1
|
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.
Collapse
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
| |
Collapse
|
2
|
Zhou Y, Chen Q, Abuduxukuer K, Wang C, Dong J, Wang Y, Shi W, Hou Y, Shi F, Luo J, Peng Q. Novel anthropometric indices are superior adiposity indexes to portend visual impairment in middle-aged and older Chinese population. BMJ Open Ophthalmol 2024; 9:e001664. [PMID: 39009464 PMCID: PMC11253769 DOI: 10.1136/bmjophth-2024-001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE To investigate differential associations of traditional and novel adiposity indices with visual impairment (VI) in the middle-aged and older Chinese population. METHODS AND ANALYSIS Based on the China Health and Retirement Longitudinal Study, 7750 Chinese older adults aged over 45 were included at baseline 2011, and 4133 participants who accomplished all three interviews from 2011 to 2015 were adapted for longitudinal analyses. We enrolled six adiposity indices, including the body mass index (BMI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI), a body shape index (ABSI), body roundness index (BRI) and conicity index (ConI). Visual status and other covariates included sociodemographic characteristics, medical supports and lifestyle-related factors. Cross-sectional correlations were assessed using univariate and multivariate logistic regression analyses. For longitudinal analysis, generalised linear models with generalised estimating equations were used to determine the association between time-varying adiposity and visual status. RESULTS Higher levels of WHtR/WWI/ABSI/BRI/ConI were significantly associated with an increased prevalence of VI, whereas a higher BMI was associated with a decreased prevalence of VI. Only WWI was significantly related to the prevalence of VI after adjustment for multiple confounders in both cross-sectional and longitudinal analyses (all p values <0.05). The multivariable-adjusted OR (95% CI) of VI associated with the highest (vs lowest) quintile of WWI was 1.900 (1.407 to 2.565). CONCLUSION WWI is a reliable alternative adiposity index that exhibits a dose-response association with the prevalence of VI in the Chinese population. The WWI-VI correlation may eliminate the obesity paradox in the ophthalmic epidemiological area and indicate the detrimental impact of changes in body composition on VI.
Collapse
Affiliation(s)
- Yifan Zhou
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qing Chen
- School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration
| | - KaiweiSa Abuduxukuer
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Chuchu Wang
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Jialong Dong
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yiting Wang
- Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenming Shi
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yanan Hou
- Department of Endocrine and Metabolic Diseases, Shanghai First People’s Hospital (Shanghai General Hospital), School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Shi
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
| | - Jianfeng Luo
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Qing Peng
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
3
|
Harrington S. Shifting landscapes: The environmental impact of urbanisation on childhood myopia, obesity and diabetes. Ophthalmic Physiol Opt 2024; 44:237-240. [PMID: 38078538 DOI: 10.1111/opo.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Síofra Harrington
- School of Physics, Clinical, and Optometric Sciences and Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland
| |
Collapse
|
4
|
Dezor-Garus J, Niechciał E, Kędzia A, Gotz-Więckowska A. Obesity-induced ocular changes in children and adolescents: A review. Front Pediatr 2023; 11:1133965. [PMID: 37033164 PMCID: PMC10076676 DOI: 10.3389/fped.2023.1133965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Childhood obesity has reached epidemic levels worldwide. Overweight and obesity is associated with an increase in several inflammatory markers, leading to chronic low-grade inflammation responsible for macro- and microvascular dysfunction. While the impact of obesity on overall health is well-described, less is known about its ocular manifestations. Still, there are few studies in children and adolescents in this regard and they are inconsistent. However, some evidence suggests a significant role of overnutrition in the development of changes in retinal microvasculature parameters (wider venules, narrower arterioles, lower arteriovenous ratio). Higher values of intraocular pressure were found to be positively correlated with high body mass index (BMI) as well as obesity. In addition, the retinal nerve fiber layer (RNFL) values seem to be lower in obese children, and there is a significant negative correlation between RNFL values and anthropometric and/or metabolic parameters. Changes also could be present in macular retinal thickness and choroidal thickness as well as in the retinal vessel density in children with obesity. However, these associations were not consistently documented. The purpose of this review is to present the most current issues on child obesity and the related potential ocular effects through an overview of international publications from the years 1992-2022.
Collapse
Affiliation(s)
- Julia Dezor-Garus
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznan, Poland
- Correspondence: Julia Dezor-Garus
| | - Elżbieta Niechciał
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Kędzia
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Gotz-Więckowska
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
5
|
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: 19] [Impact Index Per Article: 9.5] [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.
Collapse
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
| |
Collapse
|
6
|
Liu M, Lovern C, Lycett K, He M, Wake M, Wong TY, Burgner DP. The association between markers of inflammation and retinal microvascular parameters: A systematic review and meta-analysis. Atherosclerosis 2021; 336:12-22. [PMID: 34607278 DOI: 10.1016/j.atherosclerosis.2021.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Adverse changes to the microcirculation play an important role in the pathogenesis of cardiovascular disease (CVD), and inflammation is a key causal mechanism. We investigated the relationship between inflammatory markers and retinal microvascular parameters. METHODS Studies up to April 2021 were identified in Medline, Embase and PubMed with the following terms: retinal microvascular parameters, inflammatory markers, and observational studies. Correlation coefficients of inflammatory markers and retinal vascular caliber were pooled using the random-effects model. RESULTS Of 4783 studies identified, 36 met the inclusion criteria (general population 26, patients with diseases 10). C-reactive protein (CRP) and white blood cell count (WBC) were most frequently reported. We conducted meta-analysis with 12 CRP studies (22422 participants) and six WBC studies (15209 participants), and also performed a narrative review of all studies. There was consistent evidence of a modest association between CRP and venular caliber (r = 0.09, 95%CI 0.05 to 0.12), but little evidence of an association between CRP with retinal arteriolar caliber (r = 0.00, 95%CI -0.02 to 0.02). Similarly, WBC had stronger associations with venular (r = 0.18, 95%CI 0.05 to 0.31) than arteriolar caliber (r = 0.05, 95%CI 0.01 to 0.09). Narrative review of other inflammatory markers showed consistent findings. There was little evidence of associations between inflammation markers and other microvascular parameters, fractal dimension and tortuosity. CONCLUSIONS There was more evidence for an association of inflammation with retinal venular than with arterial caliber. The findings suggest a potential druggable mechanism contributing to microvascular damage that has been relatively overlooked in CVD pathogenesis and treatment.
Collapse
Affiliation(s)
- Mengjiao Liu
- School of Public Health, Nanchang University, Jiangxi, China; Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Jiangxi, China; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | | | - Kate Lycett
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; The Deakin Child Study Centre, School of Psychology, Deakin University, VIC, Australia
| | - Mingguang He
- 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
| | - Melissa Wake
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, Melbourne University, Parkville, VIC, Australia
| | - Tien Yin Wong
- Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia; Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - David P Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, Melbourne University, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia.
| |
Collapse
|
7
|
Wang J, Liu M, Sung V, Lycett K, Grobler A, Burgner D, Wong TY, Wake M. Associations of Retinal Vessel Caliber With Hearing Status in Childhood and Midlife: A Cross-Generational Population-Based Study. JAMA Otolaryngol Head Neck Surg 2021; 146:323-330. [PMID: 31999311 DOI: 10.1001/jamaoto.2019.4484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Microvascular phenotypes, which can be assessed using retinal imaging, may be informative about the life course pathogenesis of hearing loss. Objective To investigate whether differences in retinal vessel caliber (specifically wider venules and narrower arterioles) are associated with hearing threshold and hearing loss in mid-childhood and midlife. Design, Setting, and Participants A population-based cross-sectional study (Child Health CheckPoint) was nested within the Longitudinal Study of Australian Children. A total of 1281 children and 1255 attending parents were assessed using retinal microvasculature and air conduction audiometry data at a main assessment center in 7 large cities in Australia. Main Outcomes and Measures Air conduction audiometry was used to calculate the high Fletcher index (mean threshold of 1, 2, and 4 kHz), and bilateral hearing loss was defined as a high Fletcher index greater than 15 dB hearing level in the better-hearing ear. Retinal arteriolar and venular caliber were measured from fundus photographs using validated computer-based software. Linear and logistic regression quantified the associations of retinal vessel caliber with hearing threshold and hearing loss, respectively. Results Of the 1281 included children (mean age, 11.4 years; 49.1% boys), the mean (SD) high Fletcher index was 7.9 (5.8) dB hearing level. Of the 1255 included adults (mean age, 43.8 years; 86.6% women), the mean (SD) high Fletcher index was 13.0 (6.8) dB hearing level; 109 of 1281 children (8.5%) and 328 of 1255 adults (26.1%) had hearing loss. In adults, each 1-SD (18.6-μm) wider retinal venular caliber (worse) was associated with higher (worse) hearing threshold at lower individual frequencies (eg, 2 kHz: β = 0.63; 95% CI, 0.10-1.17) and overall high Fletcher index (eg, 2 kHz: β = 0.52; 95% CI, 0.07-0.96), as well as a 1.20-fold (95% CI, 1.03-1.40) higher odds of hearing loss. In children, patterns of venular associations were similar but smaller and less certain. Narrower retinal arteriolar caliber (worse) was associated with a 1.16-fold (95% CI, 1.00-1.37) higher odds of hearing loss in adults (per 1-SD [14.0-μm] narrower arteriolar caliber) but not in children. Conclusions and Relevance Adverse retinal microvascular characteristics are associated with hearing loss by midlife, with venular associations possibly emerging by age 11 to 12 years. Microvascular health may contribute to the pathogenesis of hearing loss across the life course, warranting replication and mechanistic studies to inform causal inference and prevention efforts.
Collapse
Affiliation(s)
- Jing Wang
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mengjiao Liu
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Sung
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kate Lycett
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Social and Early Emotional Development, Deakin University, Melbourne, Victoria, Australia
| | - Anneke Grobler
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Luyten LJ, Dockx Y, Madhloum N, Sleurs H, Gerrits N, Janssen BG, Neven KY, Plusquin M, Provost EB, De Boever P, Nawrot TS. Association of Retinal Microvascular Characteristics With Short-term Memory Performance in Children Aged 4 to 5 Years. JAMA Netw Open 2020; 3:e2011537. [PMID: 32706383 PMCID: PMC7382002 DOI: 10.1001/jamanetworkopen.2020.11537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Neurocognitive functions develop rapidly in early childhood and depend on the intrinsic cooperation between cerebral structures and the circulatory system. The retinal microvasculature can be regarded as a mirror image of the cerebrovascular circulation. OBJECTIVE To investigate the association between retinal vessel characteristics and neurological functioning in children aged 4 to 5 years. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, mother-child pairs were recruited at birth from February 10, 2010, to June 24, 2014, and renewed consent at their follow-up visit from December 10, 2014, to July 13, 2018. Participants were followed up longitudinally within the prospective Environmental Influence on Aging in Early Life birth cohort. A total of 251 children underwent assessment for this study. Data were analyzed from July 17 to October 30, 2019. MAIN OUTCOMES AND MEASURES Retinal vascular diameters, the central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), vessel tortuosity, and fractal dimensions were determined. Attention and psychomotor speed, visuospatial working memory, and short-term visual recognition memory were assessed by the Cambridge Neuropsychological Test Automated Battery, including the following tasks: Motor Screening (MOT), Big/Little Circle (BLC), Spatial Span (SSP), and Delayed Matching to Sample (DMS). RESULTS Among the 251 children included in the assessment (135 girls [53.8%]; mean [SD] age, 4.5 [0.4] years), for every 1-SD widening in CRVE, the children performed relatively 2.74% (95% CI, -0.12 to 5.49; P = .06) slower on the MOT test, had 1.76% (95% CI, -3.53% to -0.04%; P = .04) fewer correct DMS assessments in total, and made 2.94% (95% CI, 0.39 to 5.29; P = .02) more errors given a previous correct answer in the DMS task on multiple linear regression modeling. For every 1-SD widening in CRAE, the total percentage of errors and errors given previous correct answers in the DMS task increased 1.44% (95% CI, -3.25% to 0.29%; P = .09) and 2.30% (95% CI, -0.14% to 4.61%; P = .07), respectively. A 1-SD higher vessel tortuosity showed a 4.32% relative increase in latency in DMS task performance (95% CI, -0.48% to 9.12%; P = .07). Retinal vessel characteristics were not associated with BLC and SSP test outcomes. CONCLUSIONS AND RELEVANCE These findings suggest that children's microvascular phenotypes are associated with short-term memory and that changes in the retinal microvasculature may reflect neurological development during early childhood.
Collapse
Affiliation(s)
- Leen J. Luyten
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Unité de Recherche en Biologie Cellulaire–Namur Research Institute for Life Sciences, Namur University, Namur, Belgium
| | - Yinthe Dockx
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Narjes Madhloum
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Nele Gerrits
- Health Unit, Flemish Institute for Technological Research, Mol, Belgium
| | - Bram G. Janssen
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Kristof Y. Neven
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Eline B. Provost
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Health Unit, Flemish Institute for Technological Research, Mol, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Health Unit, Flemish Institute for Technological Research, Mol, Belgium
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, Occupational and Environmental Medicine, Leuven University, Leuven, Belgium
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Liu M, Lycett K, Moreno-Betancur M, Wong TY, He M, Saffery R, Juonala M, Kerr JA, Wake M, Burgner DP. Inflammation mediates the relationship between obesity and retinal vascular calibre in 11-12 year-olds children and mid-life adults. Sci Rep 2020; 10:5006. [PMID: 32193466 PMCID: PMC7081237 DOI: 10.1038/s41598-020-61801-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Obesity predicts adverse microvasculature from childhood, potentially via inflammatory pathways. We investigated whether inflammation mediates associations between obesity and microvascular parameters. In 1054 children (mean age 11 years) and 1147 adults (44 years) from a cross-sectional study, we measured BMI (z-scores for children) and WHtR, Glycoprotein acetyls (GlycA), an inflammatory marker, and retinal arteriolar and venular calibre. Causal mediation analysis methods decomposed a "total effect" into "direct" and "indirect" components via a mediator, considering continuous and categorical measures and adjusting for potential confounders. Compared to normal-weight BMI children, those with overweight or obesity had narrower arteriolar calibre (total effects -0.21 to -0.12 standard deviation (SD)): direct (not mediated via GlycA) effects were similar. Children with overweight or obesity had 0.25 to 0.35 SD wider venular calibre, of which 19 to 25% was mediated via GlycA. In adults, those with obesity had 0.07 SD greater venular calibre, which was completely mediated by GlycA (indirect effect: 0.07 SD, 95% CI -0.01 to 0.16). Similar findings were obtained with other obesity measures. Inflammation mediated associations between obesity and retinal venules, but not arterioles from mid-childhood, with higher mediation effects observed in adults. Interventions targeting inflammatory pathways may help mitigate adverse impacts of obesity on the microvasculature.
Collapse
Affiliation(s)
- Mengjiao Liu
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kate Lycett
- 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
| | - Margarita Moreno-Betancur
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tien Yin Wong
- The University of Melbourne, Melbourne, VIC, Australia.
- Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia.
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore.
| | - Mingguang He
- The University of Melbourne, Melbourne, VIC, Australia
- Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Richard Saffery
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jessica A Kerr
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Melissa Wake
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David P Burgner
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Infectious Diseases, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Rijks J, Vreugdenhil A, Dorenbos E, Karnebeek K, Joris P, Berendschot T, Mensink R, Plat J. Characteristics of the retinal microvasculature in association with cardiovascular risk markers in children with overweight, obesity and morbid obesity. Sci Rep 2018; 8:16952. [PMID: 30446681 PMCID: PMC6240121 DOI: 10.1038/s41598-018-35279-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
To aim of this study was to evaluate characteristics of the retinal microvasculature, but particularly potential associations with classic and novel (endothelial function and low-grade inflammation)markers for cardiovascular risk, in a cohort of children with overweight and (morbid) obesity. Central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE) were assessed. CRAE was significantly lower and AVR significantly higher in children with morbid obesity than in children with overweight and normal weight(p < 0.01). CRVE did not differ significantly between the four weight categories. A multiple linear regression model with CRAE as dependent variable showed that only DBP z-score(β = −2.848,p = 0.029) and plasma glucose concentrations(β = 6.029,p = 0.019) contributed significantly to the variation in CRAE. Remarkably, despite a correlation between CRAE and circulating concentrations of the adhesion molecules VCAM-1 or ICAM-1, markers for inflammation and endothelial function did not contribute to the variation in CRAE. This is the first study showing in population of children with overweight and obesity that the retinal arteriolar microvasculature, but not venular diameter is aberrant, with increasing BMI z-score. CRAE was significantly associated with several cardiovascular risk markers, and multiple linear regression showed that a higher diastolic blood pressure z-score and lower fasting plasma glucose concentrations significantly contributed to the variance in CRAE.
Collapse
Affiliation(s)
- Jesse Rijks
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Anita Vreugdenhil
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands. .,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Elke Dorenbos
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Kylie Karnebeek
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Peter Joris
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Tos Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald Mensink
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Jogchum Plat
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Van Aart CJC, Nawrot TS, Sioen I, De Boever P, Zaqout M, De Henauw S, Michels N. Longitudinal association between psychosocial stress and retinal microvasculature in children and adolescents. Psychoneuroendocrinology 2018; 92:50-56. [PMID: 29626707 DOI: 10.1016/j.psyneuen.2018.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Retinal microvessels provides a window to assess the microcirculation of heart and brain, and might reflect cardio- or cerebrovascular disease risk. Limited information exist on the relation between psychosocial stress and the microcirculation, even though psychosocial stress might trigger vascular diseases. This study investigates whether childhood psychosocial stress is a predictor of retinal microvasculature. METHODS We followed-up 182 Belgian children, aged 5.7-11.3 years at baseline (53.3% boys). Information about psychosocial stress was obtained using emotional, behavioral and negative life events questionnaires and hair cortisol, an objective stress marker. Retinal photographs were used to calculate vessel diameters, bifurcation angles and optimality deviation with semiautomated software. Cross-sectional and longitudinal associations were explored using multivariable regression analysis with retinal parameters in 2015 as outcome, while adjusting for age, sex, socioeconomic status, cardiovascular parameters and lifestyle factors. RESULTS Feelings of happiness, sadness and negative life events were associated with retinal vascular diameter, but behavior and hair cortisol were not. High stress levels over a 4-year time period (less happy, sadder and higher total negative emotions) were associated with larger venules (β = 0.21-0.43) and children who experienced more negative life events had smaller arterioles (β = -0.15). No consistent patterns were seen with bifurcation angles and optimality deviation. CONCLUSION Based on the results, we conclude that high levels of childhood psychosocial stress unfavorably affect the retinal vascular diameters, potentially reflecting the microvasculature of the heart and brain. It seems this might even be independent of lifestyle and BMI, but further research on mechanisms is necessary.
Collapse
Affiliation(s)
- Carola J C Van Aart
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium.
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Belgium; Department of Public Health and Primary Care, Leuven University, Belgium
| | - Isabelle Sioen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Faculty of Bioscience Engineering, Department of Food Technology, Safety and Health, Ghent University, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Belgium; Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Belgium
| | - Mahmoud Zaqout
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Stefaan De Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Department of Health Sciences, Vesalius, University College Ghent, Belgium
| | - Nathalie Michels
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| |
Collapse
|
17
|
Lundberg K, Tarp J, Vestergaard AH, Jacobsen N, Thykjaer AS, Rønne MS, Bugge A, Goldschmidt E, Peto T, Wedderkopp N, Grauslund J. Retinal vascular diameters in relation to physical activity in Danish children - The CHAMPS Eye Study. Scand J Med Sci Sports 2018; 28:1897-1907. [PMID: 29701884 DOI: 10.1111/sms.13204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/17/2023]
Abstract
Our objective was to determine associations between retinal vascular caliber and physical activity (PA) in a school-based child cohort. In a prospective study, we created a childhood cumulative average PA-index using objectively measured PA (accelerometry) assessed at four periods between 2009 and 2015. Cumulative exposure to PA intensities was estimated. Cross-sectional examinations on biomarkers, anthropometry, and ophthalmological data including retinal fundus photographs were performed in 2015. Semi-automated measurements of retinal vascular diameters were performed and summarized into central retinal arteriolar and venular equivalents (CRAE, CRVE). We included 307 participants. Mean age in 2015 was 15.4 years (0.7). The mean CRAE and CRVE were 156.5 μm (2.8) and 217.6 μm (7.7), respectively. After adjusting for age, gender, and axial length, more time in PA was independently related to thinner retinal venules (β-coefficient = -1.25 μm/%, 95% confidence interval = -2.20, -0.30, P < .01). Sedentary time was associated with wider venules (P < .01). Furthermore, birthweight (β-coefficient = 0.56 μm/%, 95% confidence interval = 0.18, 0.95, P < .01) was associated with CRVE. Blood pressure was associated with thinner retinal arterioles (β-coefficient = -0.19 μm/mmHg, 95% confidence interval = -0.36, -0.01, P = .04). We concluded that children with higher PA in childhood had thinner retinal venular caliber. Our results suggest that PA during childhood positively impacts the retinal microcirculation and that retinal vascular analysis may be a possible assessment to detect microvascular impairments in children with an increased risk of future cardiovascular disease.
Collapse
Affiliation(s)
- K Lundberg
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - J Tarp
- Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - A H Vestergaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - N Jacobsen
- Department of Ophthalmology, Rigshospitalet-Glostrup University Hospital, Copenhagen, Denmark
| | - A S Thykjaer
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M S Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - A Bugge
- Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - E Goldschmidt
- Danish Institute for Myopia Research, Vedbaek, Denmark
| | - T Peto
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - N Wedderkopp
- Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark.,The Orthopedic Department, Institute of Regional Health Services Research, Sport Medicine Clinic, University of Southern Denmark, Middelfart, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
18
|
Longitudinal study of the influence of lung function on vascular health from adolescence to early adulthood in a British multiethnic cohort. J Hypertens 2018; 35:2185-2191. [PMID: 28661960 PMCID: PMC5625963 DOI: 10.1097/hjh.0000000000001455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Vascular and lung function develop and decline over the life course; both predict cardiovascular events and mortality but little is known of how they develop over time. We analysed their relationship in a multiethnic cohort study to test whether lung function from early adolescence to young adulthood affected vascular indices. Methods: ‘DASH’ (http://dash.sphsu.mrc.ac.uk) included 6643 children aged 11–13 years in 2003; a representative 10% sample (n = 665) participated in a pilot follow-up in 2013. Psychosocial, anthropometric, blood pressure (BP), and lung function measures were collected in both surveys; aortic pulse wave velocity (PWV) and augmentation index (AIx) were measured at aged 21–23 years. Relationships between forced expiratory volume Z-scores in 1 s (zFEV1), after global initiative-ethnic adjustments and BP, PWV, and AIx were tested in linear regression and general estimating statistical models. Results: In total, 488 people with complete data were included. At 11–13 years, SBP was positively associated with zFEV1 (coefficient = 1.90, 95% confidence interval 1.11–2.68, P < 0.001); but not at 21–23 years. The 10-year increase in zFEV1 was associated with rise in SBP (1.38, 0.25–1.51, P < 0.05) in mixed effect models adjusted for age, sex, ethnicity, waist to height ratio, employment, reported racism, smoking, and alcohol use but DBP change was unrelated. In fully adjusted models, neither PWV nor central AIx were associated with zFEV1 at 11–13 years or 21–23 years (P > 0.05). Conclusion: Forced expiratory volume change is positively and independently associated with SBP change from adolescence to young adulthood, suggesting earlier lung function plays important roles in SBP development. Vascular indices were unrelated to lung function or its change.
Collapse
|
19
|
Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
20
|
Tai ELM, Kueh YC, Wan Hitam WH, Wong TY, Shatriah I. Comparison of retinal vascular geometry in obese and non-obese children. PLoS One 2018; 13:e0191434. [PMID: 29389952 PMCID: PMC5794084 DOI: 10.1371/journal.pone.0191434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/04/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose Childhood obesity is associated with adult cardiometabolic disease. We postulate that the underlying microvascular dysfunction begins in childhood. We thus aimed to compare retinal vascular parameters between obese and non-obese children. Methods This was a cross-sectional study involving 166 children aged 6 to 12 years old in Malaysia. Ocular examination, biometry, retinal photography, blood pressure and body mass index measurement were performed. Participants were divided into two groups; obese and non-obese. Retinal vascular parameters were measured using validated software. Results Mean age was 9.58 years. Approximately 51.2% were obese. Obese children had significantly narrower retinal arteriolar caliber (F(1,159) = 6.862, p = 0.010), lower arteriovenous ratio (F(1,159) = 17.412, p < 0.001), higher venular fractal dimension (F(1,159) = 4.313, p = 0.039) and higher venular curvature tortuosity (F(1,158) = 5.166, p = 0.024) than non-obese children, after adjustment for age, gender, blood pressure and axial length. Conclusions Obese children have abnormal retinal vascular geometry. These findings suggest that childhood obesity is characterized by early microvascular abnormalities that precede development of overt disease. Further research is warranted to determine if these parameters represent viable biomarkers for risk stratification in obesity.
Collapse
Affiliation(s)
- Evelyn Li Min Tai
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- * E-mail: (ELMT); (YCK); (IS)
| | - Yee Cheng Kueh
- Unit of Biostatistics & Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- * E-mail: (ELMT); (YCK); (IS)
| | - Wan-Hazabbah Wan Hitam
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Ismail Shatriah
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- * E-mail: (ELMT); (YCK); (IS)
| |
Collapse
|
21
|
van Aart CJC, Michels N, Sioen I, De Decker A, Nawrot TS, De Henauw S. Associations of leptin, insulin and lipids with retinal microvasculature in children and adolescents. J Pediatr Endocrinol Metab 2018; 31:143-150. [PMID: 29303782 DOI: 10.1515/jpem-2017-0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/16/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND We investigated whether cardiometabolic risk factors measured in serum (total cholesterol [TC], high-density lipoprotein [HDL], triglyceride, leptin, insulin, glucose and insulin resistance) are associated with the retinal microvasculature, a marker of cardiovascular aging, in healthy children and adolescents. Moreover, we tested whether these associations are due to direct biological effects or more indirectly due to adiposity-related side effects. METHODS We recruited 168 healthy Flemish children (7-16 years old, 54.8% boys). Blood samples and retinal photographs were taken during clinical examinations. Arteriolar and venular vessel calibers were calculated using a semi-automated computer program. Multivariable regression models were used and adjusted for age, sex, mean arterial pressure (MAP) and alternate retinal caliber. In a second step, we adjusted for body mass index z-score (zBMI). RESULTS Only continuous serum leptin was associated with retinal parameters, i.e. wider arterioles; however, this disappeared after adjustment for zBMI. Children with high cardiometabolic risk factors (>90th percentile for serum leptin, insulin and insulin resistance) had wider arterioles compared to children with lower concentrations, even after additional adjustment for zBMI. No significant associations were found with lipids. CONCLUSIONS In this healthy population of children and adolescents, the hormones insulin and leptin and insulin resistance were associated with retinal microvasculature alterations, mainly in children with high cardiometabolic factors (>90th percentile), while lipids were not. These associations were independent of zBMI.
Collapse
Affiliation(s)
- Carola J C van Aart
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Nathalie Michels
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Isabelle Sioen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium.,Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Annelies De Decker
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Department of Public Health and Primary Care, Leuven University, Leuven, Belgium
| | - Stefaan De Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium.,Department of Health Sciences, Vesalius University College Ghent, Ghent, Belgium
| |
Collapse
|
22
|
Chua J, Chia AR, Chee ML, Man REK, Tan GSW, Lamoureux EL, Wong TY, Chong MFF, Schmetterer L. The relationship of dietary fish intake to diabetic retinopathy and retinal vascular caliber in patients with type 2 diabetes. Sci Rep 2018; 8:730. [PMID: 29335432 PMCID: PMC5768794 DOI: 10.1038/s41598-017-18930-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/29/2022] Open
Abstract
In this cross-sectional study, we evaluated the association of dietary fish intake with varying severity of diabetic retinopathy (DR) and retinal vascular caliber in Asians with type 2 diabetes mellitus. 357 Asians (median age: 58 years; 31% women; 78% Chinese) were recruited from a tertiary eye care institution in Singapore. Fish consumption was evaluated using a validated food frequency questionnaire. Digital retinal photographs assessed for DR severity and retinal vascular caliber. Ordered logistic and linear regression models were used to investigate the association of fish intake with DR severity and vascular caliber. Increasing frequency of fish consumption was significantly associated with lower odds of having severe DR (odds ratio [OR] = 0.91, 95% CI: 0.84–0.99 per 1-unit increase of fish intake; P = 0.038). Among those with no retinopathy, persons in quartile 4 fish intake had a wider retinal vascular caliber for arteriolar (β = 22.27 µm, 95% CI: 12.64–31.90; P-trend < 0.001) and venular (β = 32.00 µm, 95% CI: 17.56–46.43; P-trend < 0.001), than those in quartile 1 fish intake. Persons with higher fish intake had a decreased likelihood of having severe DR. In diabetics without retinopathy, higher fish intake was associated with wider retinal vascular caliber. Future research is needed to reinforce the direction of the casualty.
Collapse
Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ai-Ru Chia
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Wien, Austria.
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
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).
Collapse
|
25
|
Harding S, Silva MJ, Molaodi OR, Enayat ZE, Cassidy A, Karamanos A, Read UM, Cruickshank JK. Longitudinal study of cardiometabolic risk from early adolescence to early adulthood in an ethnically diverse cohort. BMJ Open 2016; 6:e013221. [PMID: 27979836 PMCID: PMC5223645 DOI: 10.1136/bmjopen-2016-013221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To examine influences of adiposity from early adolescence to early 20s on cardiovascular disease (CVD) risk in the multiethnic Determinants of young Adult Social well-being and Health (DASH) longitudinal study. METHODS In 2002-2003, 6643 11-13-year-olds from 51 London schools participated at baseline, and 4785 were seen again at 14-16 years. Recently, 665 (97% of invited) participated in pilot follow-up at 21-23 years, with biological and psychosocial measures and blood biomarkers (only at 21-23 years). Regression models examined interplay between ethnicity, adiposity and CVD. RESULTS At 21-23 years, ∼30-40% were overweight. About half of the sample had completed a degree with little ethnic variation despite more socioeconomic disadvantage in adolescence among ethnic minorities. Regardless of ethnicity, overweight increased more steeply between 14-16 years and 21-23 years than between 11-13 years and 14-16 years. More overweight among Black Caribbean and Black African females, lower systolic blood pressure (sBP) among Indian females and Pakistani/Bangladeshi males compared with White UK peers, persisted from 11-13 years. At 21-23 years, glycated haemoglobin (HbA1c) was higher among Black Caribbean females, total cholesterol higher and high-density lipoprotein (HDL) cholesterol lower among Pakistani/Bangladeshis. Overweight was associated with a ∼+2 mm Hg rise in sBP between 11-13 years and 21-23 years. Adiposity measures at 11-13 years were related to allostatic load (a cluster of several risk markers), HbA1c and HDL cholesterol at 21-23 years. Ethnic patterns in CVD biomarkers remained after adjustments. CONCLUSIONS Adolescent adiposity posed significant risks at 21-23 years, a period in the lifespan generally ignored in cardiovascular studies, when ethnic/gender variations in CVD are already apparent.
Collapse
Affiliation(s)
- Seeromanie Harding
- Cardiovascular Medicine & Social Epidemiology Group, Division of Diabetes & Nutritional Sciences, King's College London, London, UK
| | - Maria João Silva
- Cardiovascular Medicine & Social Epidemiology Group, Division of Diabetes & Nutritional Sciences, King's College London, London, UK
| | - Oarabile R Molaodi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Zinat E Enayat
- National Hospital for Neurology and Neurosurgery, University College London Hospitals,London, UK
| | - Aidan Cassidy
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alexis Karamanos
- Department of Epidemiology and Health, ESRC International Centre for Lifecourse Studies in Society and Health, University College London, London, UK
| | - Ursula M Read
- CERMES3 (Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société), Université Paris Descartes, EHESS, CNRS UMR 8211, INSERM U988, Paris, France
| | - J Kennedy Cruickshank
- Cardiovascular Medicine & Social Epidemiology Group, Division of Diabetes & Nutritional Sciences, King's College London, London, UK
| |
Collapse
|
26
|
Gishti O, Felix JF, Reiss I, Ikram MK, Steegers EAP, Hofman A, Jaddoe VWV, Gaillard R. Gishti et al. Respond to "Hypertensive Pregnancy and Offspring Microcirculation". Am J Epidemiol 2016; 184:619-620. [PMID: 27744390 DOI: 10.1093/aje/kww061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/07/2016] [Indexed: 11/13/2022] Open
|
27
|
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
| |
Collapse
|
28
|
Li LJ, Ikram MK, Wong TY. Retinal vascular imaging in early life: insights into processes and risk of cardiovascular disease. J Physiol 2015; 594:2175-203. [PMID: 26435039 DOI: 10.1113/jp270947] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent years, studies have shown that the origins of CVD may be traced to vascular and metabolic processes in early life. Retinal vascular imaging is a new technology that allows detailed non-invasive in vivo assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low-fibre and high-sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight/obesity, childhood depression/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. Thus, the retina is a useful site for pre-clinical assessment of microvascular processes that may underlie the future development of CVD in adulthood.
Collapse
Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Mohammad Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| |
Collapse
|