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Torigoe T, Dallaire F, Slorach C, Cardinal MP, Hui W, Bradley TJ, Sarkola T, Mertens L, Jaeggi E. New Comprehensive Reference Values for Arterial Vascular Parameters in Children. J Am Soc Echocardiogr 2020; 33:1014-1022.e4. [DOI: 10.1016/j.echo.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 11/15/2022]
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Buie JNJ, Stanley A, Nietert PJ, Logan A, Adams RJ, Magwood GS. Racial Disparities in Arterial Stiffness Between Healthy Whites and African Americans in the United States: A Meta-analysis. J Natl Med Assoc 2018; 111:7-17. [PMID: 30129482 DOI: 10.1016/j.jnma.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND African Americans (AAs) present with cardiovascular disease (CVD) risk factors at younger ages than whites. Consequently, CVD and stroke occur at a higher incidence and at earlier decades in life in AA populations. Arterial stiffness is a predictor of CVD outcomes and partially explains the CVD risk experienced by racial minorities. We evaluated the differences in arterial stiffness observed in AAs and whites through a systematic review and meta-analysis. METHODS We searched PubMed and SCOPUS for comparative studies published March 1995 to November 29, 2017 comparing arterial stiffness assessments (pulse wave velocity, augmentation index, and central blood pressure) between AAs and whites. Two independent reviewers examined 195 titles/abstracts, 85 full text articles and 11 articles were included in the meta-analysis using random effects modeling approaches. MAIN RESULTS A total of 5060 white and 3225 AAs were included across 11 relevant studies. Carotid-femoral pulse wave velocity (cfPWV) measures were statistically different between AAs and whites (mean difference = -0.44, 95% confidence interval [CI]: -[-0.67, -0.21], p = 0.0002). Aortic femoral pulse wave velocity was significantly different between AAs and whites (mean difference = -0.21, [95% CI] -0.35, -0.07, p = 0.003) regardless of sex. Augmentation index (AIx) and Augmentation index at a 75 beats per minutes heart rate (AIx @75) was also significantly different between AA and whites (mean difference = -4.36 [95% CI] = -6.59, -2,12, p = 0.0001 and -6.26, [95% CI] = -9.19, -3.33, p < 0.0001, respectively). CONCLUSIONS Racial disparities in arterial stiffness persist among African American racial groups in the United States. The lack of homogeneity in studies capturing racial disparities in cfPWV suggest that additional studies are needed to understand the magnitude of racial differences in African Americans and whites that might be clinically relevant.
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Affiliation(s)
- Joy N J Buie
- Medical University of South Carolina WISSDOM Center, 96 Jonathan Lucas St., CSB 301, MSC 606, Charleston, SC 29425, USA
| | - Angela Stanley
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, USA
| | - Paul J Nietert
- Medical University of South Carolina, Department Public Health Sciences, 135 Cannon Street Suite 303, MSC 835, Charleston, SC 29425, USA
| | - Ayaba Logan
- Medical University of South Carolina, Department of Library Science and Informatics, 171 Ashley Avenue Suite 300, MSC 403, Charleston, SC 29425, USA
| | - Robert J Adams
- Medical University of South Carolina WISSDOM Center, 96 Jonathan Lucas St., CSB 301, MSC 606, Charleston, SC 29425, USA; Medical University of South Carolina, Department of Neurology, College of Medicine, 96 Jonathan Lucas St. CSB 301, MSC 606 Charleston, SC 29425, USA
| | - Gayenell S Magwood
- Medical University of South Carolina WISSDOM Center, 96 Jonathan Lucas St., CSB 301, MSC 606, Charleston, SC 29425, USA; Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, USA.
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1937] [Impact Index Per Article: 276.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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4
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Pierce GL, Pajaniappan M, DiPietro A, Darracott-Woei-A-Sack K, Kapuku GK. Abnormal Central Pulsatile Hemodynamics in Adolescents With Obesity: Higher Aortic Forward Pressure Wave Amplitude Is Independently Associated With Greater Left Ventricular Mass. Hypertension 2016; 68:1200-1207. [PMID: 27620396 PMCID: PMC5836470 DOI: 10.1161/hypertensionaha.116.07918] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/15/2016] [Indexed: 01/01/2023]
Abstract
We hypothesized that increased aortic forward pressure wave amplitude (Pf), which is determined by characteristic impedance (Zc) in the proximal aorta, is the primary hemodynamic determinant of obesity-associated higher left ventricular (LV) mass in adolescents. Aortic pulsatile hemodynamics were measured noninvasively in 60 healthy adolescents (age 14-19 years; 42% male; 50% black) by sequential recordings of pulse waveforms via tonometry, brachial blood pressure, and pulsed Doppler and diameter of the LV outflow tract using 2-dimensional echocardiography. Adolescents who were overweight/obese (n=23; age 16.0±0.3 years; body mass index ≥85th percentile) had higher LV mass index, brachial and carotid systolic blood pressure and pulse pressure, normalized Zc and Pf compared with adolescents with healthy weight (n=37; 16.7±0.3 years; body mass index <85th percentile, all P<0.01). In contrast, there was no difference in mean or diastolic blood pressure, carotid-femoral pulse wave velocity, carotid augmentation index, or aortic backward wave amplitude (all P>0.05). Stepwise multiple linear regression analysis that included age, sex, race, normalized Zc, and brachial systolic blood pressure revealed that body mass index (B±SE; 0.49±0.20, P=0.02, R2=0.26), aortic Pf (0.22±0.07; P<0.02, R2 change=0.11), and cardiac output (2.82±1.02, P<0.01; R2 change=0.08) were significant correlates of LV mass index (total R2=0.44, P<0.01). These findings suggest that higher aortic Pf is a major hemodynamic determinant of increased LV mass in adolescents with elevated adiposity. Improper matching between aortic diameter and pulsatile flow during early systole potentially contributes to the early development of LV hypertrophy in childhood obesity.
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Affiliation(s)
- Gary L Pierce
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), Center for Hypertension Research (G.L.P.), and Fraternal Order of Eagles Research Center (G.L.P.), University of Iowa, Iowa City; and Divisions of Pediatric Cardiology (A.D.P., G.K.K.) and Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia (M.P., K.D.-W.-A-S., G.K.K.), Augusta University.
| | - Mohanasundari Pajaniappan
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), Center for Hypertension Research (G.L.P.), and Fraternal Order of Eagles Research Center (G.L.P.), University of Iowa, Iowa City; and Divisions of Pediatric Cardiology (A.D.P., G.K.K.) and Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia (M.P., K.D.-W.-A-S., G.K.K.), Augusta University
| | - Amy DiPietro
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), Center for Hypertension Research (G.L.P.), and Fraternal Order of Eagles Research Center (G.L.P.), University of Iowa, Iowa City; and Divisions of Pediatric Cardiology (A.D.P., G.K.K.) and Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia (M.P., K.D.-W.-A-S., G.K.K.), Augusta University
| | - Kathryn Darracott-Woei-A-Sack
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), Center for Hypertension Research (G.L.P.), and Fraternal Order of Eagles Research Center (G.L.P.), University of Iowa, Iowa City; and Divisions of Pediatric Cardiology (A.D.P., G.K.K.) and Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia (M.P., K.D.-W.-A-S., G.K.K.), Augusta University
| | - Gaston K Kapuku
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), Center for Hypertension Research (G.L.P.), and Fraternal Order of Eagles Research Center (G.L.P.), University of Iowa, Iowa City; and Divisions of Pediatric Cardiology (A.D.P., G.K.K.) and Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia (M.P., K.D.-W.-A-S., G.K.K.), Augusta University
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Ahrens W, Moreno LA, Mårild S, Molnár D, Siani A, De Henauw S, Böhmann J, Günther K, Hadjigeorgiou C, Iacoviello L, Lissner L, Veidebaum T, Pohlabeln H, Pigeot I. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes (Lond) 2015; 38 Suppl 2:S4-14. [PMID: 25376220 DOI: 10.1038/ijo.2014.130] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS Population-based survey in eight European countries, including 18745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.
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Affiliation(s)
- W Ahrens
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - A Siani
- Institute of Food Sciences, Unit of Epidemiology & Population Genetics, National Research Council, Avellino, Italy
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J Böhmann
- Paediatric Clinic Delmenhorst, Delmenhorst, Germany
| | - K Günther
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - L Iacoviello
- Department of Epidemiology and Prevention, Unit of Molecular and Nutritional Epidemiology, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
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6
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Koopman LP, Mertens LL. Impact of Childhood Obesity on Cardiac Structure and Function. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:345. [DOI: 10.1007/s11936-014-0345-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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7
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Song YH, Kim HS, Park HS, Jung JW, Kim NS, Noh CI, Hong YM. Sex differences in the relation of body composition to cardiovascular parameters and functions in Korean adolescents: a school-based study. Obes Facts 2014; 7:165-77. [PMID: 24820977 PMCID: PMC5644790 DOI: 10.1159/000362345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 09/18/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Obesity in adolescence is associated with increased cardiovascular risk. The patterns of obesity and body composition differ between boys and girls. It is uncertain how body composition correlates with the cardiovascular system and whether such correlations differ by sex in adolescents. METHODS Body composition (fat-free mass (FFM), adipose mass, waist circumference (WC)) and cardiovascular parameters and functions were studied in 676 healthy Korean adolescents aged 12-16 years. Partial correlation and path analyses were done. RESULTS WC correlated with stroke volume (SV) and cardiac output (CO), systolic blood pressure (SBP) and pulse pressure (PP), cardiac diastolic function (ratio of early to late filling velocity (E/A ratio)), and vascular function (pulse wave velocity (PWV)) in boys. Adipose mass was related to SV, CO, SBP, PP, left ventricular mass (LVM), and PWV in girls - and to E/A ratio in both sexes. FFM affected SV, CO, SBP, and PP in both sexes and LVM in boys. Cardiac systolic functions had no relation with any body composition variable in either sex. CONCLUSION In adolescence, the interdependence of the cardiovascular system and the body composition differs between sexes. Understanding of those relations is required to control adolescent obesity and prevent adult cardiovascular disease.
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Affiliation(s)
- Young-Hwan Song
- Department of Pediatrics, Sanggye Paik Hospital, College of Medicine, Inje University, Suwon, South Korea
| | | | - Hae Sook Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Suwon, South Korea
| | - Jo Won Jung
- Department of Pediatrics, School of Medicine, Ajou University, Suwon, South Korea
| | - Nam Su Kim
- Department of Pediatrics, School of Medicine, Han Yang University, Suwon, South Korea
| | - Chung Il Noh
- Department of Pediatrics, School of Medicine, Seoul National University, Seoul, Suwon, South Korea
| | - Young Mi Hong
- Department of Pediatrics, Suwon, South Korea
- *Young Mi Hong, MD, Department of Pediatrics, Ewha Womans University School of Medicine, 911-1 Mok-dong, Yangcheon-gu, 158-710 Seoul (South Korea),
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Abstract
This study describes the relative influence of facial skin color, lifetime exposure to racial discrimination, chronic stress, and traditional prehypertension risk factors (family history of hypertension and age) on resting blood pressure and body mass index (BMI) among 196 southern African American (AA) female undergraduate students. Stepwise regression analyses indicated that skin color was the strongest predictor of systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. Skin color, chronic stress, and family history of hypertension predicted 53% of the SBP variance. Skin color, chronic stress, and family history of hypertension predicted 30.2% of the DBP variance. Racism and age were not significant predictors of SBP or DBP. Of the variance in BMI, 33% was predicted by skin color, chronic stress, and racism. Age and family history of hypertension were not predictors of BMI. The current study provides evidence of the relationship of skin color and chronic stress to blood pressure among young southern AA women. The study identifies an important relationship between increased racial stress exposure and heavier BMIs, a predictor of prehypertensive risk.
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Urinary prostasin excretion is associated with adiposity in nonhypertensive African-American adolescents. Pediatr Res 2013; 74:206-10. [PMID: 23863785 PMCID: PMC4332551 DOI: 10.1038/pr.2013.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/05/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Metabolic abnormalities in obesity can overstimulate the renal epithelial sodium channel (ENaC) and subsequently lead to blood pressure (BP) elevation. Prostasin, a membrane-bound/secretive serine protease, is thought to activate ENaC via the proteolytic cleavage of the channel. Our specific aim was to explore whether there is a relationship between adiposity and urinary prostasin excretion at the population level. METHODS In 271 African-American adolescents, urinary prostasin concentrations were determined by enzyme-linked immunosorbent assay and normalized by urinary creatinine. RESULTS Urinary prostasin excretion increased in the overweight/obese group (n = 110, 38.2 ± 4.0 ng/mg) vs. the normal-weight group (n = 161, 20.7 ± 1.2 ng/mg, P = 0.03). Urinary prostasin excretion was significantly correlated with BMI percentiles (r = 0.14, P = 0.02), waist circumference (r = 0.13, P = 0.05), total body fat mass (r = 0.20, P < 0.01), and percentage body fat (r = 0.23, P < 0.01). Urinary prostasin excretion was also correlated with plasma aldosterone (r = 0.11, P = 0.05) and systolic BP (SBP; r = 0.15, P = 0.02), but the significances disappeared after adjustment of any of the adiposity variables. CONCLUSION Our data for the first time suggest that adiposity plays a role in urinary prostasin excretion, and its associations with aldosterone and BP appear to be modulated by adiposity. Whether urinary prostasin excretion is a biomarker/mechanism underlying obesity-related hypertension deserves further investigations.
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Zhu H, Chao J, Kotak I, Guo D, Parikh SJ, Bhagatwala J, Dong Y, Patel SY, Houk C, Chao L, Dong Y. Plasma kallistatin is associated with adiposity and cardiometabolic risk in apparently healthy African American adolescents. Metabolism 2013; 62. [PMID: 23190873 PMCID: PMC3757514 DOI: 10.1016/j.metabol.2012.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE It is generally recognized that obesity and cardiometabolic risk are more prevalent in African Americans. Kallistatin, a novel tissue kallikrein inhibitor, has anti-inflammatory and anti-oxidant properties. Thus, the goal of this study was to examine the relationships among plasma kallistatin levels, adiposity and cardiometabolic risk factors in African American adolescents. MATERIALS/METHODS Plasma kallistatin levels were determined in 318 apparently healthy African American adolescents (aged 14-19 years, 48.1% females) by enzyme-linked immunosorbent assay. RESULTS Plasma kallistatin levels did not differ between males (27.9±11.2 μg/mL) and females (26.8±11.0 μg/mL) (p=0.47). Plasma kallistatin levels were inversely correlated with percent body fat (% BF, r=-0.13, p=0.04), total cholesterol (r=-0.28, p<0.01), low density lipoprotein cholesterol (LDL, r=-0.30, p<0.01) and interleukin-6 (r=-0.14, p=0.05), but positively correlated with adiponectin (r=0.16, p=0.03) and high density lipoprotein (HDL, r=0.17, p=0.02). These correlations remained significant after adjustment for age, sex and body mass index percentiles. Stepwise multiple linear regression analysis showed that LDL cholesterol alone explained 14.2% of the variance in kallistatin, while % BF and adiponectin explained an additional 3.6% and 2.8% of the variance, respectively. CONCLUSIONS The present study demonstrates that plasma kallistatin levels are inversely associated with adiposity, adverse lipid profiles and inflammation in apparently healthy African American adolescents. As a potent antioxidant and anti-inflammation agent, kallistatin may also hold therapeutic promise in cardiometabolic disorders.
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Affiliation(s)
- Haidong Zhu
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
| | - Julie Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Ishita Kotak
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
| | - Dehuang Guo
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
| | - Samip J. Parikh
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
- Department of Internal Medicine, Georgia Health Sciences University, Augusta, Georgia
| | - Jigar Bhagatwala
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
- Department of Internal Medicine, Georgia Health Sciences University, Augusta, Georgia
| | - Yutong Dong
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
| | - Sagar Y. Patel
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
| | - Chris Houk
- Endocrinology Division, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
| | - Lee Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia
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11
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Pierce GL, Zhu H, Darracott K, Edet I, Bhagatwala J, Huang Y, Dong Y. Arterial stiffness and pulse-pressure amplification in overweight/obese African-American adolescents: relation with higher systolic and pulse pressure. Am J Hypertens 2013; 26:20-6. [PMID: 23382323 DOI: 10.1093/ajh/hps014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Obesity is associated with a higher systolic blood pressure (BP) and pulse pressure (PP) in African-American youths, increasing their risk for developing hypertension. However, it is unknown whether arterial stiffness and wave reflection are associated with a higher systolic BP and PP or with smaller PP amplification in overweight/obese (OW/OB) African-American adolescents. METHODS We measured carotid-femoral pulse wave velocity (CF-PWV), carotid-radial PWV (CR-PWV), the augmentation index (AIx) adjusted to a heart rate of 75 bpm (AI75), the augmentation pressure (AugP), PP amplification, and body composition in 227 healthy African-American adolescents (age, 16.9 ± 0.2 years; 54% male). RESULTS Adolescents who were OW/OB (n = 86, body mass index (BMI) ≥ 85th percentile) demonstrated 5%-6%, 13%-16%, and 2.5% higher aortic and brachial systolic BP, brachial and aortic PP, and mean arterial pressure (MAP), respectively (all P < 0.05), than adolescents of normal-weight (NW, n = 141, BMI < 85th percentile). The OW/OB adolescents had a 7% higher CF-PWV, 5% lower CR-PWV, and 3.5% lower PP amplification than the NW group (all P < 0.05), but no differences in AI75 or AugP. In the entire cohort after adjustment for age, sex, heart rate, height, and MAP, CF-PWV was positively correlated, and CR-PWV and PP amplification were negatively correlated, with total and abdominal/hip adiposity. Additionally, CF-PWV, AI75, and AugP were positively correlated with MAP and negatively correlated with PP amplification. CR-PWV, AI75, and AugP were negatively correlated with brachial and aortic PP. CONCLUSIONS Higher aortic stiffness is associated with smaller PP amplification with increasing adiposity in African-American adolescents. Whether a reduction in PP amplification predicts increased CVD risk in obese African-American adolescents requires further study.
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Affiliation(s)
- Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, USA.
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12
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Bridger T. Childhood obesity and cardiovascular disease. Paediatr Child Health 2011; 14:177-82. [PMID: 20190900 DOI: 10.1093/pch/14.3.177] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2009] [Indexed: 11/12/2022] Open
Abstract
Childhood obesity has reached epidemic proportions. Many of these children have risk factors for later disease, including cardiovascular disease. For optimal cardiovascular health, health care professionals must be able to identify children and youth at risk and provide appropriate support as needed. The present article reviews the current medical literature on obesity and cardiovascular disease risk factors in the paediatric population, the long-term cardiovascular consequences of childhood obesity and the importance of early life. Recommendations promoting optimal cardiovascular health in all children and youth are discussed.
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Affiliation(s)
- Tracey Bridger
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador
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13
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Petty KH, Li K, Dong Y, Fortenberry J, Stallmann-Jorgensen I, Guo D, Zhu H. Sex dimorphisms in inflammatory markers and adiposity in African-American youth. ACTA ACUST UNITED AC 2010; 5:327-33. [PMID: 20078375 DOI: 10.3109/17477160903497019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are demonstrated sex differences in the association between adiposity and inflammation in adults. Our aim was to determine sex differences in inflammatory markers and in the association between adiposity and inflammation in a sample of African-American adolescents. METHODS Adiposity variables including body mass index (BMI), waist circumference, weight, total fat, trunk fat, and inflammatory markers including interleukin-6 (IL-6), leptin, monocyte chemotactic protein 1 (MCP1), C-reactive Protein (CRP), adiponectin were examined in 166 (53% female) African-American adolescents, aged 14-19 years. Total fat and trunk fat were measured using Dual-Energy X-ray Absorptiometry (DXA). RESULTS Results revealed males had higher weight (p=0.01); females had higher BMI, trunk fat, and total fat (p's <0.01). With inflammation, males had higher MCP1 (p=0.024); females had higher leptin (p<0.001), adiponectin (p=0.006), and IL-6 (p=0.026). Partial correlations in males indicated associations of adiposity variables with leptin, adiponectin (all p's <0.01), and CRP (p<0.05); in females, leptin, CRP, and IL-6 were associated with adiposity variables (all p's <0.05). multiple regression analyses revealed female adiposity variables predicted CRP, (R(2)=0.254), IL-6 (R(2)=0.167), and MCP1 (R(2)=0.220). Adiposity variables in males predicted lower adiponectin (R(2)=0245). For both, leptin was predicted by adiposity (males R(2)=0.420 and females R(2)=0.410). CONCLUSIONS Data indicate clear sex dimorphisms in the associations between inflammatory markers and adiposity in African-American adolescents, suggesting that preventive measures and treatments for adolescent obesity may need to be sex-specific.
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Affiliation(s)
- Karen H Petty
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA 30912, USA
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14
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Liu G, Zhu H, Lagou V, Gutin B, Barbeau P, Treiber FA, Dong Y, Snieder H. Common variants near melanocortin 4 receptor are associated with general and visceral adiposity in European- and African-American youth. J Pediatr 2010; 156:598-605.e1. [PMID: 20070976 PMCID: PMC4018229 DOI: 10.1016/j.jpeds.2009.10.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 08/19/2009] [Accepted: 10/28/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Recent genome-wide association studies found common variants near the melanocortin 4 receptor gene associated with obesity. This study aimed to assess the influence of the identified single nucleotide polymorphisms rs17782313 and rs17700633 on general and visceral adiposity in European- and African-American youth. STUDY DESIGN In 1890 youth (49.1% European-American, 45.6% male, mean age 16.7 years), we examined the associations of the rs17782313 and rs17700633 with anthropometry, percent body fat, visceral adipose tissue, and subcutaneous abdominal adipose tissue. Interaction of the single nucleotide polymorphisms with ethnicity or sex was investigated and haplotype analyses conducted. RESULTS Rs17782313 was significantly associated with weight (P = .02) and waist circumference (P = .03) in all subjects and with body mass index (P = .002) in females. In females rs17700633 was significantly associated with percent body fat (P = .001), visceral adipose tissue (P < .001), and subcutaneous abdominal adipose tissue (P < .001). Rs17700633 was significantly associated with fasting insulin and homeostasis model assessment, but the significance attenuated after adjustment for percent body fat. These findings were confirmed by haplotype analysis. No significant interactions of the variants with ethnicity were found for any of these phenotypes. CONCLUSIONS The relatively large effect of these common variants near melanocortin 4 receptor on general and visceral adiposity in childhood, especially in girls, could prove helpful in elucidating the molecular mechanisms underlying the development of obesity in early life.
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Affiliation(s)
- Gaifen Liu
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Haidong Zhu
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Vasiliki Lagou
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernard Gutin
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Paule Barbeau
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Frank A Treiber
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Harold Snieder
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
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Zhu H, Chao J, Guo D, Li K, Huang Y, Hawkins K, Wright N, Stallmann-Jorgenson I, Yan W, Harshfield GA, Dong Y. Urinary prostasin: a possible biomarker for renal pressure natriuresis in black adolescents. Pediatr Res 2009; 65:443-6. [PMID: 19127211 PMCID: PMC3826778 DOI: 10.1203/pdr.0b013e3181994b85] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostasin is a membrane-bound/secretive serine protease interacting with aldosterone and the epithelial sodium channel in the kidney. We and others have previously proposed the concept of stress-induced pressure natriuresis (SIPN) where increased urinary sodium excretion (UNaV) is coupled with elevated blood pressure (BP) in response to behavioral stress in normotensive adolescents. This study thus aimed to test the relationship between prostasin and pressure natriuresis using the SIPN model. A cohort of 102 normotensive black adolescents (mean age: 17.0 +/- 1.2 y; 56% females) were placed on a controlled sodium (4000 +/- 200 mg/d) and potassium (2600 +/- 200 mg/d) diet for three days before testing. The SIPN protocol consisted of a 1-h baseline period, a 1-h stress period (competitive video game), and a 1-h recovery period. During the stress period, BP elevation was coupled with an increase in UNaV. Urinary prostasin concentration had more than a 2-fold reduction from baseline (38.4 +/- 32.7 ng/mL) to stress (17.2 +/- 16.0 ng/mL), and further declined during recovery (12.1 +/- 16.2 ng/mL) (p < 0.001). Urinary prostasin was inversely correlated with UNaV during stress (r = -0.43, p = 0.0001), even after being normalized by urinary creatinine. Our data suggest that urinary prostasin could be a novel biomarker and/or mechanism for renal pressure natriuresis in normotensive black adolescents.
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Affiliation(s)
- Haidong Zhu
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Julie Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina, USA 29425
| | - Dehuang Guo
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Ke Li
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Ying Huang
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Kimberly Hawkins
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Nikki Wright
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Inger Stallmann-Jorgenson
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Weili Yan
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Gregory A. Harshfield
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA 30907
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Sleeper EJ, Ariza AJ, Binns HJ. Do hospitalized pediatric patients have weight and blood pressure concerns identified? J Pediatr 2009; 154:213-7. [PMID: 18835489 DOI: 10.1016/j.jpeds.2008.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 07/22/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the frequency and recognition of abnormal nutritional status and elevated admitting blood pressure (BP) in hospitalized children. STUDY DESIGN From children aged 3 to 18 years who were hospitalized during 4 months of 2005 (n = 1143), a stratified sample of paper-based medical records were reviewed for demographics, anthropometric and BP measurements and interpretations, care related to nutrition and BP, and discharge diagnoses. Records of 317 of 337 (94%) selected patients were reviewed, and data from 277 of these patients (records with weight and height documented) were analyzed. US references were applied to assign body mass index and BP percentiles. Data were weighted to account for sampling. RESULTS A total of 51% of subjects were Medicaid/self-pay, with a median age of 9.1 years; and 20% of subjects were obese (14% overweight, 58% healthy weight, 8% underweight). Body mass index was plotted/calculated for 35% of subjects. Six percent of subjects had BP >99th percentile + 5 mm Hg (18% BP 95th to < or =99th percentile + 5 mm Hg). A nutrition referral was documented for 61% of subjects who were underweight and 39% of subjects who were obese. BP concerns were documented for 26% of subjects with BP >99th percentile + 5 mm Hg. CONCLUSIONS Many pediatric inpatients had abnormal nutritional status or elevated BP. Systems to improve interpretation of these measures, which are commonly obtained in pediatric hospital settings, are needed.
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Affiliation(s)
- Eric J Sleeper
- Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA
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Velkoska E, Cole TJ, Dean RG, Burrell LM, Morris MJ. Early undernutrition leads to long-lasting reductions in body weight and adiposity whereas increased intake increases cardiac fibrosis in male rats. J Nutr 2008; 138:1622-7. [PMID: 18716160 DOI: 10.1093/jn/138.9.1622] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previous studies suggest that both overfeeding and undernutrition during development increase the risk of obesity and hypertension in adulthood. In this study, we examined both short- (24 d) and long- (16 wk) term effects of early postnatal over- and underfeeding in rats on body weight, body composition, plasma hormones, adiposity markers, and hypothalamic neuropeptide Y content. Cardiovascular changes were also examined by measuring blood pressure and cardiac fibrosis. Rats raised in litters of 3, 12, or 18 pups per mother were used to model early onset overfeeding, control, and underfeeding, respectively. At 24 d of age, pups raised in small litters (SL) were 10% heavier than pups from normal litters, accompanied by increased organ mass and fat mass, elevated plasma leptin, corticosterone, and uncoupling protein-1 mRNA in brown adipose tissue. On the other hand, pups raised in large litters were 17% lighter with no significant changes in plasma leptin. Overfeeding during the first 3 wk of life led to increased plasma leptin concentration in adulthood, whereas underfed rats remained significantly lighter throughout the study, with no evidence of catch-up growth. Rats raised in SL were more susceptible to developing cardiac fibrosis with a 22% increase in collagen deposition compared with control rats at 16 wk of age (P < 0.05). This was independent of any changes in blood pressure. This study demonstrates that nutritional changes early in postnatal development can have long-lasting effects on body weight, adiposity, and some mediators involved in energy homeostasis and can also lead to structural changes in the heart in adulthood. This highlights the importance of identifying potential early life risk factors involved in the modulation of childhood nutrition.
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Affiliation(s)
- Elena Velkoska
- Department of Pharmacology, University of Melbourne, Parkville, 3010, Australia
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Taking on childhood obesity in a big city: Consortium to Lower Obesity in Chicago Children (CLOCC). PROGRESS IN PEDIATRIC CARDIOLOGY 2008. [DOI: 10.1016/j.ppedcard.2008.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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