substantiate the prognostic relevance of retinal vessel diameters for cardiovascular risk in children. CONCLUSIONS Our results indicate that childhood obesity, BP, and physical inactivity are associated with retinal microvascular abnormalities. Retinal vessel diameters seem to be sensitive microvascular biomarkers for cardiovascular risk stratification in children.
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Affiliation(s)
- Sabrina Köchli
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Katharina Endes
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
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15
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Schuh DS, Piccoli ÂB, Paiani RL, Maciel CR, Pellanda LC, Vilela MA. Ocular Signs Related to Overweight and Arterial Hypertension in Children: A Systematic Review. Open Ophthalmol J 2017; 11:273-285. [PMID: 29081867 PMCID: PMC5633707 DOI: 10.2174/1874364101711010273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/20/2017] [Accepted: 06/18/2017] [Indexed: 12/18/2022] Open
Abstract
Background: The ocular effects of obesity and hypertension need to be established and can be used as prognostic markers. Objective: To estimate the prevalence of ophthalmological alterations in children and adolescents who are overweight and/or have SAH. Methods: The database for this study included all observational studies (CS, cohort, case-control and “baseline” description of randomized clinical trials) with children and/or adolescents who were overweight, obese or had SAH and that measured ophthalmological alterations. Results: Comparative studies with healthy children demonstrated positive association between body adiposity with retinal venular dilation, and SAH with retinal arteriolar narrowing. Different retinal fundus cameras and computer-assisted programs to evaluate the retinal vessels, variations in the methods of analysis, adjustments, populations, were the main arguments against formal meta-analysis. The heterogeneity was too high (I2 >90%, in fixed or randomized effects), and the lack of linearity, normal distribution and homoscedasticity did not recommend meta-regression. Conclusion: Obesity and SAH show associations with ophthalmological alterations, especially with retinal vessel diameter. Lack of standardization does not allow a quantitative evaluation.
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Affiliation(s)
- Daniela S Schuh
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Ângela B Piccoli
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Raquel L Paiani
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane R Maciel
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Lucia C Pellanda
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Manuel Ap Vilela
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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16
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Evidence of Microvascular Changes in the Retina following Kawasaki Disease. Sci Rep 2017; 7:40513. [PMID: 28094311 PMCID: PMC5240332 DOI: 10.1038/srep40513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/06/2016] [Indexed: 01/19/2023] Open
Abstract
It is unclear whether all children with Kawasaki disease (KD) have increased later cardiovascular risk. The retinal microvasculature reflects changes in the microcirculation and is associated with traditional cardiovascular risk factors and events. The aim of this study was to investigate retinal microvascular parameters in two populations of patients with previous KD and control participants. We performed case-control studies of 116 (57 patients and 59 control participants) Australian and 156 (78 patients and 78 control participants) Singaporean individuals, at least two years since their acute illness. Standardised retinal photographs were graded by trained technicians using a semi-automated software, which quantifies the retinal microvasculature (calibre, branching angle, fractal dimensions, and tortuosity). Retinal venules of Singaporean KD patients were 9.67 μm (95% CI 4.87 to 14.51, p < 0.001) larger than control participants following correction for traditional cardiovascular risk factors. An incremental increase in the size of retinal venules in those with coronary artery abnormalities was observed. There was limited evidence that retinal venules were larger in Australian KD patients with coronary artery abnormalities compared to control participants (7.34 μm, 95% CI 1.30 to 15.99, p = 0.10). Differences in retinal microvasculature were particularly evident in Singaporean KD patients. Larger retinal venules may reflect chronic inflammation and endothelial dysfunction, and are associated with coronary artery disease in adults.
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17
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Body fat evolution as predictor of retinal microvasculature in children. Int J Obes (Lond) 2016; 41:527-532. [PMID: 28008170 DOI: 10.1038/ijo.2016.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/27/2016] [Accepted: 11/24/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Microvascular changes may represent an underlying mechanism through which overweight contributes to cardiovascular disease development. Therefore, the aim of this study was to investigate whether changes in children's body fat over time are associated with the retinal microvasculature, a marker of cardiovascular aging. METHODS In a longitudinal design, 171 healthy Flemish children (53.8% boys) were followed-up for 7 years (2008-2015), aged 2.7-8.1 years at baseline.Z-scores of body mass index (zBMI; 4.1% overweight), waist circumference (zWC) and fat mass index (zFMI by BODPOD) were obtained using standardized protocols during each visit. Retinal arteriolar (central retinal arteriolar equivalent (CRAE)) and venular equivalents (central retinal venular equivalent (CRVE)) were measured from digital retinal photographs (2015) using IVAN software. Cross-sectional and longitudinal associations between changes in body fat and retinal microvasculature were explored using multivariable regression analysis, while controlling for age, sex, mean arterial pressure, alternate retinal caliber, physical activity, diet and birth weight. RESULTS In cross-sectional analysis, children with high zFMI had a higher CRVE, but only in boys (β=0.25, P=0.02). In addition, boys with high zFMI had also a lower CRAE to CRVE ratio (β=-0.26, P=0.03). No associations were seen with the CRAE, or between zBMI or zWC and the retinal microvasculature. Only changes in zFMI over time were found to be positively associated with the CRVE in boys (β=0.38, P=0.01). CONCLUSIONS Our analysis over a 7-year period shows that changes in body fat during childhood are already associated with the CRVE (especially in boys).
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18
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Newman AR, Andrew NH, Casson RJ. Review of paediatric retinal microvascular changes as a predictor of cardiovascular disease. Clin Exp Ophthalmol 2016; 45:33-44. [DOI: 10.1111/ceo.12773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Alexander R Newman
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Nicholas H Andrew
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital; Adelaide South Australia Australia
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19
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Erşan I, Battal F, Aylanç H, Kara S, Arikan S, Tekin M, Gencer B, Tufan HA. Noninvasive assessment of the retina and the choroid using enhanced-depth imaging optical coherence tomography shows microvascular impairments in childhood obesity. J AAPOS 2016; 20:58-62. [PMID: 26917074 DOI: 10.1016/j.jaapos.2015.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 10/10/2015] [Accepted: 10/18/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the retinal vascular diameters and macular and subfoveal choroidal thicknesses of obese and nonobese children using enhanced-depth imaging spectral domain optical coherence tomography (EDI SD-OCT). METHODS The retinal vascular diameters of the 4 largest retinal arterioles and venules and macular and subfoveal choroidal thickness measurements of 40 obese children (body mass index [BMI] z score above +2.0 standard deviations) were obtained by EDI SD-OCT and compared with those of 40 age- and sex-matched nonobese children. Anthropometric measures, including weight and height, were also obtained. BMI z score was defined using standardized protocols. RESULTS The mean BMI z scores of obese children were 2.59 ± 0.62; of nonobese children, -0.20 ± 0.92. The mean diameter of retinal arterioles was significantly smaller (P = 0.002) in obese children compared to nonobese children, whereas the mean diameter of retinal venules was larger (P = 0.008). The macular and subfoveal choroidal thicknesses were significantly thinner (P = 0.031 and 0.014, resp.) in obese children compared to nonobese children. CONCLUSIONS The narrower retinal arterioles, wider retinal venules, and thinner macular and subfoveal choroidal thicknesses in obese children seem to be associated with microvascular impairments in childhood obesity.
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Affiliation(s)
- Ismail Erşan
- Department of Ophthalmology, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey.
| | - Fatih Battal
- Department of Pediatrics, Canakkale Onsekiz Mart University School of Medicine, Canakkale
| | - Hakan Aylanç
- Department of Pediatrics, Canakkale Onsekiz Mart University School of Medicine, Canakkale
| | - Selcuk Kara
- Department of Ophthalmology, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Sedat Arikan
- Department of Ophthalmology, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Mustafa Tekin
- Department of Pediatrics, Canakkale Onsekiz Mart University School of Medicine, Canakkale
| | - Baran Gencer
- Department of Ophthalmology, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Hasan Ali Tufan
- Department of Ophthalmology, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
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