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Haushalter K, Burgermaster M, Hudson E, Landry MJ, Sharma SV, Davis JN. An Increase in Food Insecurity Correlated with an Increase in Plasma Triglycerides among Latinx Children. J Nutr 2024; 154:565-573. [PMID: 38110183 PMCID: PMC10900190 DOI: 10.1016/j.tjnut.2023.12.024] [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: 09/11/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Food insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity. OBJECTIVE The objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 academic year. METHODS This secondary analysis used data from TX Sprouts, a cluster-randomized school-based gardening, cooking, and nutrition trial. The study enrolled 3rd-5th-grade students from 16 schools that served primarily (>50%) Hispanic families with low income in Austin, TX. Participants (n = 619) provided household food insecurity data and fasting lipid panels at both baseline and postintervention, ∼9 mo following. RESULTS There was no intervention effect on household food insecurity. Independent of the intervention, a 1-point increase in food insecurity, indicative of becoming more food insecure, was associated with a 2.61 mg/dL increase in triglycerides (P = 0.001; 95% CI: 1.04, 4.19) at follow-up. Children who were food insecure at baseline and became food secure at follow-up had a mean 5.05 mg/dL decrease in triglycerides compared with a 7.50 mg/dL increase in triglycerides in children who remained food insecure throughout (95% CI: -23.40, -1.71, P = 0.023). There were no other associations between changes in food insecurity and cardiometabolic markers. CONCLUSION Although the intervention did not improve food insecurity, reductions in food insecurity over 9 mo were associated with improved cardiometabolic markers in high-risk children, emphasizing the need for interventions targeting food insecurity. The study is registered at clinicaltrials.gov under NCT02668744 (https://classic. CLINICALTRIALS gov/ct2/show/NCT02668744).
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Affiliation(s)
- Keally Haushalter
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Marissa Burgermaster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Erin Hudson
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States
| | - Matthew J Landry
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, United States
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences (UTHealth) School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jaimie N Davis
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, United States.
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Ferraro S, Benedetti S, Mannarino S, Marcovina S, Mario Biganzoli E, Zuccotti G. Prediction of atherosclerotic cardiovascular risk in early childhood. Clin Chim Acta 2024; 552:117684. [PMID: 38016628 DOI: 10.1016/j.cca.2023.117684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023]
Abstract
Atherosclerotic lesions are present even in very young individuals and therefore, risk stratification for cardiovascular (CV) disease should be implemented in childhood to promote early prevention strategies. In this review we critically appraise clinical, biochemical and genetic biomarkers available for pediatric clinical practice, which might be integrated to build effective algorithms to identify children at risk of future CV events. The first critical issue is to characterize in children aged 2-5 years, those CV risk factors/clinical conditions associated with dramatically accelerated atherosclerosis. Presence of clinical conditions such as obesity, diabetes mellitus, Kawasaki disease, etc., or positive family history for premature CV disease should be evaluated. Subsequently, a complete lipid profile and Lipoprotein(a) determination are recommended for children with increased baseline CV risk. Individuals with altered lipid profile could then undergo genetic testing for monogenic dyslipidemias to identify children with high CV genetic risk, who will be directed to appropriate therapeutic options. In perspective, calculation of a polygenic risk score, based on the analysis of several common single-nucleotide polymorphisms, could be integrated for better risk assessment. We here emphasize the importance of a "holistic" strategy integrating biochemical, anamnestic and genetic data to stratify CV risk in early childhood.
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Affiliation(s)
- Simona Ferraro
- Center of Functional Genomics and Rare Diseases Dept. of Pediatrics Buzzi Children's Hospital, Milan, Italy; Pediatric Department, Buzzi Children's Hospital, Milan, Italy.
| | - Sara Benedetti
- Center of Functional Genomics and Rare Diseases Dept. of Pediatrics Buzzi Children's Hospital, Milan, Italy; Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milano, Italy
| | | | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy; Data Science Research Center, University of Milan, Milan, Italy.
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy; Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
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Salama M, Balagopal B, Fennoy I, Kumar S. Childhood Obesity, Diabetes. and Cardiovascular Disease Risk. J Clin Endocrinol Metab 2023; 108:3051-3066. [PMID: 37319430 DOI: 10.1210/clinem/dgad361] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
This mini-review aims to briefly summarize the pathophysiology of childhood obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) risk in children and adolescents. Recent data on efficacy of lifestyle interventions, medications, and metabolic surgery for obesity, T2DM, and CVD risk factors are also reviewed. We conducted a PubMed search of English-language original and review articles relevant to childhood obesity, T2DM, and CVD risk factors, and biomarkers in children with an emphasis on recent publications. Childhood obesity arises from an intricate interaction between genetic, physiologic, environmental, and socioeconomic factors. The rise in the prevalence of childhood obesity is associated with the development of comorbidities including T2DM and CVD at an early age. A multipronged approach is central to the detection, monitoring, and management of childhood obesity and associated adverse metabolic consequences.
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Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
| | - Babu Balagopal
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biomedical Research, Nemours Children's Health System, Jacksonville, FL 32207, USA
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University, New York, NY 10032, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
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Raducha D, Ratajczak J, Kostrzeba E, Berus E, Walczak M, Petriczko E. Assessment of Biochemical Parameters in 8- and 9-Year-Old Children with Excessive Body Weight Participating in a Year-Long Intervention Program. J Clin Med 2023; 12:6560. [PMID: 37892696 PMCID: PMC10607870 DOI: 10.3390/jcm12206560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Childhood obesity represents a significant challenge both clinically and socio-economically. This study aimed to assess specific biochemical parameters, particularly glucose, insulin and lipid profile, before and after a year-long intervention program in 8- and 9-year-old children with excessive body weight living in Szczecin, Poland from 2016 to 2018. The research comprised two phases: screening in elementary schools and intervention in the outpatient clinic of the clinical Pomeranian Medical University hospital. Out of 11,494 8- to 9-year-olds in Szczecin, 42.54% (4890) participated in the screening. In the intervention phase, 515 children were examined. Anthropometric measurements were recorded at each visit, and blood samples were collected during the first and fourth visits. In the statistical analysis, the Kolmogorov-Smirnov, t-Student and ANOVA tests were employed (with statistical significance when p ≤ 0.05). Results highlighted a significant proportion of children exhibiting disruptions in carbohydrate and lipid metabolism. A total of 8.6% of participants had elevated total cholesterol, 9.7% had reduced HDL, 13.4% had elevated LDL, and 21.2% had elevated triglycerides. Initially, abnormal fasting glucose was detected in 4.7% of children, and elevated insulin levels in 3.1%. Metabolic disorders persisted post-intervention despite BMI improvement. The results emphasize the necessity for prolonged programs with frequent follow-ups targeting weight normalization in children.
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Affiliation(s)
- Dominika Raducha
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (D.R.); (E.B.); (M.W.); (E.P.)
| | - Joanna Ratajczak
- Institute of Physical Culture Sciences, University of Szczecin, 70-237 Szczecin, Poland;
| | - Ewa Kostrzeba
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (D.R.); (E.B.); (M.W.); (E.P.)
| | - Ewa Berus
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (D.R.); (E.B.); (M.W.); (E.P.)
| | - Mieczysław Walczak
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (D.R.); (E.B.); (M.W.); (E.P.)
| | - Elżbieta Petriczko
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (D.R.); (E.B.); (M.W.); (E.P.)
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Brar PC. Can Surrogate Markers Help Define Cardiovascular Disease in Youth? Curr Atheroscler Rep 2023:10.1007/s11883-023-01101-6. [PMID: 37148462 DOI: 10.1007/s11883-023-01101-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE OF REVIEW Non-invasive measurements such as arterial stiffness serve as proxy surrogates for detection of early atherosclerosis and ASCVD risk stratification. These surrogate measurements are influenced by age, gender, and ethnicity and affected by the physiological changes of puberty and somatic growth in children and adolescents. RECENT FINDINGS There is no consensus of the ideal method to measure surrogate markers in youth (< 18 years of age), nor standardized imaging protocols for youth. Currently, pediatric normative data are available but not generalizable. In this review, we provide rationale on how currently used surrogates can help identify subclinical atherosclerosis in youth and affirm their role in identifying youth at risk for premature CVD.
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Hyperlipidemia and Cardiovascular Risk in Children and Adolescents. Biomedicines 2023; 11:biomedicines11030809. [PMID: 36979789 PMCID: PMC10045454 DOI: 10.3390/biomedicines11030809] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) represents the major cause of morbidity and mortality worldwide. The onset of the atherosclerosis process occurs during childhood and adolescence, subsequently leading to the onset of cardiovascular disease as young adults. Several cardiovascular risk factors can be identified in children and adolescents; however, hyperlipidemia, in conjunction with the global obesity epidemic, has emerged as the most prevalent, playing a key role in the development of ASCVD. Therefore, screening for hyperlipidemia is strongly recommended to detect high-risk children presenting with these disorders, as these patients deserve more intensive investigation and intervention. Treatment should be initiated as early as possible in order to reduce the risk of future ASCVD. In this review, we will discuss lipid metabolism and hyperlipidemia, focusing on correlations with cardiovascular risk and screening and therapeutic management to reduce or almost completely avoid the development of ASCVD.
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Zhang T, Fan B, Li S, Wang X, Kong Y, Bazzano L, He J, Chen W, Yan Y. Long-Term Adiposity and Midlife Carotid Intima-Media Thickness Are Linked Partly Through Intermediate Risk Factors. Hypertension 2023; 80:160-168. [PMID: 36314120 PMCID: PMC9742127 DOI: 10.1161/hypertensionaha.122.20217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aims to determine quantitatively the mediation effects of multiple cardiovascular risk factors on the associations of childhood body mass index (BMI) and its cumulative burden with adult carotid intima-media thickness (cIMT). METHODS The longitudinal cohort consisted of 1391 adults who had been examined for BMI 4-15 times over 35.0 years on average since childhood and had data on adult cIMT, systolic blood pressure, low-density lipoprotein cholesterol, atherogenic index of plasma, and serum glucose. The area under the curve was used as a measure of cumulative burden of BMI. RESULTS After adjusting for covariates, the total effects (standardized regression coefficient) of childhood BMI (0.138), adult BMI (0.111), and area under the curve of BMI (0.150) on cIMT were all significant (P<0.001) without mediators included in the model. The mediation effects of adult systolic blood pressure, glucose, atherogenic index of plasma and low-density lipoprotein cholesterol were 8.0%, 4.3%, 3.6%, and 0.0%, respectively, in the model with childhood BMI as the predictor, 23.4%, 15.3%, 12.6%, and 7.2%, respectively, with adult BMI as the predictor, and 14.7%, 8.7%, 6.0%, and 2.0%, respectively, with area under the curve of BMI as the predictor. The direct effects on cIMT were 0.117 (P<0.001) for childhood BMI, 0.046 (P=0.224) for adult BMI, and 0.103 (P<0.001) for area under the curve of BMI after removing the mediation effects. CONCLUSIONS The long-term deleterious impact of adiposity on subclinical changes in vascular structure begins early in life and is accumulated over lifetime. Excess adiposity and higher cIMT are linked partly through other cardiovascular risk factors in later life, especially elevated blood pressure and glucose.
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Affiliation(s)
- Tao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Institute of Health Data Science, Shandong University, Jinan, Shandong, China
| | - Bingbing Fan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Institute of Health Data Science, Shandong University, Jinan, Shandong, China
| | - Shengxu Li
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN, USA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yawei Kong
- Center for Non-communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lydia Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yinkun Yan
- Center for Non-communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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Yan Y, Li S, Liu Y, Guo Y, Fernandez C, Bazzano L, He J, Chen W. Associations Between Life-Course Lipid Trajectories and Subclinical Atherosclerosis in Midlife. JAMA Netw Open 2022; 5:e2234862. [PMID: 36197664 PMCID: PMC9535509 DOI: 10.1001/jamanetworkopen.2022.34862] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Childhood lipid levels have been associated with adult subclinical atherosclerosis; however, life-course lipid trajectories and their associations with cardiovascular disease risk are poorly characterized. OBJECTIVES To examine the associations of lipid levels at different ages and discrete lipid trajectory patterns from childhood to adulthood with subclinical atherosclerosis in midlife. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Bogalusa Heart Study, a prospective, population-based cohort study conducted in a semirural, biracial community in Bogalusa, Louisiana, with follow-up from 1973 to 2016 (median follow-up, 36.8 years). Participants had 4 to 16 repeated measurements of lipids, including total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), from childhood to midlife and adult measurement of carotid intima-media thickness (IMT). Statistical analyses were conducted from July 1 to December 31, 2021. EXPOSURES Age-specific lipid levels were estimated, and lipid trajectory patterns were identified using latent mixture modeling. MAIN OUTCOMES AND MEASURES Subclinical atherosclerosis measured by carotid IMT. RESULTS The study evaluated 1201 adults (mean [SD] age, 45.7 [6.8] years; 691 [57.5%] women and 510 [42.5%] men; 392 Black [32.6%] and 809 White [67.4%] individuals). Levels of all lipids at each age from 5 to 45 years were significantly associated with adult IMT. The magnitude of associations generally increased with age, and non-HDL-C (age 5 y: β, 0.040; 95% CI, 0.025-0.055; age 45 y, β, 0.049; 95% CI, 0.026-0.072) and LDL-C (age 5 y: β, 0.039; 95% CI, 0.024-0.054; age 45 y, β, 0.043; 95% CI, 0.023-0.063) showed the strongest associations. After adjusting for race, sex, and other cardiovascular risk factors, mean IMT values were significantly higher in the low-slow increase, low-rapid increase, and high-stable trajectory groups for TC (eg, high-stable group: mean difference, 0.152 mm; 95% CI, 0.059-0.244 mm), the low-slow increase, low-rapid increase, moderate-stable, and high-stable trajectory groups for non-HDL-C (eg, low-slow increase group: mean difference, 0.048 mm; 95% CI, 0.012-0.085 mm) and LDL-C (eg, low-rapid increase group: mean difference, 0.104 mm; 95% CI, 0.056-0.151 mm) and the low-rapid increase and moderate-stable trajectory groups for TG (eg, moderate-stable group: mean difference, 0.071 mm; 95% CI, 0.019-0.122 mm) vs the corresponding low-stable trajectory groups. These associations were slightly attenuated after further adjustment for lipid levels at baseline or follow-up. There were no significant differences in mean IMT among HDL-C trajectory groups. CONCLUSIONS AND RELEVANCE In this cohort study, discrete life-course lipid trajectories were associated with the development of atherosclerosis in midlife. The findings emphasize the importance of maintaining optimal lipid levels across the lifespan.
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Affiliation(s)
- Yinkun Yan
- Center for Noncommunicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Shengxu Li
- Children’s Minnesota Research Institute, Children’s Hospitals and Clinics of Minnesota, Minneapolis
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yajun Guo
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Fan B, Zhang T, Li S, Yan Y, Fan L, Bazzano L, He J, Chen W. Differential Roles of Life-Course Cumulative Burden of Cardiovascular Risk Factors in Arterial Stiffness and Thickness. Can J Cardiol 2022; 38:1253-1262. [PMID: 35314334 DOI: 10.1016/j.cjca.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Data are limited regarding differential and common effects of cardiovascular risk factors on subclinical changes in vascular structure and function. We aimed to examine the relationships of life-course cumulative burdens of cardiovascular risk factors with adult arterial pulse wave velocity (PWV) and carotid intima-media thickness (CIMT) in a longitudinal cohort of the Bogalusa Heart Study. METHODS The cohort consisted of 900 subjects who had aortic-femoral PWV and CIMT measurements. These participants were examined 5-16 times for body mass index (BMI), blood pressure, atherogenic index of plasma (AIP), and low-density lipoprotein cholesterol (LDLC) from childhood to adulthood. The area under the curve (AUC) was calculated as a measure of long-term burden of the risk factors. RESULTS Adjusting for covariates, adult PWV was associated with AUCs of BMI, systolic blood pressure (SBP) and AIP (standardized regression coefficient [β] = 0.191, 0.321, 0.153, respectively; P < 0.001 for all). Adult CIMT was associated with AUCs of BMI, SBP, AIP and LDLC (β = 0.115, 0.202, 0.141, 0.152, respectively; P < 0.001 for all). Moreover, childhood BMI was associated with adult PWV and CIMT (β = 0.088 and 0.075, respectively; false discovery rate q values < 0.05 for both), and childhood LDLC with adult CIMT (β = 0.079; false discovery rate q value < 0.05). These associations did not differ significantly among race and sex groups. CONCLUSIONS The life-course cumulative burden of BMI, SBP, and AIP has common effects on arterial wall stiffening and thickening, whereas LDLC is specifically associated with arterial wall thickness, and this effect starts in early life.
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Affiliation(s)
- Bingbing Fan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science, Shandong University, Jinan, Shandong, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science, Shandong University, Jinan, Shandong, China.
| | - Shengxu Li
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Yinkun Yan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lijun Fan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA; Institute for Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Perng W, Friedman JE, Janssen RC, Glueck DH, Dabelea D. Endotoxin Biomarkers Are Associated With Adiposity and Cardiometabolic Risk Across 6 Years of Follow-up in Youth. J Clin Endocrinol Metab 2022; 107:e3018-e3028. [PMID: 35276001 PMCID: PMC9202713 DOI: 10.1210/clinem/dgac149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Metabolic endotoxemia may be a shared mechanism underlying childhood obesity and early-onset metabolic diseases (eg, type 2 diabetes, nonalcoholic fatty liver disease). OBJECTIVE Examine prospective associations of serum endotoxin biomarkers lipopolysaccharide (LPS) and its binding protein, LPS binding protein (LBP), and anti-endotoxin core immunoglobulin G (EndoCab IgG) with adiposity and cardiometabolic risk in youth. DESIGN/SETTING This prospective study included 393 youth in the Exploring Perinatal Outcomes Among Children cohort in Colorado. Participants were recruited from 2006 to 2009 at age 10 years (baseline) and followed for 6 years (follow-up). We examined associations of endotoxin biomarkers at baseline with adiposity [body mass index (BMI) z-score, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skinfolds, waist circumference] and cardiometabolic risk (insulin, glucose, adipokines, lipid profile, blood pressure) across both visits using mixed-effects regression, and with hepatic fat fraction (HFF) at follow-up using linear regression. RESULTS Higher LPS and LBP predicted greater adiposity across follow-up. Each 1-unit log-transformed LPS corresponded with 0.23 (95% CI 0.03, 0.43) units BMI z-score, 5.66 (95% CI 1.99, 9.33) mm3 VAT, 30.7 (95% CI 8.0, 53.3) mm3 SAT, and 8.26 (95% CI 4.13, 12.40) mm skinfold sum. EndoCab IgG was associated with VAT only [3.03 (95% CI 0.34, 5.71) mm3]. LPS was associated with higher insulin [1.93 (95% CI 0.08, 3.70) µU/mL] and leptin [2.28 (95% CI 0.66, 3.90) ng/mL] and an adverse lipid profile. No association was observed with HFF. Accounting for pubertal status and lifestyle behaviors did not change findings. However, adjustment for prepregnancy BMI and gestational diabetes attenuated most associations. CONCLUSIONS Serum endotoxin may be a marker of pathophysiological processes underlying development of childhood obesity and cardiometabolic conditions associated with exposure to fetal overnutrition.
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Affiliation(s)
- Wei Perng
- Correspondence: Wei Perng, University of Colorado Denver, Anschutz Medical Campus, 12474 E. 19th Ave, Room 208, Aurora, CO 80045, USA.
| | - Jacob E Friedman
- Harold Hamm Diabetes Center, The University of Oklahoma Health Sciences Center, School of Medicine, Oklahoma City, OK, USA
| | - Rachel C Janssen
- Harold Hamm Diabetes Center, The University of Oklahoma Health Sciences Center, School of Medicine, Oklahoma City, OK, USA
| | - Deborah H Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora CO, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora CO, USA
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Tskhvedadze N, Janjgava S, Tananashvili D, Giorgadze E. The Impact of Obesity Assessed by Different Criteria on the Metabolic Parameters in Children and Adolescents in Georgia. Glob Pediatr Health 2022; 9:2333794X221097569. [PMID: 35592792 PMCID: PMC9112292 DOI: 10.1177/2333794x221097569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of our study was comparative analysis of anthropometric characteristics
in children and adolescents significantly correlated with the parameters of
metabolic syndrome. The study group is consisted of 113 children and adolescents
(study group) with excessive body weight and obesity (group 1—BMI percentile;
group 2—waist circumference; group 3—waist to height ratio). The control group
consisted of 113 children and adolescents without. Comparative analysis of
obtained data have been carried out by multiple regression analysis. BMI
percentile is more an indicator of a generalized obesity; WC and WHR percentiles
better describe visceral obesity and metabolic disorders—insulin resistance,
hypertension and dyslipidemia. However, the WHR Percentile may be a more useful
tool. To assess obesity in children and adolescents, it is necessary to evaluate
together BMI, WC, and WHR percentiles. It can be also concluded that these
findings indicate the need to continue research in this direction.
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Affiliation(s)
- Nino Tskhvedadze
- Tbilisi State University, Tbilisi, Georgia.,National Institute of Endocrinology, Tbilisi, Georgia
| | | | | | - Elene Giorgadze
- Tbilisi State University, Tbilisi, Georgia.,National Institute of Endocrinology, Tbilisi, Georgia
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12
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Ziyab AH, Almari M, Mohammad A, Al-Taiar A, Karmaus W. Sex Differences in the Association of Sibship Size and Position in Sibship with Lipid Profile during Adolescence: A Cross-Sectional Study. Int J Endocrinol 2022; 2022:8727922. [PMID: 36204482 PMCID: PMC9532113 DOI: 10.1155/2022/8727922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epidemiologic studies have reported associations of sibship size and position of the child in the sibship with multiple health outcomes, including adiposity and diabetes. However, little is known about sibling effects on lipids. Hence, this study sought to evaluate associations of the number of total, older, and younger siblings with lipid profile among adolescents. METHODS In a cross-sectional study among high school students aged 14 to 19 years, lipid levels were measured in capillary blood. Parents reported the number of siblings (total, older, and younger). Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and 95% confidence intervals (CI). Analyses were sex stratified. RESULTS Of the total study sample (n = 1,584), 758 (47.9%) were boys and 826 (52.1%) were girls, with median age of 16.0 years. Total cholesterol (TC) was lower by 8% (adjusted-RoGM = 0.92, 95% CI: 0.88-0.96) among boys with ≥3 older siblings compared to those with no older siblings. Similarly, boys with ≥3 younger sibling compared to those with no younger siblings had reduced TC by 7% (adjusted-RoGM = 0.93, 0.87-0.99). Moreover, an increased number of total siblings (≥4 vs. 0/1: adjusted-RoGM = 0.80, 0.67-97) and older siblings (≥3 vs. 0: adjusted-RoGM = 0.90, 0.82-0.98) were associated with reduced low-density lipoprotein cholesterol (LDL-C) among boys. Similarly, lower levels of triglycerides (TG) were seen among boys with ≥3 older siblings compared to those with no older siblings (adjusted-RoGM = 0.87, 0.78-0.96). A higher number of younger siblings was associated with increased high-density lipoprotein cholesterol (HDL-C) among boys (≥3 vs. 0: adjusted-RoGM = 1.08, 1.01-1.17). Sibship characteristics were not associated with lipids among girls. CONCLUSIONS Increased number of total, older, and younger siblings were associated with favorable lipid profiles among adolescent boys, but not girls. Mechanisms underlying these associations need further investigations.
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Affiliation(s)
- Ali H. Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mohammad Almari
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Safat, Kuwait
| | - Anwar Mohammad
- Biochemistry and Molecular Biology Department, Research Division, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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13
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Matricciani L, Paquet C, Fraysse F, Grobler A, Wang Y, Baur L, Juonala M, Nguyen MT, Ranganathan S, Burgner D, Wake M, Olds T. Sleep and cardiometabolic risk: a cluster analysis of actigraphy-derived sleep profiles in adults and children. Sleep 2021; 44:6124580. [PMID: 33515457 DOI: 10.1093/sleep/zsab014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/21/2020] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVES Sleep plays an important role in cardiometabolic health. Although the importance of considering sleep as a multidimensional construct is widely appreciated, studies have largely focused on individual sleep characteristics. The association between actigraphy-derived sleep profiles and cardiometabolic health in healthy adults and children has not been examined. METHODS This study used actigraphy-measured sleep data collected between February 2015 and March 2016 in the Child Health CheckPoint study. Participants wore actigraphy monitors (GENEActiv Original, Cambs, UK) on their nondominant wrist for 7 days and sleep characteristics (period, efficiency, timing, and variability) were derived from raw actigraphy data. Actigraphy-derived sleep profiles of 1,043 Australian children aged 11-12 years and 1,337 adults were determined using K-means cluster analysis. The association between cluster membership and biomarkers of cardiometabolic health (blood pressure, body mass index, apolipoproteins, glycoprotein acetyls, composite metabolic syndrome severity score) were assessed using Generalized Estimating Equations, adjusting for geographic clustering, with sex, socioeconomic status, maturity stage (age for adults, pubertal status for children), and season of data collection as covariates. RESULTS Four actigraphy-derived sleep profiles were identified in both children and adults: short sleepers, late to bed, long sleepers, and overall good sleepers. The overall good sleeper pattern (characterized by adequate sleep period time, high efficiency, early bedtime, and low day-to-day variability) was associated with better cardiometabolic health in the majority of comparisons (80%). CONCLUSION Actigraphy-derived sleep profiles are associated with cardiometabolic health in adults and children. The overall good sleeper pattern is associated with more favorable cardiometabolic health.
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Affiliation(s)
- Lisa Matricciani
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Catherine Paquet
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia.,Faculté des Sciences de l'Administration, Université Laval, Québec, QC, Canada
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Anneke Grobler
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC,Australia
| | - Yichao Wang
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC,Australia
| | - Louise Baur
- The University of Sydney, Sydney, NSW,Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Minh Thien Nguyen
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC,Australia
| | - Sarath Ranganathan
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC,Australia.,Respiratory Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - David Burgner
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC,Australia.,Department of General Medicine, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Melissa Wake
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,The University of Auckland, Grafton, Auckland, New Zealand.,Murdoch Children's Research Institute, Parkville, VIC,Australia
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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14
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Gonzalez DO, Michalsky MP. Update on pediatric metabolic and bariatric surgery. Pediatr Obes 2021; 16:e12794. [PMID: 34041862 DOI: 10.1111/ijpo.12794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
The prevalence of childhood obesity has risen sharply over the last several decades and poses a significant threat to the health and well-being of today's youth. Childhood-onset obesity is associated with a number of cardiometabolic consequences, which contribute to diminished quality of life. Metabolic and bariatric surgery offers a powerful treatment paradigm with positive long-term health effects. A growing body of literature supports the notion that earlier intervention in younger patients results in long-term health benefits. The development of a multidisciplinary care model and best practice guidelines are central to providing optimal care for this vulnerable patient population. Although the outcomes of metabolic and bariatric surgery in pediatric patients are reassuring and support the ongoing utilization of this important treatment paradigm, a number of significant challenges remain regarding access to care. As the literature continues to support earlier intervention for youth with severe obesity, future efforts should address these challenges to ensure that eligible patients are referred in timely fashion.
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Affiliation(s)
- Dani O Gonzalez
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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15
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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16
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Almari M, Mohammad A, Abubaker J, Ziyab AH. Obesity and Prediabetes are Jointly Associated with Lipid Abnormalities Among Adolescents: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:345-353. [PMID: 33519222 PMCID: PMC7837585 DOI: 10.2147/dmso.s290383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/24/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Obesity and prediabetes are common among adolescents; however, it is unclear whether they jointly influence lipid levels. Hence, this study sought to assess whether obesity and prediabetes independently or jointly influence lipid levels among adolescents. METHODS A cross-sectional study enrolled school students aged 14-19 years (n = 1584). Body mass index (BMI)-for-age z-scores were estimated, and glycated hemoglobin A1c (HbA1c) and lipid profile were measured in capillary blood. Prediabetes was defined as 5.7≤ HbA1c% ≤6.4. Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and their 95% confidence intervals (CI). All analyses were stratified by sex. RESULTS Of the total study participants, 52.1% (826/1584) were females and the majority were aged between 14.0 (5th percentile) and 18.0 (95th percentile) years. Based on BMI-for-age categories, 356 (22.5%) and 494 (31.2%) participants were classified as overweight and obese, respectively. Moreover, 34.3% (543/1584) of the study participants met the prediabetes definition. Compared to those with normal BMI and no prediabetes (reference category), participants classified as obese and having prediabetes had elevated levels of total cholesterol (TC; RoGM=1.09, 95% CI: 1.06-1.13), low-density lipoprotein cholesterol (LDL-C; 1.21, 1.13-1.29), non-high-density lipoprotein cholesterol (non-HDL-C; 1.20, 1.14-1.26), and triglycerides (TG; 1.18, 1.09-1.27) and reduced HDL-C (0.91, 0.88-0.95) levels. Independent of prediabetes, obesity was associated with all the investigated lipids. Prediabetes alone was associated with reduced levels of LDL-C and increased levels of HDL-C only among females. CONCLUSION Obesity independently and in combination with prediabetes demonstrated unfavorable effects on lipids among male and female adolescents, whereas prediabetes independently influenced LDL-C and HDL-C favorably only among females.
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Affiliation(s)
- Mohammad Almari
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Safat, Kuwait
| | - Anwar Mohammad
- Department of Biochemistry and Molecular Biology, Research Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Research Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Correspondence: Ali H Ziyab Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait, P. O. Box 24923, Safat13110, Kuwait Tel +96524636545 Fax +96525338948 Email
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17
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Angi A, Chiarelli F. Obesity and Diabetes: A Sword of Damocles for Future Generations. Biomedicines 2020; 8:E478. [PMID: 33171922 PMCID: PMC7694547 DOI: 10.3390/biomedicines8110478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Childhood obesity is one of the most challenging problem of the 21st century. The prevalence has increased, reaching an alarming rate. Furthermore, the problem is global and is also affecting low- and middle-income countries. This global obesity epidemic explains how the roots of cardiovascular disease, the most common cause of mortality among adults, begin in childhood. Overweight and obese children are likely to stay obese into adulthood and to develop noncommunicable diseases such as diabetes and cardiovascular diseases at a younger age. Thus, prevention should be the major goal and should start early in life. The aim of this review is to present an updated framework of the current understanding of the cardiovascular and metabolic risks in obese children and adolescents and to discuss the available therapeutic options.
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Affiliation(s)
- Alessia Angi
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy;
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18
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Khoury M, Kavey REW, St Pierre J, McCrindle BW. Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology. Can J Cardiol 2020; 36:1417-1428. [PMID: 32679170 PMCID: PMC7358764 DOI: 10.1016/j.cjca.2020.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.
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Affiliation(s)
- Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Rae-Ellen W. Kavey
- Preventive Cardiology–Lipid Clinic, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Julie St Pierre
- Department of Pediatrics, McGill University, Clinique 180, Montréal, Québec, Canada
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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19
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Abstract
BACKGROUND The use of statins in children, although not frequent, is recommended in specific clinical contexts, namely, familial hypercholesterolaemia, conditions carrying a moderate-high cardiovascular risk and sub-optimal cholesterol levels after implementation of lifestyle modifications. The aim of this study is to characterise children with dyslipidaemia managed with statins, followed at a tertiary referral centre in central Portugal. METHODS AND RESULTS The authors carried out a retrospective and descriptive study made up of 66 patients (50% males, mean age of therapy onset 11.9 years) followed up at the Cardiovascular Clinic of a tertiary referral centre between January, 2012, and May, 2018. Clinical, analytical, and echocardiographic parameters were analysed. About 60.6% had clinical and/or molecular diagnosis of familial hypercholesterolaemia. On average, each patient had three cardiovascular risk factors, obesity (31%) being most prevalent, followed by arterial hypertension (14%). Statin therapy showed a statistically significant reduction in the lipid profile, particularly in the total cholesterol (23%) and low-density lipoprotein cholesterol (30%) levels, as well as in the carotid intima-media thickness (p = 0.015). Hepatic and muscle integrity markers were within normal range. CONCLUSIONS Statins are safe and efficient in the management of children with hypercholesterolaemia. Our study showed that apart from its lipid-lowering properties, it also reduced significantly the carotid intima-media thickness and, implicitly, the cardiovascular risk of these patients.
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20
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Brzeziński M, Metelska P, Myśliwiec M, Szlagatys-Sidorkiewicz A. Lipid disorders in children living with overweight and obesity- large cohort study from Poland. Lipids Health Dis 2020; 19:47. [PMID: 32178670 PMCID: PMC7076982 DOI: 10.1186/s12944-020-01218-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background While in the general paediatric population the presence of abnormal lipid values is estimated at 8–20%, depending on the population, accepted norms and age, it was shown that in the population of lean children the prevalence of dyslipidemia is lower than in obese children, in whom it ranges from 20 to over 40%. Until now, however, no results of similar studies on a large sample of children form a Central or Eastern European country have been published. The aim of this study was to evaluate the prevalence of lipid disorders in overweight and obese children and adolescents participating in an integrated weight reduction programme. Methods According to the “6-10-14 for Health” programme implementation schedule, the programme accepted patients living in Gdańsk, aged 6, 9–11 and 14 years old, with BMI above the 85th percentile for age and sex, according to the Polish percentile charts. During the first visit, each of the participants underwent basic anthropometric examinations - body weight, body height, waist and hip circumference, blood pressure and body composition by bioelectrical impedance were measured. Blood samples were taken to assess lipid, glucose and insulin levels as well as alanine transaminase (ALT) and thyroid stimulating hormone (TSH) activity. Results 1948 patients underwent full anthropomethric and blood work measurements. At least one of the lipid disorders occurred in 38.23% of girls and 40.51% of boys with overweight and obesity. The most common lipid disorderswere decreased high-density lipoprotein cholesterol (HDL-C) levels (present in 20.55% of the girls and 23.79% of the boys) and elevated low-density lipoprotein cholesterol (LDL-C) (present in 15.31% of the girls and 14.25% of the boys). There was no strong association between lipid disorders and age, sex, birth weight, gestational age at birth or body composition. Conclusions Such a frequent occurrence of lipid disorders in the population of children and adolescents should be an important warning signal both at the individual and population level. Not only effective screening methods for overweight and obese children should be implemented from an early age but also therapeutic measures are required. Trial registration The trial is registered under the Local Ethics Committee at Medical University of Gdańsk, decision No. NKBBN/228/2012 from 25 June 2012.
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Affiliation(s)
- Michał Brzeziński
- Department of Public Health and Social Medicine, Medical University of Gdańsk, al. Zwycięstwa 42a, 80-210, Gdańsk, Poland.
| | - Paulina Metelska
- "6-10-14 for Health" University Clinical Center, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Debinki 7, 80-952, Gdańsk, Poland
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, ul. Nowe Ogrody 1-6, 80-803, Gdansk, Poland
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22
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Bastos Sales L, van Esterik JCJ, Hodemaekers HM, Lamoree MH, Hamers T, van der Ven LTM, Legler J. Analysis of Lipid Metabolism, Immune Function, and Neurobehavior in Adult C57BL/6JxFVB Mice After Developmental Exposure to di (2-ethylhexyl) Phthalate. Front Endocrinol (Lausanne) 2018; 9:684. [PMID: 30519216 PMCID: PMC6259287 DOI: 10.3389/fendo.2018.00684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/01/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Developmental exposure to di (2-ethylhexyl) phthalate (DEHP) has been implicated in the onset of metabolic syndrome later in life. Alterations in neurobehavior and immune functions are also affected by phthalate exposure and may be linked to the metabolic changes caused by developmental exposure to DEHP. Objectives: Our goal was to study the effects of developmental exposure to DEHP in the context of metabolic syndrome by integrating different parameters to assess metabolic, neurobehavioral, and immune functions in one model. Methods: Female C57BL/6J mice were exposed to DEHP through the diet during gestation and lactation at doses ranging from 3.3 to 100,000 μg/kg body weight/day (μkd). During a 1-year follow-up period, a wide set of metabolic parameters was assessed in the F1 offspring, including weekly body weight measurements, food consumption, physical activity, glucose homeostasis, serum lipids, and endocrine profile. In addition, neurobehavioral and immune functions were assessed by sweet preference test, object recognition test, acute phase protein, and cytokines production. Animals were challenged with a high fat diet (HFD) in the last 9 weeks of the study. Results: Increased free fatty acids (FFA) and, high density lipoprotein (HDL-C) were observed in serum, together with a decrease in glycated hemoglobin levels in blood of 1-year old male DEHP-exposed offspring after HFD challenge. For the most sensitive endpoint measured (FFA), a lower bound of the 90%-confidence interval for benchmark dose (BMD) at a critical effect size of 5% (BMDL) of 2,160 μkd was calculated. No persistent changes in body weight or fat mass were observed. At 33,000 μkd altered performance was found in the object recognition test in males and changes in interferon (IFN)γ production were observed in females. Conclusions: Developmental exposure to DEHP combined with HFD in adulthood led to changes in lipid metabolism and neurobehavior in male offspring and cytokine production in female offspring. Our findings contribute to the evidence that DEHP is a developmental dyslipidemic chemical, however, more research is needed to further characterize adverse health outcomes and the mechanisms of action associated with the observed sex-specific effects.
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Affiliation(s)
- Liana Bastos Sales
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Hennie M. Hodemaekers
- Center for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marja H. Lamoree
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Timo Hamers
- Department of Environment and Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leo T. M. van der Ven
- Center for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Juliette Legler
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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Effect of short-term hazelnut consumption on DNA damage and oxidized LDL in children and adolescents with primary hyperlipidemia: a randomized controlled trial. J Nutr Biochem 2018; 57:206-211. [PMID: 29753234 DOI: 10.1016/j.jnutbio.2018.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 11/24/2022]
Abstract
Children with primary hyperlipidemia are prone to develop premature atherosclerosis, possibly associated with increased oxidative stress. Nutritional therapy is the primary strategy in the treatment of hyperlipidemia and associated conditions. Dietary interventions with bioactive-rich foods, such as nuts, may contribute to the modulation of both lipid profile and the oxidative/antioxidant status. Our study aimed to assess the impact of a dietary intervention with hazelnuts on selected oxidative stress markers in children and adolescents with primary hyperlipidemia. A single-blind, 8-week, randomized, controlled, three-arm, parallel-group study was performed. Children and adolescents diagnosed with primary hyperlipidemia (n=60) received dietary guidelines and were randomized into three groups: group 1 received hazelnuts with skin (HZN+S), and group 2 hazelnuts without skin (HZN-S), at equivalent doses (15-30 g/day, based on body weight); group 3 (controls) received only dietary recommendations (no nuts). At baseline and after 8 weeks, plasma oxidized low-density lipoprotein (ox-LDL) concentrations, oxidative levels of DNA damage in PBMCs and potential correlation with changes in serum lipids were examined. A reduction of endogenous DNA damage by 18.9%±51.3% (P=.002) and 23.1%±47.9% (P=.007) was observed after HZN+S and HZN-S, respectively. Oxidatively induced DNA strand breaks decreased by 16.0%±38.2% (P=.02) following HZN+S treatment. Ox-LDL levels did not change after HZN+S intervention but positively correlated with total cholesterol and LDL cholesterol. A short-term hazelnut intervention improves cell DNA protection and resistance against oxidative stress but not ox-LDL in hyperlipidemic pediatric patients. The trial was registered at ISRCTN.com, ID no. ISRCTN12261900.
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Tapp RJ, Hughes AD, Kähönen M, Wong TY, Witt N, Lehtimäki T, Hutri-Kähönen N, Sahota P, Juonala M, Raitakari OT. Cardiometabolic Health Among Adult Offspring of Hypertensive Pregnancies: The Cardiovascular Risk in Young Finns Study. J Am Heart Assoc 2018; 7:JAHA.117.006284. [PMID: 29306901 PMCID: PMC5778953 DOI: 10.1161/jaha.117.006284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Cardiometabolic health among adult offspring of hypertensive disorders of pregnancy (HDP) is relatively unknown. We hypothesized that offspring of HDP would have abnormalities in the retinal microvasculature and cardiac structure by midadulthood. Methods and Results The Cardiovascular Risk in Young Finns Study included randomly selected children from 5 Finnish university cities. The mean age of participants was 40 years (range 34–49 years) at the time of retinal photography and cardiac assessment. Offspring born ≥37 weeks of gestation and appropriate for gestational age (n=1006) were included. Offspring of HDP had higher systolic blood pressure (β=4.68, P<0.001), body mass index (β=1.25, P=0.009), and waist circumference (β=0.25, P=0.042), compared with offspring of normotensive pregnancies. However, no differences in fasting glucose, insulin, lipid profile, carotid intima media thickness, or brachial artery flow‐mediated dilatation were shown. Retinal arteriolar diameters were narrower (β=−0.43, P=0.009) and longer (β=32.5, P=0.023) and the arteriolar length‐to‐diameter ratio was higher (β=2.32, P=0.006) among offspring of HDP, after adjustment for age and sex. Left atrial volume indexed to body surface area (β=1.34, P=0.040) was increased. Adjustment for the confounding effects of birth weight, body mass index, smoking and socioeconomic status, and the mediating effect of hypertension had little impact on the associations. Conclusions Abnormalities of the retinal microvasculature and cardiac structure are seen in offspring of HDP in midadulthood. These findings may need to be considered in future primary prevention strategies of cardiovascular disease among offspring of HDP.
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Affiliation(s)
- Robyn J Tapp
- Melbourne School of Population and Global Health University of Melbourne, Australia .,School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.,Department of Optometry and Vision Sciences, The University of Melbourne, Australia
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and the University of Tampere, Finland
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore & Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Nicholas Witt
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and School of Medicine, University of Tampere, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Pinki Sahota
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Markus Juonala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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Moran-Ramos S, Ocampo-Medina E, Gutierrez-Aguilar R, Macías-Kauffer L, Villamil-Ramírez H, López-Contreras BE, León-Mimila P, Vega-Badillo J, Gutierrez-Vidal R, Villarruel-Vazquez R, Serrano-Carbajal E, Del-Río-Navarro BE, Huertas-Vázquez A, Villarreal-Molina T, Ibarra-Gonzalez I, Vela-Amieva M, Aguilar-Salinas CA, Canizales-Quinteros S. An Amino Acid Signature Associated with Obesity Predicts 2-Year Risk of Hypertriglyceridemia in School-Age Children. Sci Rep 2017; 7:5607. [PMID: 28717206 PMCID: PMC5514079 DOI: 10.1038/s41598-017-05765-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/02/2017] [Indexed: 01/21/2023] Open
Abstract
Childhood obesity is associated with a number of metabolic abnormalities leading to increased cardiovascular risk. Metabolites can be useful as early biomarkers and new targets to promote early intervention beginning in school age. Thus, we aimed to identify metabolomic profiles associated with obesity and obesity-related metabolic traits. We used data from the Obesity Research Study for Mexican children (ORSMEC) in Mexico City and included a case control (n = 1120), cross-sectional (n = 554) and a longitudinal study (n = 301) of 6-12-year-old children. Forty-two metabolites were measured using electrospray MS/MS and multivariate regression models were used to test associations of metabolomic profiles with anthropometric, clinical and biochemical parameters. Principal component analysis showed a serum amino acid signature composed of arginine, leucine/isoleucine, phenylalanine, tyrosine, valine and proline significantly associated with obesity (OR = 1.57; 95%CI 1.45-1.69, P = 3.84 × 10-31) and serum triglycerides (TG) (β = 0.067, P = 4.5 × 10-21). These associations were validated in the cross-sectional study (P < 0.0001). In the longitudinal cohort, the amino acid signature was associated with serum TG and with the risk of hypertriglyceridemia after 2 years (OR = 1.19; 95%CI 1.03-1.39, P = 0.016). This study shows that an amino acid signature significantly associated with childhood obesity, is an independent risk factor of future hypertriglyceridemia in children.
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Affiliation(s)
- Sofia Moran-Ramos
- Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico City, Mexico.
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico.
| | - Elvira Ocampo-Medina
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Ruth Gutierrez-Aguilar
- Hospital Infantil México Federico Gómez, Mexico City, Mexico
- Facultad de Medicina, UNAM, Mexico City, Mexico
| | - Luis Macías-Kauffer
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Hugo Villamil-Ramírez
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Blanca E López-Contreras
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Paola León-Mimila
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Joel Vega-Badillo
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Roxana Gutierrez-Vidal
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Ricardo Villarruel-Vazquez
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Erandi Serrano-Carbajal
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | | | | | - Isabel Ibarra-Gonzalez
- Instituto de Investigaciones Biomédicas, UNAM - Instituto Nacional de Pediatría, Mexico City, Mexico
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samuel Canizales-Quinteros
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, UNAM/Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico.
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Perng W, Watkins DJ, Cantoral A, Mercado-García A, Meeker JD, Téllez-Rojo MM, Peterson KE. Exposure to phthalates is associated with lipid profile in peripubertal Mexican youth. ENVIRONMENTAL RESEARCH 2017; 154:311-317. [PMID: 28152472 PMCID: PMC5465958 DOI: 10.1016/j.envres.2017.01.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/04/2017] [Accepted: 01/25/2017] [Indexed: 05/02/2023]
Abstract
Animal models indicate that endocrine disrupting chemicals (EDCs) affect circulating lipid concentrations by interfering with hepatic fatty acid oxidation. Little is known of the relationship between EDC exposure and lipid profile in humans. We measured bisphenol A (BPA) and 9 phthalate metabolites in maternal urine collected at up to three time points during pregnancy as a measure of in utero exposure, and in the child's urine at 8-14 years as a measure of concurrent, peripubertal exposure among 248 participants of a Mexico City pre-birth cohort. We used linear regression to examine relations of BPA and phthalate exposure with peripubertal serum lipids, while also adjusting for child age, sex, and specific gravity. While in utero EDC exposure was not associated with lipid profile, higher concurrent levels of mono-3-carboxypropyl phthalate (MCPP), monoethyl phthalate (MEP), and dibutyl phthalate metabolites (DBP) corresponded with lower total cholesterol and low-density lipoprotein (LDL-C) in boys; e.g., an interquartile range increment in MCPP corresponded with 7.4% (2.0%, 12.8%) lower total cholesterol and 12.7% (3.8%, 21.6%) lower LDL-C. In girls, higher urinary di-2-ethylhexyl phthalate metabolites (ΣDEHP) correlated with lower LDL-C (-7.9% [-15.4%, -0.4%]). Additional longitudinal research is needed to determine whether these associations persist beyond adolescence.
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Affiliation(s)
- Wei Perng
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Deborah J Watkins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Alejandra Cantoral
- Center for Nutrition and Health Research, National Institute of Public Health, Mexico City, MX
| | - Adriana Mercado-García
- Center for Nutrition and Health Research, National Institute of Public Health, Mexico City, MX
| | - John D Meeker
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
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29
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Merchán A, Ruiz ÁJ, Campo R, Prada CE, Toro JM, Sánchez R, Gómez JE, Jaramillo NI, Molina DI, Vargas-Uricoechea H, Sixto S, Castro JM, Quintero AE, Coll M, Slotkus S, Ramírez A, Pachajoa H, Ávila FA, Alonso K R. Hipercolesterolemia familiar: artículo de revisión. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Wiklund P, Zhang X, Tan X, Keinänen-Kiukaanniemi S, Alen M, Cheng S. Serum Amino Acid Profiles in Childhood Predict Triglyceride Level in Adulthood: A 7-Year Longitudinal Study in Girls. J Clin Endocrinol Metab 2016; 101:2047-55. [PMID: 26967691 DOI: 10.1210/jc.2016-1053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT Branched-chain and aromatic amino acids are associated with high risk of developing dyslipidemia and type II diabetes in adults. OBJECTIVE This study aimed to examine whether serum amino acid profiles associate with triglyceride concentrations during pubertal growth and predict hypertriglyceridemia in early adulthood. DESIGN This was a 7.5-year longitudinal study. SETTING The study was conducted at the Health Science Laboratory, University of Jyväskylä. PARTICIPANTS A total of 396 nondiabetic Finnish girls aged 11.2 ± 0.8 years at the baseline participated in the study. MAIN OUTCOME MEASURES Body composition was assessed by dual-energy x-ray absorptiometry; serum concentrations of glucose, insulin, and triglyceride by enzymatic photometric methods; and amino acids by nuclear magnetic resonance spectroscopy. RESULTS Serum leucine and isoleucine correlated significantly with future triglyceride, independent of baseline triglyceride level (P < .05 for all). In early adulthood (at the age of 18 years), these amino acids were significantly associated with hypertriglyceridemia, whereas fat mass and homeostasis model assessment of insulin resistance were not. Leucine was the strongest determinant discriminating subjects with hypertriglyceridemia from those with normal triglyceride level (area under the curve, 0.822; 95% confidence interval, 0.740-0.903; P = .000001). CONCLUSIONS Serum leucine and isoleucine were associated with future serum triglyceride levels in girls during pubertal growth and predicted hypertriglyceridemia in early adulthood. Therefore, these amino acid indices may serve as biomarkers to identify individuals at high risk for developing hypertriglyceridemia and cardiovascular disease later in life. Further studies are needed to elucidate the role these amino acids play in the lipid metabolism.
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Affiliation(s)
- Petri Wiklund
- Department of Health Sciences (P.W., X.T., S.C.), University of Jyväskylä, 40014 Jyväskylä, Finland; School of Life Sciences and Biotechnology (X.Z.), Shanghai Jiao Tong University, Shanghai 200240, China; Center for Life Course Health Research (S.K.-K., M.A.), University of Oulu, 90014 Oulu, Finland; Unit of Primary Health Care and Medical Research Center (S.K.-K.), and Department of Medical Rehabilitation (M.A.), Oulu University Hospital, 90220 Oulu, Finland; and Exercise, Health, and Technology Center (S.C.), Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiaobo Zhang
- Department of Health Sciences (P.W., X.T., S.C.), University of Jyväskylä, 40014 Jyväskylä, Finland; School of Life Sciences and Biotechnology (X.Z.), Shanghai Jiao Tong University, Shanghai 200240, China; Center for Life Course Health Research (S.K.-K., M.A.), University of Oulu, 90014 Oulu, Finland; Unit of Primary Health Care and Medical Research Center (S.K.-K.), and Department of Medical Rehabilitation (M.A.), Oulu University Hospital, 90220 Oulu, Finland; and Exercise, Health, and Technology Center (S.C.), Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiao Tan
- Department of Health Sciences (P.W., X.T., S.C.), University of Jyväskylä, 40014 Jyväskylä, Finland; School of Life Sciences and Biotechnology (X.Z.), Shanghai Jiao Tong University, Shanghai 200240, China; Center for Life Course Health Research (S.K.-K., M.A.), University of Oulu, 90014 Oulu, Finland; Unit of Primary Health Care and Medical Research Center (S.K.-K.), and Department of Medical Rehabilitation (M.A.), Oulu University Hospital, 90220 Oulu, Finland; and Exercise, Health, and Technology Center (S.C.), Shanghai Jiao Tong University, Shanghai 200240, China
| | - Sirkka Keinänen-Kiukaanniemi
- Department of Health Sciences (P.W., X.T., S.C.), University of Jyväskylä, 40014 Jyväskylä, Finland; School of Life Sciences and Biotechnology (X.Z.), Shanghai Jiao Tong University, Shanghai 200240, China; Center for Life Course Health Research (S.K.-K., M.A.), University of Oulu, 90014 Oulu, Finland; Unit of Primary Health Care and Medical Research Center (S.K.-K.), and Department of Medical Rehabilitation (M.A.), Oulu University Hospital, 90220 Oulu, Finland; and Exercise, Health, and Technology Center (S.C.), Shanghai Jiao Tong University, Shanghai 200240, China
| | - Markku Alen
- Department of Health Sciences (P.W., X.T., S.C.), University of Jyväskylä, 40014 Jyväskylä, Finland; School of Life Sciences and Biotechnology (X.Z.), Shanghai Jiao Tong University, Shanghai 200240, China; Center for Life Course Health Research (S.K.-K., M.A.), University of Oulu, 90014 Oulu, Finland; Unit of Primary Health Care and Medical Research Center (S.K.-K.), and Department of Medical Rehabilitation (M.A.), Oulu University Hospital, 90220 Oulu, Finland; and Exercise, Health, and Technology Center (S.C.), Shanghai Jiao Tong University, Shanghai 200240, China
| | - Sulin Cheng
- Department of Health Sciences (P.W., X.T., S.C.), University of Jyväskylä, 40014 Jyväskylä, Finland; School of Life Sciences and Biotechnology (X.Z.), Shanghai Jiao Tong University, Shanghai 200240, China; Center for Life Course Health Research (S.K.-K., M.A.), University of Oulu, 90014 Oulu, Finland; Unit of Primary Health Care and Medical Research Center (S.K.-K.), and Department of Medical Rehabilitation (M.A.), Oulu University Hospital, 90220 Oulu, Finland; and Exercise, Health, and Technology Center (S.C.), Shanghai Jiao Tong University, Shanghai 200240, China
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Gao Z, Khoury PR, McCoy CE, Shah AS, Kimball TR, Dolan LM, Urbina EM. Adiposity has no direct effect on carotid intima-media thickness in adolescents and young adults: Use of structural equation modeling to elucidate indirect & direct pathways. Atherosclerosis 2016; 246:29-35. [PMID: 26752690 PMCID: PMC4764416 DOI: 10.1016/j.atherosclerosis.2015.11.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/04/2015] [Accepted: 11/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carotid intima-media thickness (cIMT) is associated with CV events in adults. Thicker cIMT is found in youth with CV risk factors including obesity. Which risk factors have the most effect upon cIMT in youth and whether obesity has direct or indirect effects is not known. We used structural equation modeling to elucidate direct and indirect pathways through which obesity and other risk factors were associated with cIMT. METHODS We collected demographics, anthropometrics and laboratory data on 784 subjects age 10-24 years (mean 18.0 ± 3.3 years). Common, bulb and internal carotid cIMT were measured by ultrasound. Multivariable regression analysis was performed to assess independent determinants of cIMT. Analyses were repeated with structural equation modeling to determine direct and indirect effects. RESULTS Multivariable regression models explained 11%-22% of variation of cIMT. Age, sex and systolic blood pressure (BP) z-score were significant determinants of all cIMT segments. Body mass index (BMI) z-score, race, presence of type 2 diabetes mellitus (T2DM), hemoglobin A1c (HbA1c) and non-HDL were significant for some segments (all p = 0.05). The largest direct effect on cIMT was age (0.312) followed by BP (0.228), Blood glucose control (0.108) and non-HDL (0.134). BMI only had a significant indirect effect through blood glucose control, BP & non-HDL. High sensitivity C-reactive protein (CRP) had a small indirect effect through blood glucose control (all p = 0.05). CONCLUSIONS Age and BP are the major factors with direct effect on cIMT. Glucose and non-HDL were also important in this cohort with a high prevalence of T2DM. BMI only has indirect effects, through other risk factors. Traditional CV risk factors have important direct effects on cIMT in the young, but adiposity exerts its influence only through other CV risk factors.
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Affiliation(s)
- Zhiqian Gao
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Philip R Khoury
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Connie E McCoy
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Amy S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Thomas R Kimball
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Lawrence M Dolan
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, USA.
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Management of Moderate Hypertriglyceridemia in Childhood and Adolescence. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0484-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Benuck I. Point: The rationale for universal lipid screening and treatment in children. J Clin Lipidol 2015; 9:S93-S100. [DOI: 10.1016/j.jacl.2015.03.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/17/2015] [Accepted: 03/22/2015] [Indexed: 12/22/2022]
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Kavey REW. Combined dyslipidemia in childhood. J Clin Lipidol 2015; 9:S41-56. [PMID: 26343211 DOI: 10.1016/j.jacl.2015.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/21/2015] [Accepted: 06/05/2015] [Indexed: 01/19/2023]
Abstract
Combined dyslipidemia (CD) is now the predominant dyslipidemic pattern in childhood, characterized by moderate-to-severe elevation in triglycerides and non-high-density lipoprotein cholesterol (non-HDL-C), minimal elevation in low-density lipoprotein cholesterol (LDL-C), and reduced HDL-C. Nuclear magnetic resonance spectroscopy shows that the CD pattern is represented at the lipid subpopulation level as an increase in small, dense LDL and in overall LDL particle number plus a reduction in total HDL-C and large HDL particles, a highly atherogenic pattern. In youth, CD occurs almost exclusively with obesity and is highly prevalent, seen in more than 40% of obese adolescents. CD in childhood predicts pathologic evidence of atherosclerosis and vascular dysfunction in adolescence and young adulthood, and early clinical cardiovascular events in adult life. There is a tight connection between CD, visceral adiposity, insulin resistance, nonalcoholic fatty liver disease, and the metabolic syndrome, suggesting an integrated pathophysiological response to excessive weight gain. Weight loss, changes in dietary composition, and increases in physical activity have all been shown to improve CD significantly in children and adolescents in short-term studies. Most importantly, even small amounts of weight loss are associated with significant decreases in triglyceride levels and increases in HDL-C levels with improvement in lipid subpopulations. Diet change focused on limitation of simple carbohydrate intake with specific elimination of all sugar-sweetened beverages is very effective. Evidence-based recommendations for initiating diet and activity change are provided. Rarely, drug therapy is needed, and the evidence for drug treatment of CD in childhood is reviewed.
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Affiliation(s)
- Rae-Ellen W Kavey
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
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Hussain SM, Kähönen M, Raitakari OT, Skilton MR, Witt N, Chaturvedi N, Hutri-Kähönen N, Lehtimäki T, Vaahtoranta-Lehtonen H, Juonala M, Wijetunge S, Hughes AD, McG Thom SA, Metha A, Tapp RJ. Impact of Fetal Growth and Preterm Birth on the Retinal Microvasculature in Mid-Adulthood. Microcirculation 2015; 22:285-93. [DOI: 10.1111/micc.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sultana Monira Hussain
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Mika Kähönen
- Department of Clinical Physiology; Tampere University Hospital and the University of Tampere; Tampere Finland
| | - Olli T. Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku; Turku Finland
- Department of Clinical Physiology and Nuclear Medicine; Turku University Hospital; Turku Finland
| | - Michael R. Skilton
- Boden Institute of Obesity Nutrition Exercise and Eating Disorders; University of Sydney; Sydney New South Wales Australia
| | - Nicholas Witt
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Nish Chaturvedi
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Nina Hutri-Kähönen
- Department of Pediatrics; University of Tampere and Tampere University Hospital; Tampere Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry; Fimlab Laboratories; University of Tampere School of Medicine; Tampere Finland
| | | | - Markus Juonala
- Division of Medicine; Turku University Hospital; Turku Finland
| | - Sumangali Wijetunge
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Alun D. Hughes
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
- Institute of Cardiovascular Science; University College London; London UK
| | - Simon A. McG Thom
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Andrew Metha
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
| | - Robyn J. Tapp
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
- The Melbourne School of Population and Global Health; The University of Melbourne; Parkville Victoria Australia
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Nuotio J, Oikonen M, Magnussen CG, Viikari JSA, Hutri-Kähönen N, Jula A, Thomson R, Sabin MA, Daniels SR, Raitakari OT, Juonala M. Adult dyslipidemia prediction is improved by repeated measurements in childhood and young adulthood. The Cardiovascular Risk in Young Finns Study. Atherosclerosis 2015; 239:350-7. [PMID: 25682034 DOI: 10.1016/j.atherosclerosis.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/14/2015] [Accepted: 02/03/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prediction of adult dyslipidemia has been suggested to improve with multiple measurements in childhood or young adulthood, but there is paucity of specific data from longitudinal studies. METHODS AND RESULTS The sample comprised 1912 subjects (54% women) from the Cardiovascular Risk in Young Finns Study who had fasting lipid and lipoprotein measurements collected at three time-points in childhood/young adulthood and had at least one follow-up in later adulthood. Childhood/young adult dyslipidemia was defined as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) or triglycerides (TG) in the highest quintile, or high-density lipoprotein cholesterol (HDL-C) in the lowest quintile. Adult dyslipidemia was defined according to European cut-points (TC > 5.0 mmol/L, LDL-C >3 mmol/L, Non-HDL-C >3.8 mmol/L, HDL-C <1.0 mmol/L (in men)/<1.2 mmol/L (in women) and TG > 1.7 mmol/L). With the exception of triglycerides, Pearson correlation coefficients for predicting adult levels significantly improved when two lipid or lipoprotein measurements in childhood/young adulthood were compared with one measurement (all P < 0.01). For triglycerides, there was significant improvement only when three measurements were considered (P = 0.004). Two measurements significantly improved prediction of dyslipidemia levels in adulthood for non-HDL-C, LDL-C, HDL-C and TG compared with one measurement (P < 0.05 for improved area-under the receiver-operating characteristic curve). Risk of dyslipidemia in adulthood grew according to the number of times a person had been at risk in childhood. CONCLUSIONS Based on these results, it seems that compared to a single measurement two lipid measures in childhood/early adulthood significantly improve prediction of adult dyslipidemia. A lack of dyslipidemia in childhood does not strongly exclude later development of dyslipidemia. Multiple measurements increase the prediction accuracy, but the incremental prognostic/diagnostic accuracy of especially third measurement is modest.
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Affiliation(s)
- Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
| | - Mervi Oikonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - Russell Thomson
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Melbourne, Australia; Royal Children's Hospital and University of Melbourne, Melbourne, Australia
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; The Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland; Murdoch Childrens Research Institute, Melbourne, Australia
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Role of 3 lipoprotein lipase variants in triglycerides in children receiving highly active antiretroviral therapy. Pediatr Infect Dis J 2015; 34:155-61. [PMID: 24988117 DOI: 10.1097/inf.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lipoprotein lipase is a key enzyme in lipid metabolism, especially for plasma triglycerides (TGs). Genetic variants have been associated with lipid levels in healthy individuals, cardiovascular disease, obesity and diabetes. Our aim was to evaluate the influence of 3 polymorphisms: Hind III, Pvu II and S447X in plasma TG levels in human immunodeficiency virus-1-infected children under highly active antiretroviral therapy (HAART). METHODS Fifty-two children diagnosed with human immunodeficiency virus-1 between 2005 and 2009 were retrospectively selected with at least 1 plasma TG level assessment. TG levels were examined before and after 1 year of HAART. Hypertriglyceridemia was defined as TG > 150 mg/dL. Hind III (H+/H-), Pvu II (P+/P-) and S447X (S/X) were determined by polymerase chain reaction and restricted fragment length polymorphism. The Wilcoxon sum-rank test was used to compare median plasma TG among groups. Also, allelic frequencies were estimated for these variants in an Argentinean population. RESULTS Allelic frequencies for human immunodeficiency virus-1-infected children were: H-, 0.21; P-, 0.53; and X, 0.05 with no significant differences to controls. After 1 year of HAART, median TG levels were significantly lower in P-/P- (98.5 mg/dL) when compared with P+/P+ (180 mg/dL) (P = 0.039). The presence of the P- allele was associated with an 11-fold lower risk of hypertriglyceridemia. Hind III and S447X were not associated with TG at the selected time points. CONCLUSIONS Our findings suggest a protective effect of lipoprotein lipase polymorphisms against hypertriglyceridemia in children after 1 year of HAART. These results could endorse a prompt nutritional or pharmacological intervention in patients lacking the P- allele.
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Yoon JM. Dyslipidemia in children and adolescents: when and how to diagnose and treat? Pediatr Gastroenterol Hepatol Nutr 2014; 17:85-92. [PMID: 25061583 PMCID: PMC4107225 DOI: 10.5223/pghn.2014.17.2.85] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 06/10/2014] [Accepted: 06/18/2014] [Indexed: 01/22/2023] Open
Abstract
Recently, the incidence and prevalence of obesity and dyslipidemia are increasing. Dyslipidemia is associated with significant comorbidities and complications, and with cardiovascular risk factors (obesity, diabetes mellitus, hypertension and smoking). The main objectives of this article are that describe the prevalence of dyslipidemia in Korean children and adolescents and review the diagnosis and management of dyslipidemia in children and adolescents.
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Affiliation(s)
- Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
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Twenty years of cardiovascular risk prevention in Czech children. COR ET VASA 2014. [DOI: 10.1016/j.crvasa.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood. Curr Opin Cardiol 2014; 28:561-8. [PMID: 23928921 DOI: 10.1097/hco.0b013e32836428f4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood. RECENT FINDINGS Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor. SUMMARY Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
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Myśliwiec M, Walczak M, Małecka-Tendera E, Dobrzańska A, Cybulska B, Filipiak K, Mazur A, Jarosz-Chobot P, Szadkowska A, Rynkiewicz A, Chybicka A, Socha P, Brandt A, Bautembach-Minkowska J, Zdrojewski T, Limon J, Gidding SS, Banach M. Management of familial hypercholesterolemia in children and adolescents. Position paper of the Polish Lipid Expert Forum. J Clin Lipidol 2014; 8:173-80. [DOI: 10.1016/j.jacl.2014.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 10/25/2022]
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What the Long Term Cohort Studies that Began in Childhood Have Taught Us about the Origins of Coronary Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0373-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Järvelä LS, Niinikoski H, Heinonen OJ, Lähteenmäki PM, Arola M, Kemppainen J. Endothelial function in long-term survivors of childhood acute lymphoblastic leukemia: effects of a home-based exercise program. Pediatr Blood Cancer 2013; 60:1546-51. [PMID: 23606359 DOI: 10.1002/pbc.24565] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/20/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND The risk for cardiovascular disease (CVD) is increased in long-term survivors of childhood acute lymphoblastic leukemia (ALL). Chemotherapy may have direct toxic effects on vascular endothelium, potentially increasing the significance of endothelial dysfunction in the development of CVD in ALL survivors. Endothelial structure and function can be measured with carotid intima media thickness (IMT) and brachial flow mediated dilation (FMD). IMT and FMD are intermediate markers of CVD. We studied endothelial function and the effects of an exercise program on vascular endothelium in long-term survivors of childhood ALL. PROCEDURE Twenty-one 16-30 year old long-term survivors of ALL (age at diagnosis ≤16 years) and 21 healthy controls were studied at baseline, and 17 of the ALL survivors participated in a 16 week home-based exercise program. IMT and FMD were studied before and after the exercise program. RESULTS At baseline, the ALL survivors had impaired overall FMD response (FMDauc, P = 0.02). FMDmax(%) was 22% lower (P = 0.06) and FMD at 40 seconds 44% lower (P = 0.01) compared to healthy controls. After the exercise program, FMD at 40 seconds (P < 0.01) and IMT (P = 0.02) improved. The mean overall FMD response increased by 25% after the exercise program, but this change was not statistically significant (P = 0.27). CONCLUSIONS Our results show that the excess burden of CVD morbidity in this population may possibly be alleviated by simple means. The importance of physical activity on the health of childhood ALL survivors should be emphasized. Longer, controlled studies are needed to confirm our findings.
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Affiliation(s)
- Liisa S Järvelä
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Nobre LN, Lamounier JA, Franceschini SDC. Sociodemographic, anthropometric and dietary determinants of dyslipidemia in preschoolers. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sociodemographic, anthropometric and dietary determinants of dyslipidemia in preschoolers. J Pediatr (Rio J) 2013; 89:462-9. [PMID: 23850110 DOI: 10.1016/j.jped.2013.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/06/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the determinants of dyslipidemia in preschoolers. METHODS A total of 227 preschoolers residing in an urban area of the city of Diamantina, Minas Gerais, Brazil were evaluated at age 5 years, using a cross-sectional design. Dietary intake from a food frequency questionnaire, anthropometric/biochemical parameters, and socioeconomic/behavioral information from a questionnaire were evaluated. 'Mixed diet', 'snack', and 'unhealthy' dietary patterns were identified using principal component analysis. The determinants of dyslipidemia were examined using Poisson regression analysis. RESULTS The prevalence of dyslipidemia in this study was 65.19%. Preschoolers who less frequently consumed foods in the 'mixed diet' dietary pattern had a higher risk of high concentrations of low-density lipoprotein cholesterol (PR=2.30; p=0.004) when compared with those with more frequent consumption of the 'mixed diet' dietary pattern. Preschoolers whose mothers had lower levels of education presented a lower risk of high concentrations of low-density lipoprotein cholesterol (PR=0.43; p=0.003), and preschoolers who were overweight/obese presented with greater risk of high concentrations of low-density lipoprotein cholesterol (PR=2.23; p=0.003). CONCLUSION The determinants of dyslipidemia identified in this study were less frequent consumption of foods in the 'mixed diet' dietary pattern, higher body mass index, and lower level of maternal education. This study shows that despite the young age of the group under study, they already present a high prevalence of dyslipidemia, which is an important risk factor for cardiovascular disease.
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Martino F, Puddu PE, Pannarale G, Colantoni C, Martino E, Niglio T, Zanoni C, Barillà F. Low dose chromium-polynicotinate or policosanol is effective in hypercholesterolemic children only in combination with glucomannan. Atherosclerosis 2013; 228:198-202. [DOI: 10.1016/j.atherosclerosis.2013.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/12/2012] [Accepted: 02/04/2013] [Indexed: 11/24/2022]
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Urbina EM, Khoury PR, McCoy CE, Dolan LM, Daniels SR, Kimball TR. Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults. Pediatrics 2013; 131:e1082-90. [PMID: 23460684 PMCID: PMC3608484 DOI: 10.1542/peds.2012-1726] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Lipid levels are linked to early atherosclerosis. Risk stratification may be improved by using triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), which relates to arterial stiffness in adults. We tested whether TG/HDL-C was an independent predictor of arterial stiffness in youth. METHODS Subjects 10 to 26 years old (mean 18.9 years, 39% male, 56% non-Caucasian, n = 893) had laboratory, anthropometric, blood pressure, and arterial stiffness data collected (brachial distensibility, augmentation index, carotid-femoral pulse-wave velocity). Subjects were stratified into tertiles of TG/HDL-C (low, n = 227; mid, n = 288; high, n = 379). RESULTS There was a progressive rise in cardiovascular (CV) risk factors and arterial stiffness across TG/HDL-C ratio. The high TG/HDL-C ratio group had the stiffest vessels (all P < .03 by analysis of variance). TG/HDL-C as a continuous variable was an independent determinant of brachial distensibility in CV risk factor adjusted model and for carotid-femoral pulse-wave velocity in obese subjects, with trend for higher augmentation index. CONCLUSIONS TG/HDL-C, an estimate of small, dense low-density lipoprotein cholesterol, is an independent determinant of arterial stiffness in adolescents and young adults, especially in obese youth. These data suggest that use of TG/HDL-C may be helpful in identifying young adults requiring aggressive intervention to prevent atherosclerotic CV diseases.
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Affiliation(s)
- Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC-7002, Cincinnati, OH 45229, USA.
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Lim JS. The current state of dyslipidemia in Korean children and adolescents and its management in clinical practice. Ann Pediatr Endocrinol Metab 2013; 18:1-8. [PMID: 24904843 PMCID: PMC4027065 DOI: 10.6065/apem.2013.18.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/18/2013] [Indexed: 01/19/2023] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death worldwide including Korea. The risk factors of CVD are known as positive family history of early CVD, obesity, hypertension, diabetes, and dyslipidemia. Among those, dyslipidemia is one of modifiable risk factors. Dyslipidemia starts in childhood and progress to adulthood. Furthermore, dyslipidemia cause atherosclerosis and is closely related to other CVD risks. On the rationale that early identification and control of pediatric dyslipidemia will reduce the risk and severity of CVD in adulthood, the National Heart, Lung, and Blood Institute guidelines expanded to universal screening for lipid levels. However, there was no guideline for lipid screening and management in Korean children and adolescents yet. This review deals with the rationale of early identification and control of pediatric dyslipidemia along with the current Korean status of pediatric dyslipidemia. This review also deals with how to screen, diagnosis, and treatment of pediatric dyslipidemia.
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Affiliation(s)
- Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
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Magnussen CG, Niinikoski H, Juonala M, Kivimäki M, Rönnemaa T, Viikari JSA, Simell O, Raitakari OT. When and how to start prevention of atherosclerosis? Lessons from the Cardiovascular Risk in the Young Finns Study and the Special Turku Coronary Risk Factor Intervention Project. Pediatr Nephrol 2012; 27:1441-52. [PMID: 21877168 DOI: 10.1007/s00467-011-1990-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 12/14/2022]
Abstract
This review provides an up-to-date summary of findings from two ongoing population-based, prospective studies conducted in Finland: The Cardiovascular Risk in Young Finns Study, and the Special Turku Coronary Risk Factor Intervention Project (STRIP), which have contributed significantly to the scientific literature concerning the childhood origin of cardiovascular disease, and whether prevention efforts in adults can be expanded to young people. From the Young Finns Study, we summarize evidence demonstrating childhood risk factors to be associated with both risk factors and preclinical markers of atherosclerosis in adulthood, and from STRIP, we summarize evidence showing that supervised dietary counseling of a low saturated fat diet effectively decreases exposure to cardiovascular risk factors without affecting growth and development of healthy children and adolescents. The evidence available from these studies supports that the ability to prevent or delay the risk of premature atherosclerosis and its clinical sequelae later in life lies in maintaining a low lifetime risk by preventing the development of risk factors in early life.
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Affiliation(s)
- Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Finland, Finland
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Rocco CA, Mecikovsky D, Aulicino P, Bologna R, Sen L, Mangano A. Hypercholesterolemia is associated with the apolipoprotein C-III (APOC3) genotype in children receiving HAART: an eight-year retrospective study. PLoS One 2012; 7:e39678. [PMID: 22848358 PMCID: PMC3405089 DOI: 10.1371/journal.pone.0039678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 05/25/2012] [Indexed: 12/30/2022] Open
Abstract
Polymorphisms in apolipoprotein genes have shown to be predictors of plasma lipid levels in adult cohorts receiving highly active antiretroviral therapy (HAART). Our objective was to confirm the association between the APOC3 genotype and plasma lipid levels in an HIV-1-infected pediatric cohort exposed to HAART. A total of 130 HIV-1-infected children/adolescents that attended a reference center in Argentina were selected for an 8-year longitudinal study with retrospective data collection. Longitudinal measurements of plasma triglycerides, total cholesterol, HDL-C and LDL-C were analyzed under linear or generalized linear mixed models. The contribution of the APOC3 genotype at sites −482, −455 and 3238 to plasma lipid levels prediction was tested after adjusting for potential confounders. Four major APOC3 haplotypes were observed for sites −482/−455/3238, with estimated frequencies of 0.60 (C/T/C), 0.14 (T/C/C), 0.11 (C/C/C), and 0.11 (T/C/G). The APOC3 genotype showed a significant effect only for the prediction of total cholesterol levels (p<0.0001). However, the magnitude of the differences observed was dependent on the drug combination (p = 0.0007) and the drug exposure duration at the time of the plasma lipid measurement (p = 0.0002). A lower risk of hypercholesterolemia was predicted for double and triple heterozygous individuals, mainly at the first few months after the initiation of Ritonavir-boosted protease inhibitor-based regimens. We report for the first time a significant contribution of the genotype to total cholesterol levels in a pediatric cohort under HAART. The genetic determination of APOC3 might have an impact on a large portion of HIV-1-infected children at the time of choosing the treatment regimens or on the counter-measures against the adverse effects of drugs.
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Affiliation(s)
- Carlos A Rocco
- Laboratorio de Biología Celular y Retrovirus, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.
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