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Kruger R, Monyeki MA, Schutte AE, Smith W, Mels CMC, Kruger HS, Pienaar AE, Gafane-Matemane LF, Breet Y, Lammertyn L, Mokwatsi GG, Kruger A, Deacon E, Hanssen H. The Exercise, Arterial Modulation and Nutrition in Youth South Africa Study (ExAMIN Youth SA). Front Pediatr 2020; 8:212. [PMID: 32411640 PMCID: PMC7201091 DOI: 10.3389/fped.2020.00212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/09/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children. Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ~1,000 primary school children (black and white boys and girls between ages 5-9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging. Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs. Trial registration: The study was retrospectively registered on ClinicalTrials.gov on 15 August 2019 (NCT04056377).
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Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Makama Andries Monyeki
- Physical Activity, Sport and Recreation Research Focus Area; North-West University, Potchefstroom, South Africa
| | - Aletta Elisabeth Schutte
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Public Health and Community Medicine, University of New South Wales and The George Institute for Global Health, Sydney, NSW, Australia
| | - Wayne Smith
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Catharina Martha Cornelia Mels
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Herculina Salomé Kruger
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Anita Elizabeth Pienaar
- Physical Activity, Sport and Recreation Research Focus Area; North-West University, Potchefstroom, South Africa
| | - Lebo Francina Gafane-Matemane
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Leandi Lammertyn
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Gontse Gratitude Mokwatsi
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ankebé Kruger
- Physical Activity, Sport and Recreation Research Focus Area; North-West University, Potchefstroom, South Africa
| | - Elmari Deacon
- Optentia Research Focus Area, North-West University, Potchefstroom, South Africa
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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2
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Schutte AE, Gona PN, Delles C, Uys AS, Burger A, Mels CM, Kruger R, Smith W, Fourie CM, Botha S, Lammertyn L, van Rooyen JM, Gafane-Matemane LF, Mokwatsi GG, Breet Y, Kruger HS, Zyl TV, Pieters M, Zandberg L, Louw R, Moss SJ, Khumalo IP, Huisman HW. The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): Design, recruitment and initial examination. Eur J Prev Cardiol 2019; 26:458-470. [PMID: 30681377 PMCID: PMC6423686 DOI: 10.1177/2047487318822354] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Globally hypertension is stabilising, but in sub-Saharan Africa the incidence
of hypertension remains on an increase. Although this might be attributed to
poor healthcare and ineffective antihypertensive treatment, there is a
limited understanding of population and individual-specific cardiovascular
pathophysiology – necessary for effective prevention and treatment
strategies in Africa. As there is a lack of longitudinal studies tracking
the early pathophysiological development of hypertension in black
populations, the African-PREDICT study was initiated. The purpose of this
paper is to describe the detailed methodology and baseline cohort profile of
the study. Methods and results From 2013 to 2017, the study included 1202 black (N = 606)
and white (N = 596) men and women (aged 20–30 years) from
South Africa – screened to be healthy and clinic normotensive. At baseline,
and each 5-year follow-up examination, detailed measures of health
behaviours, cardiovascular profile and organ damage are taken. Also,
comprehensive biological sampling for the ‘omics’ and biomarkers is
performed. Overall, the baseline black and white cohort presented with
similar ages, clinic and 24-hour blood pressures, but black adults had lower
socioeconomic status and higher central systolic blood pressure than white
individuals. Conclusions The prospective African-PREDICT study in young black and white adults will
contribute to a clear understanding of early cardiovascular disease
development.
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Affiliation(s)
- Aletta E Schutte
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Philimon N Gona
- 3 Department of Exercise and Health Sciences, University of Massachusetts Boston, USA
| | - Christian Delles
- 4 Institute of Cardiovascular and Medical Sciences (ICAMS), University of Glasgow, UK
| | - Aletta S Uys
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Adele Burger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Catharina Mc Mels
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Ruan Kruger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Wayne Smith
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Carla Mt Fourie
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Shani Botha
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Leandi Lammertyn
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Johannes M van Rooyen
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Lebo F Gafane-Matemane
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Gontse G Mokwatsi
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Yolandi Breet
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - H Salome Kruger
- 2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.,5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Tertia van Zyl
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Marlien Pieters
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Lizelle Zandberg
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Roan Louw
- 6 Human Metabolomics, North-West University, South Africa
| | - Sarah J Moss
- 7 Physical activity, Sport and Recreation Research Focus Area, North-West University, South Africa
| | | | - Hugo W Huisman
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
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3
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Erasmus D, Mels CMC, Louw R, Lindeque JZ, Kruger R. Urinary Metabolites and Their Link with Premature Arterial Stiffness in Black Boys: The ASOS Study. Pulse (Basel) 2018; 6:144-153. [PMID: 31049314 DOI: 10.1159/000492155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background and Aims Black boys (6-8 years of age) were shown to have higher pulse wave velocity with potential early vascular compromise. We aimed to compare predefined urinary metabolites in black and white boys to explore associations of pulse wave velocity with these metabolites. Methods and Results We included 40 white and 40 black apparently healthy boys between the ages of 6 and 8 years. Femoral pulse wave velocity was measured along with various metabolites using liquid chromatography tandem mass spectrometry (LC-MS/MS) and gas chromatography-time of flight-mass spectrometry (GC-TOF-MS) methods. Pulse wave velocity and diastolic blood pressure were higher in the black compared to the white boys (both p ≤ 0.002). Isovalerylcarnitine was lower and 1-metylhistidine tended to be lower (p = 0.002 and p = 0.073, respectively), whereas L-proline levels tended to be higher (p = 0.079) in the black compared to the white boys. In single, partial, and multiple regression analyses, pulse wave velocity correlated inversely with β-alanine (β = -0.414; p = 0.008) and 1-methylhistidine (β = -0.347; p = 0.032) and positively with L-proline (β = 0.420; p = 0.008), threonic acid (β = 0.977; p = 0.033), and malonic acid (β = 0.348; p = 0.030) in black boys only. Conclusion Our study is the first to discover the associations of pulse wave velocity with β-alanine, 1-methylhistidine, and L-proline in children from South Africa, which may suggest potential early compromise in cardiac protective metabolic pathways in black boys as young as 6 years of age.
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Affiliation(s)
- Dalene Erasmus
- Hypertension in Africa Research Team (HART), North-West University - Potchefstroom Campus, Potchefstroom, South Africa
| | - Carina M C Mels
- Hypertension in Africa Research Team (HART), North-West University - Potchefstroom Campus, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Roan Louw
- Human Metabolomics, North-West University - Potchefstroom Campus, Potchefstroom, South Africa
| | - J Zander Lindeque
- Human Metabolomics, North-West University - Potchefstroom Campus, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University - Potchefstroom Campus, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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4
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Morning blood pressure surge in young black and white adults: The African-PREDICT Study. J Hum Hypertens 2018; 33:22-33. [DOI: 10.1038/s41371-018-0089-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
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5
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Breet Y, Huisman HW, Kruger R, van Rooyen JM, Gafane-Matemane LF, Ware LJ, Schutte AE. Pulse pressure amplification and its relationship with age in young, apparently healthy black and white adults: The African-PREDICT study. Int J Cardiol 2017; 249:387-391. [PMID: 28893431 DOI: 10.1016/j.ijcard.2017.08.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/06/2017] [Accepted: 08/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulse pressure amplification (PPA), i.e. the amplification from central arteries to the periphery, is inversely related to arterial stiffness, organ damage and mortality. It is known that arterial stiffness is higher in black than white populations, but it is unclear if this is due to early vascular aging. We therefore investigated whether PPA declines earlier in young normotensive black South Africans, when compared to their white counterparts. METHODS We included 875 black and white men and women from the African-PREDICT study (55% black, 41% men), aged 20-30years, with no prior diagnosis of chronic disease, screened for normotensive clinic blood pressure (BP). We determined supine central PP (cPP), and supine brachial systolic- and diastolic BP, from which brachial PP (bPP) was calculated. PPA was defined as the ratio of the amplitude of the PP between these distal and proximal locations (bPP/cPP). RESULTS We found the mean PPA to be lower in black compared to white participants (1.43 vs. 1.46; P=0.013). In black adults PPA declined earlier with increasing age (P-trend<0.001), with a weak trend in whites (P=0.069) after adjustment for sex, socio-economic status, height, heart rate and mean arterial pressure. In multivariable-adjusted regression, we found an independent inverse association between PPA and age only in the black group (β=-0.18, P=0.002). CONCLUSION PPA declines earlier with age in normotensive black adults younger than 30years, exemplifying early vascular aging which may predispose black individuals to future cardiovascular outcomes.
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Affiliation(s)
- Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Hugo W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Johannes M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Lebo F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Lisa J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa..
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6
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Ethnic differences regarding arterial stiffness of 6‐8‐year-old black and white boys. J Hypertens 2017; 35:960-967. [DOI: 10.1097/hjh.0000000000001267] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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7
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Reed KE, Warburton DER, Lewanczuk RZ, Haykowsky MJ, Scott JM, Whitney CL, McGavock JM, McKay HA. Arterial compliance in young children: the role of aerobic fitness. ACTA ACUST UNITED AC 2017; 12:492-7. [PMID: 16210937 DOI: 10.1097/01.hjr.0000176509.84165.3d] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Reduced arterial compliance is reflective of vascular dysfunction, which promotes the atherosclerotic process, and is therefore an important predictor of vascular disease. In adults, obesity, age, aerobic fitness, oestrogens and race influence arterial compliance. Although stature and blood pressure are known to influence compliance in children, other determinants are less established. This investigation sought to determine the predictors of arterial compliance in children, assess the extent to which aerobic fitness is related to compliance, and compare compliance between girls and boys. Methods Participants (99 children aged 9-11 years, 55 boys) were assessed for aerobic fitness, physical activity level, blood pressure, body mass, percentage fat mass, height, maturity and arterial compliance (large and small). Predictors of compliance were determined using stepwise regression. Second, children were divided into quartiles according to fitness, and arterial compliance was compared using analysis of covariance (ANCOVA). Finally, differences in compliance between girls and boys were assessed using ANCOVA. Results We found that fitness, blood pressure and height accounted for 37% of the variance in large artery compliance. Mass, fitness, maturity and blood pressure accounted for 44% of the variance in small artery compliance. Children in the highest fitness quartile had greater compliance than children in the two lowest quartiles, by as much as 34%. There were no differences in compliance between girls and boys after adjusting for covariates. Discussion These data show that aerobic fitness is associated with arterial compliance in 9-11-year-old children, supporting the concept that physical fitness may exert a protective effect on the cardiovascular system.
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Affiliation(s)
- Katharine E Reed
- School of Human Kinetics, University of British Columbia, Vancouver, BC, Canada
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8
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Steyn N, Eksteen G, Senekal M. Assessment of the Dietary Intake of Schoolchildren in South Africa: 15 Years after the First National Study. Nutrients 2016; 8:nu8080509. [PMID: 27548214 PMCID: PMC4997422 DOI: 10.3390/nu8080509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/02/2016] [Accepted: 08/16/2016] [Indexed: 11/17/2022] Open
Abstract
There has not been a national dietary study in children in South Africa since 1999. Fortification of flour and maize meal became mandatory in October 2003 to address micronutrient deficiencies found in the national study in 1999. The purpose of this review was to identify studies done after 1999 in schoolchildren, 6–15 years old, in order to determine whether dietary intakes reflected improvements in micronutrients, namely: iron, zinc, vitamin A, folate, thiamine, riboflavin, vitamin B6, and niacin. An electronic and hand search was done to identify all studies complying with relevant inclusion criteria. The search yielded 10 studies. Overall, there is a paucity of dietary studies which have included the fortified nutrients; only four, of which only one, reported on all micronutrients; making it difficult to determine whether fortification has improved the micronutrient intake of schoolchildren. This is further complicated by the fact that different dietary methods were used and that studies were only done in three of the nine provinces and thus are not generalizable. The results of these studies clearly point to the importance of doing a national study on the dietary intake of schoolchildren in order to confirm the outcomes of the fortification process.
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Affiliation(s)
- Nelia Steyn
- Division of Human Nutrition, Department of Human Biology, University of Cape Town, Cape Town 8000, South Africa.
| | - Gabriel Eksteen
- Division of Human Nutrition, Department of Human Biology, University of Cape Town, Cape Town 8000, South Africa.
- South African Heart and Stroke Foundation, Cape Town 8000, South Africa.
| | - Marjanne Senekal
- Division of Human Nutrition, Department of Human Biology, University of Cape Town, Cape Town 8000, South Africa.
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9
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Muthuri SK, Francis CE, Wachira LJM, LeBlanc AG, Sampson M, Onywera VO, Tremblay MS. Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review. PLoS One 2014; 9:e92846. [PMID: 24676350 PMCID: PMC3968060 DOI: 10.1371/journal.pone.0092846] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 02/27/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts. OBJECTIVE This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa. METHODS Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included. RESULTS A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status. CONCLUSIONS This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions. PROSPERO REGISTRATION NUMBER CRD42013004399.
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Affiliation(s)
- Stella K. Muthuri
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E. Francis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Allana G. LeBlanc
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Vincent O. Onywera
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Kenyatta University, Nairobi, Kenya
| | - Mark S. Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Kenyatta University, Nairobi, Kenya
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10
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Abstract
There is a considerable debate about the potential influence of ‘fetal programming’ on cardiovascular diseases in adulthood. In the present prospective epidemiological cohort study, the relationship between birthweight and arterial elasticity in 472 children between 5 and 8 years of age was assessed. LAEI (large artery elasticity index), SAEI (small artery elasticity index) and BP (blood pressure) were assessed using the HDI/PulseWave™ CR-2000 CardioVascular Profiling System. Blood concentrations of glucose, total cholesterol and its fractions [LDL (low-density lipoprotein)-cholesterol and HDL (high-density lipoprotein)-cholesterol] and triacylglycerols (triglycerides) were determined by automated enzymatic methods. Insulin was assessed by a chemiluminescent method, insulin resistance by HOMA (homoeostasis model assessment) and CRP (C-reactive protein) by immunonephelometry. Two linear regression models were applied to investigate the relationship between the outcomes, LAEI and SAEI, and the following variables: birthweight, gestational age, glucose, LDL-cholesterol, HDL-cholesterol, triacylglycerols, insulin, CRP, HOMA, age, gender, waist circumference, per capita income, SBP (systolic BP) and DBP (diastolic BP). LAEI was positively associated with birthweight (P=0.036), waist circumference (P<0.001) and age (P<0.001), and negatively associated with CRP (P=0.024) and SBP (P<0.001). SAEI was positively associated with birthweight (P=0.04), waist circumference (P=0.001) and age (P<0.001), and negatively associated with DBP (P<0.001). Arterial elasticity was decreased in apparently healthy children who had lower birthweights, indicating an earlier atherogenetic susceptibility to cardiovascular diseases in adolescence and adult life. Possible explanations for the results include changes in angiogenesis during critical phases of intrauterine life caused by periods of fetal growth inhibition and local haemodynamic anomalies as a way of adaptation to abnormal pressure and flow.
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11
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van Rooyen JM, Kruger HS, Huisman HW, Schutte AE, Malan NT, Schutte R. Early cardiovascular changes in 10- to 15-year-old stunted children: the Transition and Health during Urbanization in South Africa in Children study. Nutrition 2005; 21:808-14. [PMID: 15975488 DOI: 10.1016/j.nut.2004.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2004] [Accepted: 12/20/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Early changes in vascular function could be associated with stunting, which may contribute to the development of cardiovascular diseases in later life. In this study we tested the hypothesis that stunting may be related to changes in cardiovascular function in African children ages 10 to 15 y. METHODS In the Transition and Health during Urbanization in South Africa in Children study, the health status of children in the North-West Province of South Africa was studied. It was an epidemiologic, cross-sectional study in which 583 black non-stunted and 192 stunted children (stature below the fifth percentile for age) of both sexes ages 10 to 15 y were recruited from 44 schools. Blood pressure was monitored with the Finapres (finger-arterial pressure) apparatus and by means of the Fast Modelflo software program; measurements for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, and arterial compliance were obtained. Dietary intake data were collected with a 24-h dietary recall questionnaire. Nutrient coding was the same for all recalls and macro- and micronutrients were calculated. Anthropometric measurements were done according to standard methods. RESULTS There were no significant differences in systolic blood pressure and diastolic blood pressure between stunted and non-stunted children after correction for body mass index and heart rate. Stroke volume, arterial compliance, and cardiac output were significantly lower and total peripheral resistance was significantly higher in stunted children than in non-stunted children. No significant differences in dietary intake could be detected, although dietary intakes were slightly lower in the stunted children. CONCLUSIONS We found that compliance, a marker of vascular function, is significantly lower in stunted children. Stunting was related to early changes in cardiovascular function in African children ages 10 to 15 y.
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Affiliation(s)
- Johannes M van Rooyen
- School of Physiology, Nutrition and Consumer Sciences, Faculty of Health Science, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
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