Metabolic syndrome, clustering of cardiovascular risk factors and high carotid intima-media thickness in children and adolescents

Association between clustering of cardiovascular risk factors and left ventricular geometric remodeling in Chinese children

Background

Several cardiovascular (CV) risk factors are reported to be associated with abnormal cardiac structure in children and adults. However, no study has assessed the association between clustering of multiple CV risk factors and left ventricular geometric (LVG) remodeling. We examined the association between clustering of CV risk factors and LVG remodeling among Chinese children.

Methods

This cross-sectional study included 1,406 children aged 6-11 years. Clustering of CV risk factors was quantified as the sum of the number of five CV risk factors (abdominal obesity, elevated blood pressure, high fasting blood glucose, high triglycerides and low high-density lipoprotein cholesterol). Based on left ventricular mass index and relative wall thickness (RWT), left ventricular hypertrophy (LVH), high RWT and LVG remodeling [concentric remodeling (CR), eccentric hypertrophy (EH) and concentric hypertrophy (CH)] were defined.

Results

Compared to participants without CV risk factor, those with 1, 2 and ≥3 risk factors were at increased risk of LVH [ORs (95% CIs): 3.49 (2.19-5.56), 5.53 (3.20-9.55), and 19.19 (9.67-38.08), respectively]; corresponding values for high RWT were 2.47 (1.63-3.74), 3.76 (2.25-6.27), and 5.47 (2.65-11.28). Similar associations between clustering of CV risk factors and LVG remodeling were found [CR: 1.71 (1.06-2.76), 2.83 (1.54-5.18), and 3.82 (1.37-10.62); EH: 2.42 (1.42-4.11), 4.23 (2.24-7.96), and 16.86 (7.70-36.92); CH: 14.92 (4.41-50.47), 23.15 (6.32-84.83), and 71.19 (17.09-296.56)].

Conclusion

CV risk factors in isolation and combination were associated with an increased risk of LVH, high RWT and LVG remodeling among children, emphasizing the need to consider multiple risk factors when assessing the risk of cardiac outcomes.

The number of metabolic syndrome risk factors predicts alterations in gut microbiota in Chinese children from the Huantai study

BACKGROUND

Evidence on the effect of gut microbiota on the number of metabolic syndrome (MetS) risk factors among children is scarce. We aimed to examine the alterations of gut microbiota with different numbers of MetS risk factors among children.

METHODS

Data were collected from a nested case-control study at the baseline of the Huantai Childhood Cardiovascular Health Cohort Study in Zibo, China. We compared the differences in gut microbiota based on 16S rRNA gene sequencing among 72 children with different numbers of MetS risk factors matched by age and sex (i.e., none, one, and two-or-more MetS risk factors; 24 children for each group).

RESULTS

The community richness (i.e., the total number of species in the community) and diversity (i.e., the richness and evenness of species in the community) of gut microbiota decreased with an increased number of MetS risk factors in children (P for trend < 0.05). Among genera with a relative abundance greater than 0.01%, the relative abundance of Lachnoclostridium (P_FDR = 0.009) increased in the MetS risk groups, whereas Alistipes (P_FDR < 0.001) and Lachnospiraceae_NK4A136_group (P_FDR = 0.043) decreased in the MetS risk groups compared to the non-risk group. The genus Christensenellaceae_R-7_group excelled at distinguishing one and two-or-more risk groups from the non-risk group (area under the ROC curve [AUC]: 0.84 - 0.92), while the genera Family_XIII_AD3011_group (AUC: 0.73 - 0.91) and Lachnoclostridium (AUC: 0.77 - 0.80) performed moderate abilities in identifying none, one, and two-or-more MetS risk factors in children.

CONCLUSIONS

Based on the nested case-control study and the 16S rRNA gene sequencing technology, we found that dysbiosis of gut microbiota, particularly for the genera Christensenellaceae_R-7_group, Family_XIII_AD3011_group, and Lachnoclostridium may contribute to the early detection and the accumulation of MetS risk factors in childhood.

Metabolic syndrome and risk factors in children: a risk score proposal

INTRODUCTION/OBJECTIVE

The lack of international consensus on the definition of Metabolic Syndrome (MS) in the pediatric population makes it difficult to estimate its prevalence. In this study, we intend to identify MS prevalence and a cutoff point based on a continuous score in children aged four to seven years.

METHODS

A cross-sectional study of 402 children (4-7 years) monitored by the Lactation Support Program (PROLAC). A continuous MS risk score was assessed using Principal Component Analysis (PCA). In order to calculate the score, the following MS risk factors were considered: Waist circumference (WC), High Density Lipoprotein (HDL), Triglycerides (TG), Blood Pressure (BP) and Blood sugar. Using a Receiver Operating Characteristics (ROC) curve, the cutoff point for predicting MS risk based on continuous score was evaluated.

RESULTS

A progressive increase in MS scores was observed according to increase in the number of risk factors. This increase was also observed when comparing boys and girls (p < 0.001). In the absence of MS, the median score among the children was -0.0486 (-0.2929-0.2151). For children with MS, the median score was 0.5237 (0.2286-0.7104) (p < 0.001). The best cutoff score for predicting MS in children aged four to five years was >0.09 (100% sensitivity and specificity 72.67%). For children aged six to seven years, this value was >0.14 (100% sensitivity and 64.65% specificity).

CONCLUSION

The calculated continuous risk score can predict MS with good accuracy and high sensitivity and reasonable specificity.

Association of childhood metabolic syndrome and metabolic phenotypes with the carotid intima-media thickness (CIMT) in early adulthood: Tehran lipid and glucose study

BACKGROUND

The clinical significance of metabolic syndrome (MetS) during adolescence and its association with adulthood adverse outcomes is a controversial issue. This study aimed to investigate the association of MetS and metabolic phenotypes with a high carotid intima-media thickness (CIMT) in early adulthood.

METHODS

MetS was defined as proposed by Cook, de Ferranti, the National Cholesterol Education Program (NCEP), and the pediatric International Diabetes Federation (IDF). Metabolic phenotypes were defined based on the binary clustering of cardiovascular risk factors. The participants were adolescent's individual selected from a large cohort study and followed for 18.2 years. Multivariate-adjusted odds ratios (ORs) were calculated for a high CIMT incidence (≥95th percentile).

RESULTS

In this study, 862 adolescents (52.3% males), with the mean age of 13.4 ± 2.2 years, were included. The presence of MetS, based on the definitions proposed by Cook (OR = 1.90, 95% CI: 1.01-3.57, P = 0.046) and de Ferranti (OR = 1.74; 95% CI: 1.04-2.90, P = 0.033), was associated with the increased risk of a high CIMT in early adulthood. Metabolic phenotypes, including high waist circumference (WC)/hypertension (HTN), high WC/low high-density lipoprotein-cholesterol (HDL-C), and high triglyceride (TG)/high WC, showed higher risks of a high CIMT. However, these positive associations become insignificant after adjusting for the adulthood BMI, except for the high WC/low HDL-C phenotype (OR = 2.04, 95% CI: 1.02-4.11, P = 0.044).

CONCLUSION

The high WC/low HDL-C phenotype had a better predictive value and could be used as a simpler alternative for MetS to identify adolescents with a higher risk of high CIMT during early adulthood.

Association of Carotid Intima Media Thickness With Metabolic Syndrome Among Low-Income Middle-Aged and Elderly Chinese: A Population-Based Cross-Sectional Study

Background: We aimed to evaluate the relationship between metabolic syndrome (MetS) including its components and carotid intima media thickness (CIMT) in a low-income Chinese population aged ≥45 years.

Methods: The participants underwent a general health screening and B-mode carotid ultrasonography that measured CIMT. The diagnosis of MetS and its components was based on the modified International Diabetes Federation Criteria for the Asian Population. The univariate and multivariable linear regression analyses were used to evaluate the relationship between MetS and CIMT.

Results: A total of 3,583 participants (mean age, 60 years) was included in the analyses (41.4% male and 58.6% female); more than 50% of the participants were diagnosed with MetS. In the multivariable linear regression analysis, the mean CIMT was 0.009 mm greater in the participants with MetS than in those without MetS (β = 0.009; 95% CI, 0.003–0.014; P < 0.05). Moreover, a high number of MetS components was associated with greater CIMT values; for example, CIMT increased by 0.007 and 0.015 mm for the individuals diagnosed with 3–4 and 5 MetS components, respectively. Among the MetS components, elevated blood pressure (β = 0.022; 95% CI, 0.015–0.029; P < 0.001) and abdominal obesity (β = 0.008; 95% CI, 0.001–0.015; P < 0.001) were positively correlated with CIMT. However, the increased triglyceride levels were negatively associated with CIMT (β = −0.008; 95% CI: −0.015 to −0.002; P = 0.012), especially among the elderly population.

Conclusions: The risk of carotid atherosclerosis increased in the presence of multiple MetS components in a low-income, middle-aged, and elderly population. Accordingly, more detailed management strategies are essential for the early prevention and intervention of atherosclerosis in this low-income population with MetS, in China.

Postprandial dyslipidemia after a standardized high-fat meal in BMI-matched healthy individuals, and in subjects with prediabetes or type 2 diabetes

BACKGROUND & AIMS

A relationship between postprandial hyperlipidemia and glucose homeostasis/cardiovascular diseases has been suggested. We investigated postprandial plasma lipid patterns after a standardized high-fat meal and their association with glucose homeostasis and subclinical atherosclerosis.

METHODS

Using matching by BMI, 32 healthy individuals with normal glucose tolerance (NGT), 21 subjects with impaired glucose tolerance (IGT), and 20 subjects with drug-naïve type 2 diabetes (T2D) were enrolled. Plasma concentrations of triglycerides (TGs), apolipoprotein-B (ApoB), ApoB48, ApoB100, glucose, and insulin at baseline and 1, 2, 3, 4, 5, 6, and 8 h after a standardized meal (1041.03 kcal with 70.99 g of fat) were measured. Body composition, abdominal visceral fat area, and resting energy expenditure (REE) were measured using dual energy X-ray absorptiometry, computed tomography, and indirect calorimetry, respectively. The intima-media thickness (IMT) of the carotid artery and the ankle-brachial index (ABI) were used to detect subclinical atherosclerosis.

RESULTS

Baseline data and area under the curve (AUC) of plasma concentrations of TGs, ApoB, and ApoB48 in the IGT and T2D groups were higher than in the NGT group. The peak TG concentrations after the meal was observed at 5 h in subjects with IGT and T2D, while healthy subjects showed the highest concentrations at 4 h. In multivariable analysis, high abdominal visceral fat area and low HDL-cholesterol concentrations were independently associated with the AUC_TG and AUC_ApoB after adjusting for confounders including baseline TG and the REE. High LDL-cholesterol and high HbA1c concentrations were also associated with the AUC_ApoB. Furthermore, high AUC_TG and AUC_ApoB values were independent factors for an increased carotid IMT and a low ABI after adjusting for relevant variables.

CONCLUSIONS

Abdominal visceral obesity and low HDL-cholesterol concentrations were associated with increased post load excursions of TGs and ApoB in this series. These elevated concentrations of TGs and ApoB were linked with subclinical atherosclerosis.

Central Systolic Blood Pressure Is Associated With Early Vascular Damage in Children and Adolescents With Type 1 Diabetes

Objective of the study: This study aimed to test the effect of multiple cardiovascular risk factors on subclinical indices of atherosclerosis in children and adolescents with type 1 diabetes (T1D).

Methods: Carotid intima-media thickness (cIMT), carotid distensibility coefficient (cDC), and carotid–femoral pulse wave velocity (PWV) were measured in children and adolescents with T1D, in a follow-up at the outpatient clinics of Verona. Blood pressure (BP; both central and peripheral), metabolic and other cardiovascular risk factors were evaluated in multivariate linear regressions to assess the association with the measured indices of subclinical vascular damage.

Results: One hundred and twenty-six children and adolescents were included. cIMT was above the 95th percentile for age and height in 60.8% of the population, whereas 26% of the sample had cDC impairment (less than the 5th percentile) and 4.8% had an elevated PWV. Independent determinants of cIMT according to the regression models were only gender type of glucose monitoring and central systolic BP (cSBP). PWV was associated with age, sex, heart rate, and cSBP; cDC with age and both cSBP and, alternatively, peripheral BP (pBP). Neither pBP nor any of the tested metabolic parameters, including glycated hemoglobin, was associated with PWV and cIMT.

Conclusions: A high proportion of early vascular damage, especially an increased cIMT, is present in children and adolescents with T1D in whom cSBP seems to be a common determinant. In children and adolescents with T1DM, a special focus should be on hemodynamic risk factors beyond metabolic ones.

Obesity, metabolic syndrome, and primary hypertension

Primary hypertension is the dominant form of arterial hypertension in adolescents. Disturbed body composition with, among other things, increased visceral fat deposition, accelerated biological maturation, metabolic abnormalities typical for metabolic syndrome, and increased adrenergic drive constitutes the intermediary phenotype of primary hypertension. Metabolic syndrome is observed in 15-20% of adolescents with primary hypertension. These features are also typical of obesity-related hypertension. Metabolic abnormalities and metabolic syndrome are closely associated with both the severity of hypertension and the risk of target organ damage. However, even though increased body mass index is the main determinant of blood pressure in the general population, not every hypertensive adolescent is obese and not every obese patient suffers from hypertension or metabolic abnormalities typical for metabolic syndrome. Thus, the concepts of metabolically healthy obesity, normal weight metabolically unhealthy, and metabolically unhealthy obese phenotypes have been developed. The risk of hypertension and hypertensive target organ damage increases with exposure to metabolic risk factors which are determined by disturbed body composition and visceral obesity. Due to the fact that both primary hypertension and obesity-related hypertension present similar pathogenesis, the principles of treatment are the same and are focused not only on lowering blood pressure, but also on normalizing body composition and metabolic abnormalities.

Origins of Primary Hypertension in Children

Although relatively rare in childhood, primary hypertension (PH) is thought to have originated in childhood and may be even determined perinatally. PH prevalence increases in school-age children and affects 11% of 18-year-old adolescents. Associated with metabolic risk factors, elevated blood pressure in childhood is carried into adulthood. Analysis of the phenotype of hypertensive children has revealed that PH is a complex of anthropometric and neuro-immuno-metabolic abnormalities, typically found in hypertensive adults. Children with elevated blood pressure have shown signs of accelerated biological development, which are closely associated with further development of PH, metabolic syndrome, and cardiovascular disease in adulthood. At the time of diagnosis, hypertensive children were reported to have significant arterial remodelling expressed as significantly increased carotid intima-media thickness, increased stiffness of large arteries, lower area of microcirculation, and decreased endothelial function. These changes indicate that their biological age is 4 to 5 years older than their normotensive peers. All these abnormalities are typical features of early vascular aging described in adults with PH. However, as these early vascular changes in hypertensive children are closely associated with features of accelerated biological development and neuro-immuno-metabolic abnormalities observed in older subjects, it seems that PH in childhood is not only an early vascular aging event, but also an early biological maturation phenomenon.

Validity of the pediatric simple metabolic syndrome score

AIMS

To compare the validity of the conventional continuous metabolic syndrome score (ccMS) and pediatric simple metabolic syndrome score (PsiMS) for the prediction of MS in Korean adolescents.

METHODS

A total of 2983 adolescents aged 10-18 years who participated in the Korea National Health and Nutrition Examination Survey (2013-2017) were enrolled. The ccMS was calculated by aggregating the sex and age-specific z-scores of body mass index, systolic blood pressure (SBP), glucose, high-density lipoprotein cholesterol (HDL-C), and triglycerides. The PsiMS was calculated using the following formula: 〔2x(waist/height (cm)〕+〔glucose (mg/dL)/100〕+〔triglycerides (mg/dL)/150〕+〔SBP (mmHg)/130〕-〔HDL-C (mg/dL)/40〕.

RESULTS

Mean PsiMS was significantly higher in subjects with MS compared with those without MS (3.24 vs. 1.93 in boys, 3.11 vs. 1.80 in girls; P < 0.001). Both ccMS and PsiMS were significantly higher in subjects with more MS components compared to adolescents with fewer components (P-for-trend<0.001). Among the adolescents without MS but in the PsiMS quintile 5, 33.5% presented two or more MS components. The receiver operating characteristic analysis demonstrated an equally good performance of ccMS (AUC = 0.975) and PsiMS (AUC = 0.958) for identifying adolescent MS risk. PsiMS showed a good stratification of MS risk in the generalized linear model.

CONCLUSION

PsiMS is an accurate and efficient scoring system to assess and monitor the risk of adolescent MS in the research and clinical practice.