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Ding J, Wu Y, Wang B, Sun Z. The relationship between depression severity and heart rate variability in children and adolescents: A meta-analysis. J Psychosom Res 2024; 182:111804. [PMID: 38788284 DOI: 10.1016/j.jpsychores.2024.111804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Depression in children and adolescents has gradually attracted social attention. Heart rate variability (HRV) has been found to be influenced by depression severity, but results have not been uniformed in children and adolescents. This study investigated the relationship between depression severity and heart rate variability in children and adolescents, aiming to provide additional evidence for an objective, effective, and convenient depression screening tool in this population. METHODS Literature searching was conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, PubMed, ScienceDirect, and EBSCO. Relevant studies investigating the relationship between depression severity and HRV in children and adolescents were selected for meta-analysis. RESULTS 31 articles were included in this meta-analysis, involving 4534 participants. Depression severity in children and adolescents was significantly negatively correlated with high frequency (HF) and root mean square of successive differences (RMSSD) in HRV (HF: r = -0.10, 95% CI: -0.17 to -0.04, p = 0.001; RMSSD: r = -0.18, 95% CI: -0.30 to -0.05, p = 0.01). The relationship between HF and depression severity was moderated by age, higher among those aged >12 than among those aged <12 (r = -0.17, -0.02, Q = 7.32, p = 0.007). CONCLUSION Heart rate variability is associated with depression severity in children and adolescents.
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Affiliation(s)
- Jiaxin Ding
- Institute of Applied Psychology, College of Education, Zhejiang University of Technology, 288 Liuhe Road, 310023 Hangzhou, Zhejiang Province, China
| | - Yi Wu
- Institute of Applied Psychology, College of Education, Zhejiang University of Technology, 288 Liuhe Road, 310023 Hangzhou, Zhejiang Province, China
| | - Bo Wang
- Institute of Applied Psychology, College of Education, Zhejiang University of Technology, 288 Liuhe Road, 310023 Hangzhou, Zhejiang Province, China
| | - Zaoyi Sun
- Institute of Applied Psychology, College of Education, Zhejiang University of Technology, 288 Liuhe Road, 310023 Hangzhou, Zhejiang Province, China.
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Tsuda T, Robinson BW. Beneficial Effects of Exercise on Hypertension-Induced Cardiac Hypertrophy in Adolescents and Young Adults. Curr Hypertens Rep 2024:10.1007/s11906-024-01313-4. [PMID: 38888690 DOI: 10.1007/s11906-024-01313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE OF REVIEW Hypertension-induced cardiac hypertrophy is widely known as a major risk factor for increased cardiovascular morbidity and mortality. Although exercise is proven to exert overall beneficial effects on hypertension and hypertension-induced cardiac hypertrophy, there are some concerns among providers about potential adverse effects induced by intense exercise, especially in hypertensive athletes. We will overview the underlying mechanisms of physiological and pathological hypertrophy and delineate the beneficial effects of exercise in young people with hypertension and consequent hypertrophy. RECENT FINDINGS Multiple studies have demonstrated that exercise training, both endurance and resistance types, reduces blood pressure and ameliorates hypertrophy in hypertensives, but certain precautions are required for hypertensive athletes when allowing competitive sports: Elevated blood pressure should be controlled before allowing them to participate in high-intensity exercise. Non-vigorous and recreational exercise are always recommended to promote cardiovascular health. Exercise-induced cardiac adaptation is a benign and favorable response that reverses or attenuates pathological cardiovascular remodeling induced by persistent hypertension. Exercise is the most effective nonpharmacological treatment for hypertensive individuals. Distinction between recreational-level exercise and competitive sports should be recognized by medical providers when allowing sports participation for adolescents and young adults.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, 19107, USA.
| | - Bradley W Robinson
- Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, 19107, USA
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Fang M, Zhang S, Tang O, Christenson RH, Brady T, McEvoy JW, Selvin E. Determinants of High-Sensitivity Cardiac Troponin T and I in US Children and Adolescents. J Am Heart Assoc 2024; 13:e035142. [PMID: 38842269 PMCID: PMC11255754 DOI: 10.1161/jaha.123.035142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Michael Fang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Sui Zhang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Olive Tang
- Johns Hopkins Hospital and Johns Hopkins University School of MedicineBaltimoreMD
| | | | - Tammy Brady
- Department of PediatricsJohns Hopkins Hospital and Johns Hopkins University School of MedicineBaltimoreMD
| | - John W. McEvoy
- University of Galway School of Medicine and National Institute for Prevention and Cardiovascular HealthGalwayIreland
| | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Taylor HCM, Chaturvedi N, Davey Smith G, Ferreira DLS, Fraser A, Howe LD, Hughes AD, Lawlor DA, Timpson NJ, Park CM. Is Height 2.7 Appropriate for Indexation of Left Ventricular Mass in Healthy Adolescents? The Importance of Sex Differences. Hypertension 2023; 80:2033-2042. [PMID: 37548044 PMCID: PMC10510825 DOI: 10.1161/hypertensionaha.121.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Left ventricular mass (LVM) is an important predictor of cardiovascular risk. In adolescence, LVM is commonly indexed to height2.7, although some evidence suggests that this may not fully account for sex differences. METHODS We investigated appropriate allometric scaling of LVM to height, total lean mass, and body surface area, in a UK birth cohort of 2039 healthy adolescents (17±1 years). Allometric relationships were determined by linear regression stratified by sex, following log transformation of x and y variables [log(y)=a+b×log(x)], b is the allometric exponent. RESULTS Log (LVM) showed linear relationships with log(height) and log(lean mass). Biased estimates of slope resulted when the sexes were pooled. The exponents were lower than the conventional estimate of 2.7 for males (mean [95% CI]=1.66 [1.30-2.03]) and females (1.58 [1.27-1.90]). When LVM was indexed to lean mass, the exponent was 1.16 (1.05-1.26) for males and 1.07 (0.97-1.16) for females. When LVM was indexed to estimated body surface area, the exponent was 1.53 (1.40-1.66) for males and 1.34 (1.24-1.45) for females. CONCLUSIONS Allometric exponents derived from pooled data, including men and women without adjustment for sex were biased, possibly due to sex differences in body composition. We suggest that when assessing LVM, clinicians should consider body size, body composition, sex, and age. Our observations may also have implications for the identification of young individuals with cardiac hypertrophy.
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Affiliation(s)
- Hannah C M Taylor
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
- Oxford Population Health (NDPH), University of Oxford, United Kingdom (H.C.M.T.)
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (H.C.M.T.)
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Diana L S Ferreira
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Nic J Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Chloe M Park
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
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Talbot JS, Perkins DR, Dawkins TG, Douglas AJM, Griffiths TD, Richards CT, Owen K, Lord RN, Pugh CJA, Oliver JL, Lloyd RS, Ainslie PN, McManus AM, Stembridge M. Neurovascular coupling and cerebrovascular hemodynamics are modified by exercise training status at different stages of maturation during youth. Am J Physiol Heart Circ Physiol 2023; 325:H510-H521. [PMID: 37450291 PMCID: PMC10538977 DOI: 10.1152/ajpheart.00302.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Neurovascular coupling (NVC) is mediated via nitric oxide signaling, which is independently influenced by sex hormones and exercise training. Whether exercise training differentially modifies NVC pre- versus postpuberty, where levels of circulating sex hormones will differ greatly within and between sexes, remains to be determined. Therefore, we investigated the influence of exercise training status on resting intracranial hemodynamics and NVC at different stages of maturation. Posterior and middle cerebral artery velocities (PCAv and MCAv) and pulsatility index (PCAPI and MCAPI) were assessed via transcranial Doppler ultrasound at rest and during visual NVC stimuli. N = 121 exercise-trained (males, n = 32; females, n = 32) and untrained (males, n = 28; females, n = 29) participants were characterized as pre (males, n = 33; females, n = 29)- or post (males, n = 27; females, n = 32)-peak height velocity (PHV). Exercise-trained youth demonstrated higher resting MCAv (P = 0.010). Maturity and training status did not affect the ΔPCAv and ΔMCAv during NVC. However, pre-PHV untrained males (19.4 ± 13.5 vs. 6.8 ± 6.0%; P ≤ 0.001) and females (19.3 ± 10.8 vs. 6.4 ± 7.1%; P ≤ 0.001) had a higher ΔPCAPI during NVC than post-PHV untrained counterparts, whereas the ΔPCAPI was similar in pre- and post-PHV trained youth. Pre-PHV untrained males (19.4 ± 13.5 vs. 7.9 ± 6.0%; P ≤ 0.001) and females (19.3 ± 10.8 vs. 11.1 ± 7.3%; P = 0.016) also had a larger ΔPCAPI than their pre-PHV trained counterparts during NVC, but the ΔPCAPI was similar in trained and untrained post-PHV youth. Collectively, our data indicate that exercise training elevates regional cerebral blood velocities during youth, but training-mediated adaptations in NVC are only attainable during early stages of adolescence. Therefore, childhood provides a unique opportunity for exercise-mediated adaptations in NVC.NEW & NOTEWORTHY We report that the change in cerebral blood velocity during a neurovascular coupling task (NVC) is similar in pre- and postpubertal youth, regardless of exercise-training status. However, prepubertal untrained youth demonstrated a greater increase in cerebral blood pulsatility during the NVC task when compared with their trained counterparts. Our findings highlight that childhood represents a unique opportunity for exercise-mediated adaptations in cerebrovascular hemodynamics during NVC, which may confer long-term benefits in cerebrovascular function.
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Affiliation(s)
- Jack S Talbot
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Dean R Perkins
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Tony G Dawkins
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Andrew J M Douglas
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Thomas D Griffiths
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Cory T Richards
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Kerry Owen
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Windsor Clive Primary School, Cardiff, United Kingdom
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Christopher J A Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom
- Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom
- Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Waikato, New Zealand
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Ali M McManus
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, United Kingdom
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Agbaje AO. Longitudinal left ventricular mass indexing for DEXA-measured lean mass and fat mass: novel normative reference centiles in postpubertal adolescents and young adults. Am J Physiol Heart Circ Physiol 2023; 324:H571-H577. [PMID: 36827226 PMCID: PMC10042592 DOI: 10.1152/ajpheart.00045.2023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Left ventricular (LV) hypertrophy derived from LV mass (LVM) cut point is a marker of cardiovascular events in adults and target organ damage in pediatric research. Inadequate LVM indexing for body size due to scarcity of dual-energy X-ray absorptiometry (DEXA)-measured lean mass may lead to misclassification in the pediatric population. The only LVM indexed for DEXA-measured lean mass reference in children, mean age 11.6 yr, is 3-decades old and accurate LVM indexing in postpubertal adolescents and young adults is nonexistent. We generate new sex-specific LVM indexed for lean mass percentiles in healthy adolescence and young adulthood and correlated them with surrogates for normalizing body size. From the Avon Longitudinal Study of Parents and Children UK birth cohort, 868 adolescents (531 females) aged 17 yr were followed up for 7 yr. Lean mass was measured by DEXA at both time points. Echocardiography M-mode, two-dimensional (2-D), and three-dimensional (3-D) echo data for estimating LVM were collected at baseline and follow-up. Over 7 years, LVM increased in males (177.1 g) and females (133.5 g) at 17 yr to 199.9 g (males) and 145 g (females) at 24 yr. LVM/height3 and LVM/height2.7 provided the most consistent cross-sectional and longitudinal intraclass correlation coefficients with LVM/lean mass in both sexes (0.90-0.93). Indexing LVM by lean mass eliminated the sex difference only at age 24 yr but not at 17 yr. LVM/height2.7 85th percentiles for males and females at age 17 yr were 45.1 g/m2.7 and 41.4 g/m2.7, respectively, and at age 24 yr the 75th percentiles were 45.5 g/m2.7 and 41.7 g/m2.7, respectively. The 95th percentiles for males and females at age 17 yr were 49.5 g/m2.7 and 46.8 g/m2.7, respectively, and at age 24 yr were 57.1 g/m2.7 and 50.2 g/m2.7, respectively. These new reference percentile cut points were higher than the currently used 95th percentile pediatric reference of 38.6 g/m2.7. Future studies are warranted in youth with clinical diseases to examine whether these new cut points provide a more accurate stratification of cardiovascular risk.NEW & NOTEWORTHY Current left ventricular mass cut points for pediatric left ventricular hypertrophy are inaccurate. The inaccuracies are due, in part, to the average age of participants (11.6 yr) evaluated and also due to the lack of Echo and DEXA-measured body composition in postpubertal youth. Novel sex-based cut points are proposed for postpubertal youths at 17 and 24 yr. The new 95th percentile cut points are 15-20 g/m2.7 higher than the current cut point.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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7
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Haapala EA, Tompuri T, Lintu N, Viitasalo A, Savonen K, Lakka TA, Laukkanen JA. Is low cardiorespiratory fitness a feature of metabolic syndrome in children and adults? J Sci Med Sport 2022; 25:923-929. [DOI: 10.1016/j.jsams.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
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Johansson M, Tangruksa B, Heydarkhan-Hagvall S, Jeppsson A, Sartipy P, Synnergren J. Data Mining Identifies CCN2 and THBS1 as Biomarker Candidates for Cardiac Hypertrophy. Life (Basel) 2022; 12:life12050726. [PMID: 35629393 PMCID: PMC9147176 DOI: 10.3390/life12050726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiac hypertrophy is a condition that may contribute to the development of heart failure. In this study, we compare the gene-expression patterns of our in vitro stem-cell-based cardiac hypertrophy model with the gene expression of biopsies collected from hypertrophic human hearts. Twenty-five differentially expressed genes (DEGs) from both groups were identified and the expression of selected corresponding secreted proteins were validated using ELISA and Western blot. Several biomarkers, including CCN2, THBS1, NPPA, and NPPB, were identified, which showed significant overexpressions in the hypertrophic samples in both the cardiac biopsies and in the endothelin-1-treated cells, both at gene and protein levels. The protein-interaction network analysis revealed CCN2 as a central node among the 25 overlapping DEGs, suggesting that this gene might play an important role in the development of cardiac hypertrophy. GO-enrichment analysis of the 25 DEGs revealed many biological processes associated with cardiac function and the development of cardiac hypertrophy. In conclusion, we identified important similarities between ET-1-stimulated human-stem-cell-derived cardiomyocytes and human hypertrophic cardiac tissue. Novel putative cardiac hypertrophy biomarkers were identified and validated on the protein level, lending support for further investigations to assess their potential for future clinical applications.
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Affiliation(s)
- Markus Johansson
- Systems Biology Research Center, School of Bioscience, University of Skövde, SE-541 28 Skövde, Sweden; (S.H.-H.); (P.S.); (J.S.)
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden;
- Correspondence: (M.J.); (B.T.)
| | - Benyapa Tangruksa
- Systems Biology Research Center, School of Bioscience, University of Skövde, SE-541 28 Skövde, Sweden; (S.H.-H.); (P.S.); (J.S.)
- Correspondence: (M.J.); (B.T.)
| | - Sepideh Heydarkhan-Hagvall
- Systems Biology Research Center, School of Bioscience, University of Skövde, SE-541 28 Skövde, Sweden; (S.H.-H.); (P.S.); (J.S.)
- Bioscience, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, SE-413 83 Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden;
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Peter Sartipy
- Systems Biology Research Center, School of Bioscience, University of Skövde, SE-541 28 Skövde, Sweden; (S.H.-H.); (P.S.); (J.S.)
| | - Jane Synnergren
- Systems Biology Research Center, School of Bioscience, University of Skövde, SE-541 28 Skövde, Sweden; (S.H.-H.); (P.S.); (J.S.)
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Kean AC, Saroufim R, Meininger E, Fuqua JS, Fortenberry JD. Cardiovascular Health of Youth During Gender-Affirming Testosterone Treatment: A Review. J Adolesc Health 2021; 69:896-904. [PMID: 34627656 DOI: 10.1016/j.jadohealth.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Many birth-assigned female/transgender male and nonbinary people (identified as masculine spectrum here) begin gender-affirming testosterone therapy by the age of 24 years. Few data inform assessment of cardiovascular health of masculine spectrum youth as a specific subgroup of the 1.5 million transgender people in the United States. The purpose of this review is to help youth-serving practitioners consider, understand, and evaluate cardiovascular health in adolescent and young adult masculine spectrum patients receiving gender-affirming testosterone treatment. METHODS This is a narrative review intended to synthesize a broad body of clinical and research literature. RESULTS Common cardiovascular health changes associated with testosterone include increased red blood cell mass and likely insignificant changes in high-density lipoprotein and low-density lipoprotein levels. Changes in heart mass, heart electrophysiology, and endothelial reactivity are likely, based on extrapolation of data from adults. Testosterone may have indirect effects on cardiovascular health through influences on depression, anxiety, stress, and anorexia nervosa as well as on behaviors such as tobacco use. CONCLUSIONS Testosterone contributes importantly to the cardiovascular health and well-being of masculine spectrum gender-diverse youth. We need to do a better job of supporting these young people with data on cardiovascular health over the life span.
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Affiliation(s)
- Adam C Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rita Saroufim
- Division of Pediatric Endocrinology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Eric Meininger
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - John S Fuqua
- Division of Pediatric Endocrinology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Wang H, Du B, Wu Y, Li Z, Niu Y, Ouyang F, Wang J, Chen S, Sun K. Sex-Disparity in the Association Between Birthweight and Cardiovascular Parameters in 4-Year-Old Children: A Chinese Cohort Study. Front Nutr 2021; 8:756512. [PMID: 34765632 PMCID: PMC8576373 DOI: 10.3389/fnut.2021.756512] [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: 08/10/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sex-related differences in cardiovascular parameters have been well documented in adults, and the impact of birthweight on cardiovascular health in later life has been acknowledged. However, data was limited regarding the association between birthweight and cardiovascular outcomes at an early age, and the sex-disparity in the association remained unclear. Objective: To investigate the association between birthweight and cardiovascular parameters in 4-year-old children. Furthermore, to explore whether sex-disparity exist in this association or in cardiovascular risk. Methods: Follow-up data from the Shanghai Birth Cohort (SBC) was analyzed. Detailed perinatal information including both maternal and offspring datum were recorded. Blood pressure, echocardiography, and anthropometry assessment were conducted during the follow-up of 4-year-old children. Linear regression models were used to analyze the association between birthweight and left ventricle (LV) structure and function changes in each sex and birthweight category. Multivariable logistic regression models were used to compare risk of left ventricular hypertrophy (LVH) in different birthweight subgroups. Results: Overall, macrosomia was significantly associated with thickened LV posterior wall thickness in systole [LVPWs, (β = 0.26, 95% CI: 0.06, 0.45)] and diastole [LVPWd, (β = 0.18, 95% CI: 0.06, 0.30)], and thickened interventricular septal thickness in diastole [IVSd, (β = 0.16, 95% CI: 0.05, 0.28)]. Boys with macrosomia showed a higher left ventricle mass index [LVMI, (β = 1.29, 95% CI: 0.14, 2.43)], thickened LVPWs (β = 0.30, 95% CI: 0.05, 0.56) and LVPWd (β = 0.21, 95% CI: 0.06, 0.36), and thickened IVSd (β = 0.23, 95% CI: 0.09, 0.36). However, no significant association of structural changes was found in girls. Furthermore, an increased risk of LVH was found solely in macrosomic boys (OR = 2.79, 95% CI: 1.17, 6.63). Conclusion: Children with macrosomia developed cardiovascular changes as early as 4 years of age. Macrosomia was associated with LV structural changes and higher LVH risk in pre-school-aged boys, while no association was found in girls.
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Affiliation(s)
- Hualin Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bowen Du
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yujian Wu
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhuoyan Li
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiwei Niu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fengxiu Ouyang
- Ministry of Education, Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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11
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Sex differences in cardiac function and clinical outcome in patients with a Fontan circulation. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100197] [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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12
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Gumus Balikcioglu P, Ramaker ME, Mason KA, Huffman KM, Johnson JL, Ilkayeva O, Muehlbauer MJ, Freemark M, Kraus WE. Branched-Chain Amino Acid Catabolism and Cardiopulmonary Function Following Acute Maximal Exercise Testing in Adolescents. Front Cardiovasc Med 2021; 8:721354. [PMID: 34485418 PMCID: PMC8416443 DOI: 10.3389/fcvm.2021.721354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To provide energy for cardiopulmonary function and maintenance of blood glucose, acute aerobic exercise induces lipolysis, fatty acid oxidation (FAO), glycolysis, and glycogenolysis/gluconeogenesis. These adaptations are mediated by increases in cortisol, growth hormone (GH), and catecholamines and facilitated by a decline in insulin. Branched-chain amino acids (BCAA) also undergo catabolism during intense exercise. Here, we investigated the relationship between BCAA catabolism and metrics of cardiopulmonary function in healthy, well-developed, mature adolescent athletes undergoing an acute bout of maximal aerobic exercise. Hypothesis: We hypothesized: (a) acute maximal exercise in adolescents induces lipolysis, FAO, and BCAA catabolism associated with increases in GH and cortisol and a reduction in insulin; (b) increases in GH are associated with increases in ghrelin; and (c) metrics of cardiopulmonary function (aVO2, rVO2, aVO2/HRmax) following maximal exercise correlate with increases in GH secretion, FAO, and BCAA catabolism. Methods: Blood samples before and after maximal cardiopulmonary exercise in 11 adolescent athletes were analyzed by tandem-mass spectrometry. Paired, two-tailed student's t-tests identified significant changes following exercise. Linear regression determined if pre-exercise metabolite levels, or changes in metabolite levels, were associated with aVO2, rVO2, and aVO2/HRmax. Sex and school of origin were included as covariates in all regression analyses. Results: Following exercise there were increases in GH and cortisol, and decreases in ghrelin, but no changes in glucose or insulin concentrations. Suggesting increased lipolysis and FAO, the levels of glycerol, ketones, β-hydroxybutyrate, and acetylcarnitine concentrations increased. Pyruvate, lactate, alanine, and glutamate concentrations also increased. Plasma concentrations of valine (a BCAA) declined (p = 0.002) while valine degradation byproducts increased in association with decreases in urea cycle amino acids arginine and ornithine. Metrics of cardiopulmonary function were associated with increases in propionylcarnitine (C3, p = 0.013) and Ci4-DC/C4-DC (p < 0.01), byproducts of BCAA catabolism. Conclusions: Induction of lipolysis, FAO, gluconeogenesis, and glycogenolysis provides critical substrates for cardiopulmonary function during exercise. However, none of those pathways were significantly associated with metrics of cardiopulmonary function. The associations between rVO2, and aVO2/HRmax and C3 and Ci4-DC/C4-DC suggest that the cardiopulmonary response to maximal exercise in adolescents is linked to BCAA utilization and catabolism.
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Affiliation(s)
- Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University School of Medicine, Durham, NC, United States
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Megan E. Ramaker
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Kelly A. Mason
- Division of Pediatric Endocrinology and Diabetes, Duke University School of Medicine, Durham, NC, United States
| | - Kim M. Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Johanna L. Johnson
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, NC, United States
| | - Michael J. Muehlbauer
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes, Duke University School of Medicine, Durham, NC, United States
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - William E. Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Adult Cardiology, Duke University School of Medicine, Durham, NC, United States
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13
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Cai H, Wang S, Zou R, Li F, Zhang J, Wang Y, Xu Y, Wang C. Diagnostic Value of Diurnal Variability of Orthostatic Heart Rate Increment in Children and Adolescents With POTS. Front Pediatr 2021; 9:644461. [PMID: 34055686 PMCID: PMC8157922 DOI: 10.3389/fped.2021.644461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aims to investigate the diurnal variability of heart rate (HR) increment after standing (ΔHR) in pediatric postural tachycardia syndrome (POTS) and explore appropriate cutoff values of ΔHR at different times for the POTS diagnosis. Materials and Methods: Seventy-eight patients (9-14 years) who presented with orthostatic intolerance symptoms were enrolled. Forty-three patients were diagnosed as POTS (ΔHR ≥40 bpm), and 35 patients were assigned to the non-POTS group (ΔHR <40 bpm). Twenty-six healthy children served as the control group. All subjects completed three standing tests in the morning, afternoon, and evening. Orthostatic HR parameters were analyzed to predict the diagnosis of POTS. Additionally, 41 patients were recruited as an external validation group. Results: Orthostatic HR increments in both the POTS and non-POTS groups exhibited diurnal variability, which was markedly larger in the morning (P < 0.05), whereas it did not differ with the time of day in the control group. Among the POTS patients, 100% met the diagnostic criteria for POTS in the morning, 44.2% in the afternoon, and 27.9% in the evening. Almost half of the POTS patients (51.2%) displayed a positive result only in the morning standing test. However, in the three standing tests at different times, ΔHR from 1 to 10 min after standing and ΔHRmax were the highest in the POTS group compared with in the non-POTS and control groups (P < 0.05). Furthermore, the maximum ΔHR (ΔHRmax) and ΔHR at 5 and 10 min in the afternoon and evening standing tests yielded moderate predictive values for the POTS diagnosis. The external validation test showed that the afternoon ΔHRmax ≥30 bpm to diagnose POTS yielded sensitivity, specificity, and accuracy of 85, 71.4, and 78%, respectively, and the evening ΔHRmax ≥25 bpm yielded sensitivity, specificity, and accuracy of 85, 76.2, and 80.5%, respectively. Conclusions: The orthostatic HR increment exhibits diurnal variability in children and adolescents with POTS that may affect the diagnosis of POTS. Supplementary criteria are proposed for the POTS diagnosis based on diurnal variability.
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Affiliation(s)
- Hong Cai
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Wang
- Jishou University School of Medicine, Jishou, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Li
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Juan Zhang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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14
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Dump the "dimorphism": Comprehensive synthesis of human brain studies reveals few male-female differences beyond size. Neurosci Biobehav Rev 2021; 125:667-697. [PMID: 33621637 DOI: 10.1016/j.neubiorev.2021.02.026] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/01/2021] [Accepted: 02/16/2021] [Indexed: 12/21/2022]
Abstract
With the explosion of neuroimaging, differences between male and female brains have been exhaustively analyzed. Here we synthesize three decades of human MRI and postmortem data, emphasizing meta-analyses and other large studies, which collectively reveal few reliable sex/gender differences and a history of unreplicated claims. Males' brains are larger than females' from birth, stabilizing around 11 % in adults. This size difference accounts for other reproducible findings: higher white/gray matter ratio, intra- versus interhemispheric connectivity, and regional cortical and subcortical volumes in males. But when structural and lateralization differences are present independent of size, sex/gender explains only about 1% of total variance. Connectome differences and multivariate sex/gender prediction are largely based on brain size, and perform poorly across diverse populations. Task-based fMRI has especially failed to find reproducible activation differences between men and women in verbal, spatial or emotion processing due to high rates of false discovery. Overall, male/female brain differences appear trivial and population-specific. The human brain is not "sexually dimorphic."
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15
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Haapala EA, Barker AR, Lakka TA. Response. Med Sci Sports Exerc 2021; 53:454. [PMID: 33416273 DOI: 10.1249/mss.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Management of orthostatic intolerance in children: the state of the art. World J Pediatr 2020; 16:543-548. [PMID: 31912316 DOI: 10.1007/s12519-019-00329-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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17
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Johansson M, Ulfenborg B, Andersson CX, Heydarkhan-Hagvall S, Jeppsson A, Sartipy P, Synnergren J. Cardiac hypertrophy in a dish: a human stem cell based model. Biol Open 2020; 9:bio052381. [PMID: 32878883 PMCID: PMC7522030 DOI: 10.1242/bio.052381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/23/2020] [Indexed: 12/23/2022] Open
Abstract
Cardiac hypertrophy is an important and independent risk factor for the development of heart failure. To better understand the mechanisms and regulatory pathways involved in cardiac hypertrophy, there is a need for improved in vitro models. In this study, we investigated how hypertrophic stimulation affected human induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CMs). The cells were stimulated with endothelin-1 (ET-1) for 8, 24, 48, 72, or 96 h. Parameters including cell size, ANP-, proBNP-, and lactate concentration were analyzed. Moreover, transcriptional profiling using RNA-sequencing was performed to identify differentially expressed genes following ET-1 stimulation. The results show that the CMs increase in size by approximately 13% when exposed to ET-1 in parallel to increases in ANP and proBNP protein and mRNA levels. Furthermore, the lactate concentration in the media was increased indicating that the CMs consume more glucose, a hallmark of cardiac hypertrophy. Using RNA-seq, a hypertrophic gene expression pattern was also observed in the stimulated CMs. Taken together, these results show that hiPSC-derived CMs stimulated with ET-1 display a hypertrophic response. The results from this study also provide new molecular insights about the underlying mechanisms of cardiac hypertrophy and may help accelerate the development of new drugs against this condition.
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Affiliation(s)
- Markus Johansson
- Systems Biology Research Center, School of Bioscience, Department for Biology and Bioinformatics, University of Skövde, SE-541 28 Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Benjamin Ulfenborg
- Systems Biology Research Center, School of Bioscience, Department for Biology and Bioinformatics, University of Skövde, SE-541 28 Skövde, Sweden
| | | | - Sepideh Heydarkhan-Hagvall
- Systems Biology Research Center, School of Bioscience, Department for Biology and Bioinformatics, University of Skövde, SE-541 28 Skövde, Sweden
- Bioscience, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals, R&D AstraZeneca, 431 50 Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Peter Sartipy
- Systems Biology Research Center, School of Bioscience, Department for Biology and Bioinformatics, University of Skövde, SE-541 28 Skövde, Sweden
- Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, 431 50 Gothenburg, Sweden
| | - Jane Synnergren
- Systems Biology Research Center, School of Bioscience, Department for Biology and Bioinformatics, University of Skövde, SE-541 28 Skövde, Sweden
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18
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Wahab RJ, Jaddoe VWV, Roest AAW, Toemen L, Gaillard R. Associations of Maternal Glycemia in the First Half of Pregnancy With Alterations in Cardiac Structure and Function in Childhood. Diabetes Care 2020; 43:2272-2280. [PMID: 32661110 PMCID: PMC7613757 DOI: 10.2337/dc19-2580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus has been associated with offspring cardiac congenital malformations, ventricular hypertrophy, and diastolic dysfunction in large observational cohort studies and experimental animal models. We assessed the associations of maternal random glucose concentrations across the full range with childhood cardiac ventricular structure and function. RESEARCH DESIGN AND METHODS In a population-based prospective cohort among 1,959 women and their offspring, maternal random glucose concentrations were measured at a median 13.1 weeks' gestation (95% range 10.5-16.8 weeks). We obtained offspring cardiac outcomes, relative to body size, through cardiac MRI at 10 years. RESULTS The mean maternal random glucose concentration was 4.4 mmol/L (SD 0.8). The highest quintile of maternal glucose concentrations, compared with the lowest quintile, was associated with a lower childhood left ventricular mass (-0.19 SD score [SDS]; 95% CI -0.31, -0.07) and left ventricular end-diastolic volume (-0.17 SDS; 95% -0.28, -0.05). Also, higher maternal glucose concentrations across the full range per 1 mmol/L increase were associated with a lower childhood left ventricular mass and left ventricular end-diastolic volume (P values ≤0.05). Adjustment for maternal prepregnancy BMI, gestational age, and weight at birth or childhood BMI and blood pressure did not influence the effect estimates. Maternal glucose concentrations were not significantly associated with childhood right ventricular end-diastolic volume or left and right ventricular ejection fraction. CONCLUSIONS Higher maternal random glucose concentrations in the first half of pregnancy are associated with a lower childhood left ventricular mass and left ventricular end-diastolic volume, with the strongest associations for childhood left ventricular mass. These associations were not explained by maternal, birth, or childhood characteristics. Further studies are needed to replicate these findings using repeated maternal glucose measurements throughout pregnancy and offspring cardiac outcomes throughout childhood and adulthood.
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Affiliation(s)
- Rama J Wahab
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arno A W Roest
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Liza Toemen
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands .,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
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19
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Burtscher M. The bi- (or multi-) phasic response of cardiac remodelling to endurance exercise related to the article: 'From talented child to elite athlete: The development of cardiac morphology and function in a cohort of endurance athletes from age 12 to 18' by Bjerring and colleagues. Eur J Prev Cardiol 2020; 28:1058-1060. [PMID: 33611568 DOI: 10.1177/2047487320929245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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Ai L, Perez E, Asimes A, Kampaengsri T, Heroux M, Zlobin A, Hiske MA, Chung CS, Pak TR, Kirk JA. Binge Alcohol Exposure in Adolescence Impairs Normal Heart Growth. J Am Heart Assoc 2020; 9:e015611. [PMID: 32319345 PMCID: PMC7428579 DOI: 10.1161/jaha.119.015611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Approximately 1 in 6 adolescents report regular binge alcohol consumption, and we hypothesize it affects heart growth during this period. Methods and Results Adolescent, genetically diverse, male Wistar rats were gavaged with water or ethanol once per day for 6 days. In vivo structure and function were assessed before and after exposure. Binge alcohol exposure in adolescence significantly impaired normal cardiac growth but did not affect whole‐body growth during adolescence, therefore this pathology was specific to the heart. Binge rats also exhibited signs of accelerated pathological growth (concentric cellular hypertrophy and thickening of the myocardial wall), suggesting a global reorientation from physiologic to pathologic growth. Binge rats compensated for their smaller filling volumes by increasing systolic function and sympathetic stimulation. Consequently, binge alcohol exposure increased PKA (protein kinase A) phosphorylation of troponin I, inducing myofilament calcium desensitization. Binge alcohol also impaired in vivo relaxation and increased titin‐based cellular stiffness due to titin phosphorylation by PKCα (protein kinase C α). Mechanistically, alcohol inhibited extracellular signal‐related kinase activity, a nodal signaling kinase activating physiology hypertrophy. Thus, binge alcohol exposure depressed genes involved in growth. These cardiac structural alterations from binge alcohol exposure persisted through adolescence even after cessation of ethanol exposure. Conclusions Alcohol negatively impacts function in the adult heart, but the adolescent heart is substantially more sensitive to its effects. This difference is likely because adolescent binge alcohol impedes the normal rapid physiological growth and reorients it towards pathological hypertrophy. Many adolescents regularly binge alcohol, and here we report a novel pathological consequence as well as mechanisms involved.
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Affiliation(s)
- Lizhuo Ai
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - Edith Perez
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - AnnaDorothea Asimes
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - Theerachat Kampaengsri
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - Maxime Heroux
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - Andrei Zlobin
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - Mark A Hiske
- Department of Physiology Wayne State University Detroit MI
| | | | - Toni R Pak
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
| | - Jonathan A Kirk
- Department of Cell and Molecular Physiology Loyola University Chicago Stritch School of Medicine Maywood IL
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21
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V. Martinho D, Valente-dos-Santos J, Coelho-e-Silva MJ, Gutiérrez AO, Duarte JP, Lourenço-Farinha P, Luz LGO, Gonçalves-Santos J, Machado DRL, Leite N, Conde J, Castanheira JM, Cumming SP, Sherar LB, Malina RM. Scaling left ventricular mass in adolescent female soccer players. BMC Pediatr 2020; 20:157. [PMID: 32284059 PMCID: PMC7153237 DOI: 10.1186/s12887-020-02043-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/24/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of the study was to examine the contribution of chronological age (CA), skeletal maturation, training experience and concurrent body size descriptors, to inter-individual variance in left ventricular mass (LVM) among female adolescent soccer players. METHODS The sample included 228 female soccer players 11.8-17.1 years. Training experience defined as years of participation in competitive soccer (range 2-9 years), was obtained by interview. Stature, body mass and skinfolds (triceps, medial calf) were measured. Fat mass was estimated; Fat-free mass was derived. LVM was assessed by echocardiography. Skeletal maturity status was as the difference of skeletal age (SA, Fels method) minus CA. RESULTS Fat-free mass was the most prominent single predictor of LVM (R2 = 36.6%). It was associated with an allometric coefficient close to linearity (k = 0.924, 95%CI: 0.737 to 1.112). A significant multiplicative allometric model including body mass, fat-free mass, CA, training experience and skeletal maturity status was also obtained (R = 0.684; R2 = 46.2%). CONCLUSION Stature has limitations as a valid size descriptor of LVM. Body mass, fat-free mass, training experience, CA, body mass and skeletal maturity status were relevant factors contributing to inter-individual variability in LVM.
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Affiliation(s)
- Diogo V. Martinho
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
| | - João Valente-dos-Santos
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
- Faculty of Physical Education and Sport, Lusófona University, Lisbon, Portugal
| | - Manuel J. Coelho-e-Silva
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
| | - Arturo O. Gutiérrez
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
- Sonora Institute of Technology, Sonora, Mexico
| | - João P. Duarte
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
| | - Pedro Lourenço-Farinha
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Leonardo G. O. Luz
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
- LACAPS, Federal University of Alagoas, Arapiraca, Brazil
| | | | - Dalmo R. L. Machado
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Neiva Leite
- Physical Education Department, Research Nucleus of Quality of Life, Federal University of Parana, Curitiba, Parana Brazil
| | - Jorge Conde
- Department of Clinical Physiology, School of Health and Technology, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Joaquim M. Castanheira
- CIDAF (uid/dtp/04213/2020), University of Coimbra, Estadio Universitario, Pavilhao III, Coimbra, Portugal
- Department of Clinical Physiology, School of Health and Technology, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | | | - Lauren B. Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Robert M. Malina
- Department of Kinesiology and Health Education, University of Texas, Austin, USA
- School of Public Health and Information Sciences, University of Louisville, Louisville, KY USA
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Wong SWL, Yu CCW, Li AM. The Understanding of Peak Oxygen Uptake in Children Aged 8-16. Front Pediatr 2020; 8:599571. [PMID: 33520890 PMCID: PMC7841111 DOI: 10.3389/fped.2020.599571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: To examine the understanding of the concept peak oxygen uptake (peak VO2) among children and adolescents at different ages from a developmental perspective. Methods: A total of 549 children and adolescents aged 8 to 16 were recruited and instructed to fill in a 20-item Peak VO 2 Understanding Inventory developed with reference to the research literature on peak VO2. We presented the participants with twenty scenarios and asked them to indicate whether peak VO2 would "remain unchanged," "increase," or "decrease," or that there was "insufficient information for a definite answer." The cross-sectional data was analyzed by employing a series of ANOVA analyses and chi-square association tests. Additional statistical analyses were performed to examine the error patterns and if there were gender differences. Results: Except for the 8-year-old group, the overall accuracy rate did not improve with age. Age-related differences in the choice of answers ("increase," "decrease," "unchanged," and "uncertain") for determining the resulting peak VO2 after a change of antecedent were observed. Error analysis by item showed that prefactual thinking that is important to understand the concept was emerging rather than fully developed in our child and adolescent samples. Conclusion: The mastery of peak VO2 is not subject to age-related maturation but might demand the acquisition of specific logical reasoning skill such as perfactual thinking. Early introduction of peak VO2 and related concepts is advocated and should be emphasized on the reasoning rather than providing model answers in physical literacy education.
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Affiliation(s)
- Simpson W L Wong
- Department of Education Studies, Hong Kong Baptist University, Hong Kong, China
| | - Clare C W Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Albert M Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
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23
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Resting Level of Insulin-Like Growth Factor-1 Is Not at Play in Cardiac Enlargement in Endurance-Trained Adolescents. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9647964. [PMID: 31663002 PMCID: PMC6791235 DOI: 10.1155/2019/9647964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/08/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022]
Abstract
Purpose The study aimed to investigate resting levels of several selected growth and metabolic hormones in a group of 24 endurance-trained adolescents (aged 13–19 years) compared with 24 untrained age- and sex-matched controls, and to investigate if increased cardiac dimensions were related to these hormones at rest with emphasis on insulin-like growth factor-1 (IGF-1). Methods The hormones (cortisol, IGF-1, IGF-2, follicle-stimulating hormone, growth hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone) were analysed with chemiluminescence microparticle immunoassay (CMIA) or multiplex fluorochrome (Luminex) technique. Cardiac dimensions were assessed by echocardiographic examination at rest. Peak oxygen uptake was obtained by a maximal cardiopulmonary exercise test on a treadmill. Results Circulating levels of analysed hormones at rest did not differ between the groups. A correlation was found between increased cardiac dimensions and IGF-1 in the controls, but not in the active group. This correlation declined also among the controls when the cardiac parameters were indexed for body surface area. Conclusion Increased cardiac dimensions in endurance-trained adolescents could not be related to resting levels of hormones associated with growth and metabolism, including IGF-1 and GH. In addition, the resting levels of these hormones seem not to be affected by intense regular endurance exercise in adolescents. These findings may contribute to the knowledge about cellular signaling that trigger growth as well as cardiac adaptation to endurance training in young athletes.
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24
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Guasch E, Mont L. Endurance training in young athletes: What happens in childhood, stays in childhood? Eur J Prev Cardiol 2019; 26:1998-2000. [PMID: 31426670 DOI: 10.1177/2047487319871649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Eduard Guasch
- Cardiovascular Institute, Hospital Clínic, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Cardiovascular Institute, Hospital Clínic, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
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25
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Krysztofiak H, Młyńczak M, Małek ŁA, Folga A, Braksator W. Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization. PLoS One 2019; 14:e0217637. [PMID: 31141818 PMCID: PMC6541472 DOI: 10.1371/journal.pone.0217637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/15/2019] [Indexed: 01/20/2023] Open
Abstract
Background Left ventricular mass normalization for body size is recommended, but a question remains: what is the best body size variable for this normalization—body surface area, height or lean body mass computed based on a predictive equation? Since body surface area and computed lean body mass are derivatives of body mass, normalizing for them may result in underestimation of left ventricular mass in overweight children. The aim of this study is to indicate which of the body size variables normalize left ventricular mass without underestimating it in overweight children. Methods Left ventricular mass assessed by echocardiography, height and body mass were collected for 464 healthy boys, 5–18 years old. Lean body mass and body surface area were calculated. Left ventricular mass z-scores computed based on reference data, developed for height, body surface area and lean body mass, were compared between overweight and non-overweight children. The next step was a comparison of paired samples of expected left ventricular mass, estimated for each normalizing variable based on two allometric equations—the first developed for overweight children, the second for children of normal body mass. Results The mean of left ventricular mass z-scores is higher in overweight children compared to non-overweight children for normative data based on height (0.36 vs. 0.00) and lower for normative data based on body surface area (-0.64 vs. 0.00). Left ventricular mass estimated normalizing for height, based on the equation for overweight children, is higher in overweight children (128.12 vs. 118.40); however, masses estimated normalizing for body surface area and lean body mass, based on equations for overweight children, are lower in overweight children (109.71 vs. 122.08 and 118.46 vs. 120.56, respectively). Conclusion Normalization for body surface area and for computed lean body mass, but not for height, underestimates left ventricular mass in overweight children.
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Affiliation(s)
- Hubert Krysztofiak
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- National Centre for Sports Medicine, Warsaw, Poland
- * E-mail:
| | - Marcel Młyńczak
- Warsaw University of Technology, Faculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw Poland
| | - Łukasz A. Małek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | | | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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26
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Ventricular remodeling in preterm infants: computational cardiac magnetic resonance atlasing shows significant early remodeling of the left ventricle. Pediatr Res 2019; 85:807-815. [PMID: 30758323 DOI: 10.1038/s41390-018-0171-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/01/2018] [Accepted: 08/27/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Premature birth is associated with ventricular remodeling, early heart failure, and altered left ventricular (LV) response to physiological stress. Using computational cardiac magnetic resonance (CMR) imaging, we aimed to quantify preterm ventricular remodeling in the neonatal period, and explore contributory clinical factors. METHODS Seventy-three CMR scans (34 preterm infants, 10 term controls) were performed to assess in-utero development and preterm ex-utero growth. End-diastolic computational atlases were created for both cardiac ventricles; t statistics, linear regression modeling, and principal component analysis (PCA) were used to describe the impact of prematurity and perinatal factors on ventricular volumetrics, ventricular geometry, myocardial mass, and wall thickness. RESULTS All preterm neonates demonstrated greater weight-indexed LV mass and higher weight-indexed end-diastolic volume at term-corrected age (P < 0.05 for all preterm gestations). Independent associations of increased term-corrected age LV myocardial wall thickness were (false discovery rate <0.05): degree of prematurity, antenatal glucocorticoid administration, and requirement for >48 h postnatal respiratory support. PCA of LV geometry showed statistical differences between all preterm infants at term-corrected age and term controls. CONCLUSIONS Computational CMR demonstrates that significant LV remodeling occurs soon after preterm delivery and is associated with definable clinical situations. This suggests that neonatal interventions could reduce long-term cardiac dysfunction.
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27
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Mintjens S, Menting MD, Daams JG, van Poppel MNM, Roseboom TJ, Gemke RJBJ. Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies. Sports Med 2019; 48:2577-2605. [PMID: 30144022 PMCID: PMC6182463 DOI: 10.1007/s40279-018-0974-5] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although cardiorespiratory fitness (CRF) in childhood and adolescence may be linked to future cardiovascular health, there is currently limited evidence for a longitudinal association. OBJECTIVES To provide a systematic review on the prospective association between CRF in childhood and adolescence and cardiovascular disease (CVD) risk factors at least 2 years later. METHODS Using a systematic search of Medline, Embase, and SPORTDiscus, relevant articles were identified by the following criteria: generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline, and a follow-up period of ≥ 2 years. The outcome measures were CVD risk factors. We appraised quality of the included articles with STROBE and QUIPS checklists. RESULTS After screening 7524 titles and abstracts, we included 38 articles, assessing 44,169 children and adolescents followed up for a median of 6 years. Eleven articles were of high quality. There was considerable heterogeneity in methodology, measurement of CRF, and outcomes, which hampered meta-analysis. In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index (BMI), waist circumference, body fatness and lower prevalence of metabolic syndrome in later life. No associations between CRF in childhood and adolescence and future waist-to-hip ratio, blood pressure, lipid profile, and glucose homeostasis were observed. CONCLUSION Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI, body fatness, and metabolic syndrome, evidence for other CVD risk factors was unconvincing. Many articles did not account for important confounding factors such as adiposity. Recommendations for future research include standardizing the measurement of CRF, i.e. by reporting VO2max, using standardized outcome assessments, and performing individual patient data meta-analyses.
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Affiliation(s)
- Stijn Mintjens
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, Room KTC 4-021, 1081 HZ, Amsterdam, The Netherlands. .,Department of Gynecology and Obstetrics, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Malou D Menting
- Department of Gynecology and Obstetrics, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library AMC, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Tessa J Roseboom
- Department of Gynecology and Obstetrics, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Reinoud J B J Gemke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, Room KTC 4-021, 1081 HZ, Amsterdam, The Netherlands
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28
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Mintjens S, Menting MD, Daams JG, van Poppel MNM, Roseboom TJ, Gemke RJBJ. Reply to Tarp et al.: Comment on: "Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies". Sports Med 2018; 49:163-165. [PMID: 30593651 DOI: 10.1007/s40279-018-01042-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stijn Mintjens
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Gynecology and Obstetrics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Malou D Menting
- Department of Gynecology and Obstetrics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost G Daams
- Medical Library AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Institute of Sport Science, University of Graz, Graz, Austria
| | - Tessa J Roseboom
- Department of Gynecology and Obstetrics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud J B J Gemke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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29
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Isasi CR, Strizich GM, Kaplan R, Daviglus ML, Sotres-Alvarez D, Vidot DC, Llabre MM, Talavera G, Carnethon MR. The association of cardiorespiratory fitness with cardiometabolic factors, markers of inflammation, and endothelial dysfunction in Latino youth: findings from the Hispanic Community Children's Health Study/Study of Latino Youth. Ann Epidemiol 2018; 28:583-589.e3. [PMID: 29548689 DOI: 10.1016/j.annepidem.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the relationship of cardiorespiratory fitness (CRF) with cardiovascular disease risk factors and a biomarker of endothelial dysfunction (e-selectin) among Hispanic/Latino youth. METHODS The study included 1380 Hispanic/Latino youths (8-16 years old) from the Hispanic Community Children's Health Study/Study of Latino Youth that enrolled from four cities (Bronx, Chicago, Miami, and San Diego). CRF was assessed by a 3-minute step test that uses postexercise heart rate to estimate maximal oxygen uptake. Regression models assessed differences in cardiometabolic markers across quartiles of CRF, adjusting for potential confounders. RESULTS CRF was higher among boys (mean: 57.6 mL per kg/min, 95% confidence interval, 56.8-58.4) compared to girls (mean: 54.7 mL per kg/min, 95% confidence interval, 53.9-55.5). Higher levels of CRF were associated with more favorable levels of cardiometabolic, inflammation, and endothelial dysfunction factors (P-values <.001) and independently of physical activity and sedentary time. Compared to the lowest quartile of CRF, the odds of having greater than or equal to two cardiovascular disease risk factors was lower at higher quartiles of CRF, after adjustment for potential confounders. CONCLUSIONS Among Hispanic/Latino youth, CRF appears to be a strong protective factor for endothelial dysfunction and cardiometabolic risk factors. Strategies to improve CRF may be a useful approach for improving cardiovascular health in youth.
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Affiliation(s)
- Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.
| | - Garrett M Strizich
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Robert Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Denise C Vidot
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL
| | - Maria M Llabre
- Department of Psychology, University of Miami, Miami, FL
| | - Gregory Talavera
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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30
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Madan S, Patel SR, Vlismas P, Saeed O, Murthy S, Forest S, Jakobleff W, Sims D, Lamour JM, Hsu DT, Shin J, Goldstein D, Jorde UP. Outcomes of Early Adolescent Donor Hearts in Adult Transplant Recipients. JACC-HEART FAILURE 2017; 5:879-887. [DOI: 10.1016/j.jchf.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/07/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
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Barjaktarovic M, Korevaar TIM, Gaillard R, de Rijke YB, Visser TJ, Jaddoe VWV, Peeters RP. Childhood thyroid function, body composition and cardiovascular function. Eur J Endocrinol 2017; 177:319-327. [PMID: 28724570 DOI: 10.1530/eje-17-0369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/27/2017] [Accepted: 07/19/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The cardiovascular system is a known target for thyroid hormone. Early-life cardiovascular alterations may lead to a higher risk of cardiovascular disease in adulthood. Little is known about the effects of thyroid hormone on cardiovascular function during childhood, including the role of body composition in this association. DESIGN Population-based prospective cohort of children (n = 4251, median age 6 years, 95% range: 5.7-8.0 years). METHODS Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were measured to assess thyroid function. Left ventricular (LV) mass was assessed with echocardiography. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (CFPWV). Systolic and diastolic blood pressure (BP) was measured. Body composition was assessed by dual-energy X-ray absorptiometry scan. RESULTS FT4 was inversely associated with LV mass (P = 0.002), and with lean body mass (P < 0.0001). The association of FT4 with LV mass was partially mediated through variability in lean body mass (55% mediated effect). TSH was inversely associated with LV mass (P = 0.010), predominantly in boys. TSH was positively associated with systolic and diastolic BP (both P < 0.001). FT4 was positively associated with CFPWV and diastolic BP (P < 0.0001, P = 0.008, respectively), and the latter association attenuated after adjustment for CFPWV. CONCLUSIONS At the age of 6 years, higher FT4 is associated with lower LV mass (partially through effects on lean body mass) and with higher arterial stiffness, which may lead to higher BP. Our data also suggest different mechanisms via which TSH and FT4 are associated with cardiovascular function during early childhood.
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Affiliation(s)
| | - Tim I M Korevaar
- The Generation R Study Group
- Department of Internal Medicine
- Rotterdam Thyroid Center
| | - Romy Gaillard
- The Generation R Study Group
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Theo J Visser
- Department of Internal Medicine
- Rotterdam Thyroid Center
| | - Vincent W V Jaddoe
- The Generation R Study Group
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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Toemen L, de Jonge LL, Gishti O, van Osch-Gevers L, Taal HR, Steegers EAP, Hofman A, Helbing WA, Jaddoe VWV. Longitudinal growth during fetal life and infancy and cardiovascular outcomes at school-age. J Hypertens 2017; 34:1396-406. [PMID: 27115338 DOI: 10.1097/hjh.0000000000000947] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Low birth weight is associated with cardiovascular disease. We examined the effects of fetal and infant growth patterns on cardiovascular outcomes in children. METHODS In a population-based prospective cohort study among 6239 children, we estimated fetal-femur length and weight by 20 and 30 weeks ultrasound, and child length and weight at birth, 0.5, 1, 2 and 6 years. We measured blood pressure (BP), carotid-femoral pulse wave velocity, aortic root diameter, left ventricular mass and fractional shortening at 6 years. We used regression analyses to identify longitudinal growth patterns associated with height-standardized vascular outcomes and body-surface-area-standardized cardiac outcomes. RESULTS Younger gestational age and lower birth weight were associated with higher BP, smaller aortic root diameter and lower left ventricular mass in childhood (all P values <0.05). Children with decelerated or normal fetal growth followed by accelerated infant growth had higher BP, whereas those with decelerated growth during both fetal life and infancy had a relatively larger left ventricular mass. Longitudinal growth analyses showed that children with increased BP tended to be smaller during third trimester of fetal life, but of normal size during infancy, than children with normal BP. Children with increased aortic root diameter or left ventricular mass tended to be larger during fetal life, but of similar size during infancy. CONCLUSION Specific fetal and infant growth patterns are associated with different cardiovascular outcomes in children. Further studies are needed to identify the underlying mechanisms and the long-term cardiovascular consequences.
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Affiliation(s)
- Liza Toemen
- aGeneration R Study Group bDepartment of Epidemiology cDepartment of Pediatrics dDepartment of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Exposure to tobacco smoke and childhood rhinitis: a population-based study. Sci Rep 2017; 7:42836. [PMID: 28205626 PMCID: PMC5311963 DOI: 10.1038/srep42836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/16/2017] [Indexed: 11/08/2022] Open
Abstract
Exposure to tobacco smoke has been associated with harmful effects on child health. The association between tobacco smoke exposure and childhood rhinitis has not been established in developed or developing countries. We investigated the association between serum cotinine levels and rhinitis in a population sample of 1,315 Asian children. Serum cotinine levels were positively associated with rhinitis ever (adjusted odds ratio [AOR] = 2.95; 95% confidence interval [CI]: 1.15–7.60) and current rhinitis (AOR = 2.71; 95% CI: 1.07–6.89), while the association for physician-diagnosed rhinitis approaching borderline significance (AOR = 2.26; 95% CI: 0.88–5.83). Stratified analyses demonstrated significant association of serum cotinine levels with current rhinitis among children without allergic sensitization (AOR = 6.76; 95% CI: 1.21–37.74), but not among those with allergic sensitization. Serum cotinine levels were positively associated with rhinitis ever (AOR = 3.34; 95% CI: 1.05–10.61) and current rhinitis (AOR = 4.23; 95% CI: 1.28–13.97) among adolescents but not in children aged less than 10 years. This population-based study demonstrates supportive evidence for positive association of tobacco smoke exposure with rhinitis, while the effect is mainly confined to non-allergic rhinitis and more pronounced in adolescents than in young children, highlighting the need for raising public health awareness about the detrimental effects of tobacco smoke exposure on children’s respiratory health.
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Ikon N, Ryan RO. Barth Syndrome: Connecting Cardiolipin to Cardiomyopathy. Lipids 2017; 52:99-108. [PMID: 28070695 DOI: 10.1007/s11745-016-4229-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/20/2016] [Indexed: 12/18/2022]
Abstract
The Barth syndrome (BTHS) is caused by an inborn error of metabolism that manifests characteristic phenotypic features including altered mitochondrial membrane phospholipids, lactic acidosis, organic acid-uria, skeletal muscle weakness and cardiomyopathy. The underlying cause of BTHS has been definitively traced to mutations in the tafazzin (TAZ) gene locus on chromosome X. TAZ encodes a phospholipid transacylase that promotes cardiolipin acyl chain remodeling. Absence of tafazzin activity results in cardiolipin molecular species heterogeneity, increased levels of monolysocardiolipin and lower cardiolipin abundance. In skeletal muscle and cardiac tissue mitochondria these alterations in cardiolipin perturb the inner membrane, compromising electron transport chain function and aerobic respiration. Decreased electron flow from fuel metabolism via NADH ubiquinone oxidoreductase activity leads to a buildup of NADH in the matrix space and product inhibition of key TCA cycle enzymes. As TCA cycle activity slows pyruvate generated by glycolysis is diverted to lactic acid. In turn, Cori cycle activity increases to supply muscle with glucose for continued ATP production. Acetyl CoA that is unable to enter the TCA cycle is diverted to organic acid waste products that are excreted in urine. Overall, reduced ATP production efficiency in BTHS is exacerbated under conditions of increased energy demand. Prolonged deficiency in ATP production capacity underlies cell and tissue pathology that ultimately is manifest as dilated cardiomyopathy.
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Affiliation(s)
- Nikita Ikon
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr. Way, Oakland, CA, 94609, USA
| | - Robert O Ryan
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr. Way, Oakland, CA, 94609, USA.
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Taimeh Z, Cogswell R, Duval S, Martin C, Colvin M, Thenappan T, Adatya S, Eckman P. WITHDRAWN: Novel Method of Matching Size of Donors and Heart Transplant Recipients Using Predicted Total Ventricular Mass Is Associated with Improved Survival After Cardiac Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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36
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Wu F, Koenig KL, Zeleniuch-Jacquotte A, Jonas S, Afanasyeva Y, Wójcik OP, Costa M, Chen Y. Serum Taurine and Stroke Risk in Women: A Prospective, Nested Case-Control Study. PLoS One 2016; 11:e0149348. [PMID: 26866594 PMCID: PMC4750934 DOI: 10.1371/journal.pone.0149348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/29/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Taurine (2-aminoethanesulfonic acid), a conditionally essential sulfur-containing amino acid, is mainly obtained from diet in humans. Experimental studies have shown that taurine's main biological actions include bile salt conjugation, blood pressure regulation, anti-oxidation, and anti-inflammation. METHODS We conducted a prospective case-control study nested in the New York University Women's Health Study, a cohort study involving 14,274 women enrolled since 1985. Taurine was measured in pre-diagnostic serum samples of 241 stroke cases and 479 matched controls. RESULTS There was no statistically significant association between serum taurine and stroke risk in the overall study population. The adjusted ORs for stroke were 1.0 (reference), 0.87 (95% CI, 0.59-1.28), and 1.03 (95% CI, 0.69-1.54) in increasing tertiles of taurine (64.3-126.6, 126.7-152.9, and 153.0-308.5 nmol/mL, respectively). A significant inverse association between serum taurine and stroke risk was observed among never smokers, with an adjusted OR of 0.66 (95% CI, 0.37-1.18) and 0.50 (95% CI, 0.26-0.94) for the second and third tertile, respectively (p for trend = 0.01), but not among past or current smokers (p for interaction < 0.01). CONCLUSIONS We observed no overall association between serum taurine and stroke risk, although a protective effect was observed in never smokers, which requires further investigation. Taurine, Stroke, Epidemiology, Prospective, Case-control study, NYUWHS.
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Affiliation(s)
- Fen Wu
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, New York, United States of America
| | - Karen L. Koenig
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, New York, United States of America
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, New York, United States of America
| | - Saran Jonas
- Department of Neurology, New York University School of Medicine, 462 First Avenue, New York, New York, United States of America
| | - Yelena Afanasyeva
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, New York, United States of America
| | - Oktawia P. Wójcik
- Robert Wood Johnson Foundation, Route 1 and College Road East, Princeton, New Jersey, United States of America
| | - Max Costa
- Department of Environmental Medicine, New York University School of Medicine, 57 Old Forge Rd, Tuxedo Park, New York, United States of America
| | - Yu Chen
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, New York, United States of America
- * E-mail:
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Pelà G, Crocamo A, Li Calzi M, Gianfreda M, Gioia MI, Visioli F, Pattoneri P, Corradi D, Goldoni M, Montanari A. Sex-related differences in left ventricular structure in early adolescent non-professional athletes. Eur J Prev Cardiol 2015; 23:777-84. [DOI: 10.1177/2047487315608826] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanna Pelà
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Antonio Crocamo
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Mauro Li Calzi
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Marina Gianfreda
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Margherita I Gioia
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | | | | | - Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University Medical School and University Hospital of Parma, Italy
| | - Matteo Goldoni
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Alberto Montanari
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
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Quante M, Wang R, Weng J, Rosen CL, Amin R, Garetz SL, Katz E, Paruthi S, Arens R, Muzumdar H, Marcus CL, Ellenberg S, Redline S. The Effect of Adenotonsillectomy for Childhood Sleep Apnea on Cardiometabolic Measures. Sleep 2015; 38:1395-403. [PMID: 25669177 DOI: 10.5665/sleep.4976] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/08/2014] [Indexed: 02/01/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea syndrome (OSAS) has been associated with cardiometabolic disease in adults. In children, this association is unclear. We evaluated the effect of early adenotonsillectomy (eAT) for treatment of OSAS on blood pressure, heart rate, lipids, glucose, insulin, and C-reactive protein. We also analyzed whether these parameters at baseline and changes at follow-up correlated with polysomnographic indices. DESIGN Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT). SETTING Clinical referral setting from multiple centers. PARTICIPANTS There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia. INTERVENTIONS Randomization to eAT or Watchful Waiting with Supportive Care (WWSC). MEASUREMENTS AND RESULTS There was no significant change of cardiometabolic parameters over the 7-mo interval in the eAT group compared to WWSC group. However, overnight heart rate was incrementally higher in association with baseline OSAS severity (average heart rate increase of 3 beats per minute [bpm] for apnea-hypopnea index [AHI] of 2 versus 10; [standard error = 0.60]). Each 5-unit improvement in AHI and 5 mmHg improvement in peak end-tidal CO2 were estimated to reduce heart rate by 1 and 1.5 bpm, respectively. An increase in N3 sleep also was associated with small reductions in systolic blood pressure percentile. CONCLUSIONS There is little variation in standard cardiometabolic parameters in children with obstructive sleep apnea syndrome (OSAS) but without severe hypoxemia at baseline or after intervention. Of all measures, overnight heart rate emerged as the most sensitive parameter of pediatric OSAS severity. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov (#NCT00560859).
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Affiliation(s)
- Mirja Quante
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Rui Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jia Weng
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA
| | - Carol L Rosen
- Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals-Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Raouf Amin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Susan L Garetz
- Department of Otolaryngology, Head and Neck Surgery and Sleep Disorders Center, University of Michigan Medical Center, Ann Arbor, MI
| | - Eliot Katz
- Harvard Medical School, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Shalini Paruthi
- Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, St Louis, MO
| | - Raanan Arens
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Hiren Muzumdar
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Carole L Marcus
- Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Susan Ellenberg
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
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Zhao J, Han Z, Zhang X, Du S, Liu AD, Holmberg L, Li X, Lin J, Xiong Z, Gai Y, Yang J, Liu P, Tang C, Du J, Jin H. A cross-sectional study on upright heart rate and BP changing characteristics: basic data for establishing diagnosis of postural orthostatic tachycardia syndrome and orthostatic hypertension. BMJ Open 2015; 5:e007356. [PMID: 26033944 PMCID: PMC4458681 DOI: 10.1136/bmjopen-2014-007356] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to determine upright heart rate and blood pressure (BP) changes to suggest diagnostic criteria for postural orthostatic tachycardia syndrome (POTS) and orthostatic hypertension (OHT) in Chinese children. METHODS In this cross-sectional study, 1449 children and adolescents aged 6-18 years were randomly recruited from two cities in China, Kaifeng in Henan province and Anguo in Hebei province. They were divided into two groups: 844 children aged 6-12 years (group I) and 605 adolescents aged 13-18 years (group II). Heart rate and BP were recorded during an active standing test. RESULTS 95th percentile (P(95)) of δ heart rate from supine to upright was 38 bpm, with a maximum upright heart rate of 130 and 124 bpm in group I and group II, respectively. P(95) of δ systolic blood pressure (SBP) increase was 18 mm Hg and P(95) of upright SBP was 132 mm Hg in group I and 138 mm Hg in group II. P(95) of δ diastolic blood pressure (DBP) increase was 24 mm Hg in group I and 21 mm Hg in group II, and P(95) of upright DBP was 89 mm Hg in group I and 91 mm Hg in group II. CONCLUSIONS POTS is suggested when δ heart rate is ≥ 38 bpm (for easy memory, ≥ 40 bpm) from supine to upright, or maximum heart rate ≥ 130 bpm (children aged 6-12 years) and ≥ 125 pm (adolescents aged 13-18 years), associated with orthostatic symptoms. OHT is suggested when δ SBP (increase) is ≥ 20 mm Hg, and/or δ DBP (increase) ≥ 25 mm Hg (in children aged 6-12 years) or ≥ 20 mm Hg (in adolescents aged 13-18 years) from supine to upright; or upright BP ≥ 130/90 mm Hg (in children aged 6-12 years) or ≥ 140/90 mm Hg (in adolescents aged 13-18 years).
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Affiliation(s)
- Juan Zhao
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhenhui Han
- Department of Pediatrics, Kaifeng Children's Hospital, Henan, People's Republic of China
| | - Xi Zhang
- Department of Pediatrics, Kaifeng Children's Hospital, Henan, People's Republic of China
| | - Shuxu Du
- Department of Pediatrics, The Capital Medical University, Shijitan Hospital, Beijing, People's Republic of China
| | - Angie Dong Liu
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lukas Holmberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing, People's Republic of China
| | - Jing Lin
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhenyu Xiong
- Department of Pediatrics, Kaifeng Children's Hospital, Henan, People's Republic of China
| | - Yong Gai
- Department of Pediatrics, Kaifeng Children's Hospital, Henan, People's Republic of China
| | - Jinyan Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology, Peking University Health Sciences Centre, Beijing, People's Republic of China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
- Key Laboratory of Cardiovascular Medicine, Ministry of Education, Beijing, People's Republic of China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
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Valente-Dos-Santos J, Coelho-E-Silva MJ, Castanheira J, Machado-Rodrigues AM, Cyrino ES, Sherar LB, Esliger DW, Elferink-Gemser MT, Malina RM. The effects of sports participation on the development of left ventricular mass in adolescent boys. Am J Hum Biol 2015; 27:530-7. [PMID: 25753526 DOI: 10.1002/ajhb.22681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/04/2014] [Accepted: 12/27/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To examine the contribution of body size, biological maturation, and nonelite sports participation to longitudinal changes of left ventricular mass (LVM) in healthy boys. METHODS One hundred and ten boys (11.0-14.5 years at baseline) were assessed biannually for 2 years. Stature, body mass, and four skinfolds were measured. Lean body mass (LBM) was estimated. Biological maturation was assessed as years from age at peak height velocity (APHV). Sports participation was assessed by questionnaire. LVM was obtained from M-mode echocardiograms using two-dimensional images. To account for the repeated measures within individual nature of longitudinal data, multilevel random effects regression analyses were used in the analysis. RESULTS LVM increased on average 42 ± 18 g from 11 to 15 years (P < 0.05) and 76 ± 14 g from 3.5 years pre-APHV to 1.5 years post-APHV (P < 0.05). The multilevel model with the best statistical fit (Model B) showed that changes of 1 cm in stature, 1 year post-APHV, and 1 kg of LBM predicts 4.7, 0.5, and 1 g of LVM (P < 0.05), respectively. CONCLUSIONS Among healthy, male adolescents aged 11-15 years individual differences in growth and biological maturation influence growth of LVM. Subcutaneous adiposity and sports participation were not associated with greater LVM.
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Affiliation(s)
- João Valente-Dos-Santos
- Faculty of Physical Education and Sport, Lusófona University of Humanities and Technologies, Lisbon, Portugal.,Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | | | - Joaquim Castanheira
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal.,Department of Clinical Physiology, School of Health and Technology, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Aristides M Machado-Rodrigues
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal.,Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra, Portugal
| | - Edilson S Cyrino
- Department of Physical Education, Center of Physical Education and Sport, Londrina State University, Londrina, Parana, Brazil
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Marije T Elferink-Gemser
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Studies in Sports and Exercise, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Robert M Malina
- Department of Kinesiology and Health Education, University of Texas, Austin, Texas, United States of America.,Department of Kinesiology, Tarleton State University, Stephenville, Texas, United States of America
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41
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Lawless CE, Asplund C, Asif IM, Courson R, Emery MS, Fuisz A, Kovacs RJ, Lawrence SM, Levine BD, Link MS, Martinez MW, Matherne GP, Olshansky B, Roberts WO, Salberg L, Vetter VL, Vogel RA, Whitehead J. Protecting the Heart of the American Athlete. J Am Coll Cardiol 2014; 64:2146-71. [DOI: 10.1016/j.jacc.2014.08.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tapp RJ, Venn A, Huynh QL, Raitakari OT, Ukoumunne OC, Dwyer T, Magnussen CG. Impact of adiposity on cardiac structure in adult life: the Childhood Determinants of Adult Health (CDAH) study. BMC Cardiovasc Disord 2014; 14:79. [PMID: 24980215 PMCID: PMC4090182 DOI: 10.1186/1471-2261-14-79] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/28/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We have examined the association between adiposity and cardiac structure in adulthood, using a life course approach that takes account of the contribution of adiposity in both childhood and adulthood. METHODS The Childhood Determinants of Adult Health study (CDAH) is a follow-up study of 8,498 children who participated in the 1985 Australian Schools Health and Fitness Survey (ASHFS). The CDAH follow-up study included 2,410 participants who attended a clinic examination. Of these, 181 underwent cardiac imaging and provided complete data. The measures were taken once when the children were aged 9 to 15 years, and once in adult life, aged 26 to 36 years. RESULTS There was a positive association between adult left ventricular mass (LVM) and childhood body mass index (BMI) in males (regression coefficient (β) 0.41; 95% confidence interval (CI): 0.14 to 0.67; p = 0.003), and females (β = 0.53; 95% CI: 0.34 to 0.72; p < 0.001), and with change in BMI from childhood to adulthood (males: β = 0.27; 95% CI: 0.04 to 0.51; p < 0.001, females: β = 0.39; 95% CI: 0.20 to 0.58; p < 0.001), after adjustment for confounding factors (age, fitness, triglyceride levels and total cholesterol in adulthood). After further adjustment for known potential mediating factors (systolic BP and fasting plasma glucose in adulthood) the relationship of LVM with childhood BMI (males: β = 0.45; 95% CI: 0.19 to 0.71; p = 0.001, females: β = 0.49; 95% CI: 0.29 to 0.68; p < 0.001) and change in BMI (males: β = 0.26; 95% CI: 0.04 to 0.49; p = 0.02, females: β = 0.40; 95% CI: 0.20 to 0.59; p < 0.001) did not change markedly. CONCLUSIONS Adiposity and increased adiposity from childhood to adulthood appear to have a detrimental effect on cardiac structure.
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Affiliation(s)
- Robyn J Tapp
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, 4th Floor │ Alice Hoy Building (Blg 162), Monash Road │, Melbourne, Australia
| | - Alison Venn
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Quan L Huynh
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Olli T Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, and the Department of Clinical Physiology AND NUCLEAR MEDICINE, Turku University Hospital, Turku, Finland
| | - Obioha C Ukoumunne
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Terence Dwyer
- Murdoch Children’s Research Institute, Royal Children’s Hospital Parkville, Melbourne, Australia
| | - Costan G Magnussen
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, and the Department of Clinical Physiology AND NUCLEAR MEDICINE, Turku University Hospital, Turku, Finland
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de Jonge LL, Langhout MA, Taal HR, Franco OH, Raat H, Hofman A, van Osch-Gevers L, Jaddoe VWV. Infant feeding patterns are associated with cardiovascular structures and function in childhood. J Nutr 2013; 143:1959-65. [PMID: 24089417 DOI: 10.3945/jn.113.174326] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nutrition in infancy seems to be associated with cardiovascular disease and its risk factors in adulthood. These associations may be explained by cardiovascular developmental adaptations in childhood in response to specific infant feeding patterns. The aim of this study was to assess whether duration and exclusivity of breastfeeding and timing of introduction of solid foods affect cardiovascular development in childhood. In a population-based prospective cohort study from fetal life onward, information about duration and exclusivity of breastfeeding and timing of introduction of solid foods was obtained from delivery reports and questionnaires. Blood pressure, carotid-femoral pulse wave velocity (PWV), left atrial diameter (LAD), aortic root diameter (AOD), left ventricular (LV) mass, and fractional shortening (FS) were measured at a median age of 6.0 y (95% range: 5.6-7.4 y). Analyses were based on 5003 children. Age at introduction of solid foods was negatively associated with systolic and diastolic blood pressure at the age of 6 y. Compared with children who had ever been breast-fed, never-breast-fed children had a higher carotid-femoral PWV (β: 0.13 m/s; 95% CI: 0.03, 0.24 m/s), a smaller LAD (β: -0.29 mm; 95% CI: -0.55, -0.03 mm), and less LV mass (β:-1.46 g; 95% CI: -2.41, -0.52 g) at the age of 6 y. Among breast-fed children, duration and exclusivity were not associated with cardiovascular structures or function. Breastfeeding pattern and age at introduction of solid foods were not associated with AOD or FS. Feeding patterns in infancy may influence cardiovascular development in childhood. Further research is required to replicate these findings and to investigate whether these changes contribute to an increased risk of cardiovascular disease in later life.
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Affiliation(s)
- Layla L de Jonge
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128:1689-712. [PMID: 24016455 DOI: 10.1161/cir.0b013e3182a5cfb3] [Citation(s) in RCA: 707] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.
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Maillet M, van Berlo JH, Molkentin JD. Molecular basis of physiological heart growth: fundamental concepts and new players. Nat Rev Mol Cell Biol 2013; 14:38-48. [PMID: 23258295 PMCID: PMC4416212 DOI: 10.1038/nrm3495] [Citation(s) in RCA: 376] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The heart hypertrophies in response to developmental signals as well as increased workload. Although adult-onset hypertrophy can ultimately lead to disease, cardiac hypertrophy is not necessarily maladaptive and can even be beneficial. Progress has been made in our understanding of the structural and molecular characteristics of physiological cardiac hypertrophy, as well as of the endocrine effectors and associated signalling pathways that regulate it. Physiological hypertrophy is initiated by finite signals, which include growth hormones (such as thyroid hormone, insulin, insulin-like growth factor 1 and vascular endothelial growth factor) and mechanical forces that converge on a limited number of intracellular signalling pathways (such as PI3K, AKT, AMP-activated protein kinase and mTOR) to affect gene transcription, protein translation and metabolism. Harnessing adaptive signalling mediators to reinvigorate the diseased heart could have important medical ramifications.
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Affiliation(s)
- Marjorie Maillet
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Hietalampi H, Pahkala K, Jokinen E, Rönnemaa T, Viikari JSA, Niinikoski H, Heinonen OJ, Salo P, Simell O, Raitakari OT. Left ventricular mass and geometry in adolescence: early childhood determinants. Hypertension 2012; 60:1266-72. [PMID: 22987921 DOI: 10.1161/hypertensionaha.112.194290] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is not known whether birth weight and early childhood growth are associated with the development of cardiac left ventricular mass (LVM) in healthy adolescents. Left ventricular growth and geometric remodeling may have long-term consequences on cardiovascular health later in life. We studied the determinants of LVM and patterns of geometric remodeling in adolescents with specific emphasis on birth size and growth in early childhood. Left ventricular measurements were obtained with echocardiography in 418 adolescents at the age of 15 years in a prospective atherosclerosis prevention study, Special Turku Coronary Risk Factor Intervention Project (STRIP). Birth weight (P=0.0004), current pulse pressure (P=0.013), physical activity level (P=0.0024), weight (P<0.0001), and male sex (P<0.001) had an independent direct association with LVM in adolescents explaining 47% of the variation. Growth in early childhood was not associated with LVM in adolescents. Birth weight (P=0.0066), current weight (P<0.0001), and physical activity level (P=0.0017) were directly associated with left ventricular posterior wall thickness. Current weight was also directly associated with septal thickness (P<0.0001). Boys had a thicker septum than girls (P=0.0092). Normal relative wall thickness and increased left ventricular mass index (eccentric remodeling) (P<0.0001), as well as increase in both variables (concentric, increased LVM) (P=0.0003), were associated with higher body mass index. Our results indicate that birth weight has a long-lasting impact on LVM and normal body weight is beneficial for cardiac structure in adolescents.
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Affiliation(s)
- Hanna Hietalampi
- University of Turku, Research Centre of Applied and Preventive Cardiovascular Medicine, Kiinamyllynkatu 10, FI-20520 Turku, Finland.
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Yu CCW, Li AM, Au CT, McManus AM, So RCH, Lam HS, Chu WCW, So HK, Chiu WK, Leung CW, Yau YS, Fok TF, Sung RYT. Follow up of aerobic capacity in children affected by severe acute respiratory syndrome. Respirology 2012; 17:513-8. [PMID: 22212464 PMCID: PMC7192205 DOI: 10.1111/j.1440-1843.2011.02125.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and objective: The aim of this study was to investigate the aerobic capacity of children 3 years after they were diagnosed with severe acute respiratory syndrome (SARS). Methods: Twenty‐seven patients who completed both pulmonary function and maximal aerobic capacity tests at 6 and 15 months after the acute illness were invited to return for reassessment. Results: Twenty‐one patients (median age 18.2 years, interquartile range (IQR) 16.5–19.7) completed all investigations at 36 months. Pulmonary function was normal in all patients. Maximal aerobic capacity, peak oxygen pulse (peak VO2) and ventilatory anaerobic threshold showed significant improvements compared with values measured at 6 months in both boys and girls. In girls, ventilatory efficiency (ventilatory equivalents for oxygen and carbon dioxide) and perfusion of the lungs (end‐tidal partial carbon dioxide pressure) had not increased further compared with the values measured at 15 months. Although peak VO2 improved further at 36 months in patients with or without persistent radiological abnormalities, the values were 68% (IQR 50–84) and 74% (IQR 60–99), respectively, of those for normal control subjects. Conclusions: There were improvements in aerobic capacity at 36 months in children affected by SARS; however, the measured values remained suboptimal. This long‐term follow‐up study demonstrated that the aerobic capacity of children improved three years after the diagnosis of severe acute respiratory syndrome, but the values remained suboptimal.
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Affiliation(s)
- Clare C W Yu
- Institute of Human Performance, University of Hong Kong, Pokfulam, Hong Kong.
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McMurray RG, Hosick PA, Bugge A. Importance of proper scaling of aerobic power when relating to cardiometabolic risk factors in children. Ann Hum Biol 2011; 38:647-54. [DOI: 10.3109/03014460.2011.598561] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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50
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de Jonge LL, van Osch-Gevers L, Willemsen SP, Steegers EA, Hofman A, Helbing WA, Jaddoe VW. Growth, Obesity, and Cardiac Structures in Early Childhood. Hypertension 2011; 57:934-40. [DOI: 10.1161/hypertensionaha.110.163303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Layla L. de Jonge
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lennie van Osch-Gevers
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sten P. Willemsen
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric A.P. Steegers
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Willem A. Helbing
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent W.V. Jaddoe
- From the Generation R Study Group (L.L.d.J., V.W.V.J.) and Departments of Paediatrics (L.L.d.J., L.v.O.-G., W.A.H., V.W.V.J.), Epidemiology (L.L.d.J., A.H., V.W.V.J.), Biostatistics (S.P.W.), and Obstetrics and Gynaecology (E.A.P.S.), Erasmus Medical Center, Rotterdam, The Netherlands
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