1
|
Calmarza P, Pérez-Ajami RI, Prieto-López C, Gallego-Royo A, García-Carro C, Lou-Francés GM. Glycemic control and study of lipid and bone metabolism in type 1 diabetic children. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:171-181. [PMID: 39079139 DOI: 10.7705/biomedica.7132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/15/2024] [Indexed: 08/04/2024]
Abstract
Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients’ lipid and bone profiles are more favorable when metabolic control of the disease is achieved.
Collapse
Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, España; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | | | | | - Alba Gallego-Royo
- Servicio de Medicina Preventiva, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Celia García-Carro
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España
| | | |
Collapse
|
2
|
Henson SE, Urbina EM. Use of lipid ratios to predict vascular target organ damage in youth. J Clin Lipidol 2024; 18:e444-e451. [PMID: 38462388 PMCID: PMC11209812 DOI: 10.1016/j.jacl.2024.02.002] [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: 05/19/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Elevated lipid levels are risk factors for early atherosclerosis. Lipid ratios have emerged as potentially stronger predictors of adverse cardiovascular changes and atherogenic cholesterol. Risk stratification in youth with obesity or type 2 diabetes may be improved by using lipid ratios. We sought to determine if lipid ratios would identify abnormalities in arterial structure and stiffness in adolescents and young adults. METHODS A total of 762 youth aged 10-24 years had laboratory, anthropometric, blood pressure, and carotid intima-media thickness and arterial stiffness data collected. Subjects were stratified into tertiles (low, mid, high) of lipid ratios and non-high-density lipoprotein cholesterol (HDL-C). Vascular outcomes by tertile were assessed by analyses of variance. General linear models were constructed for each lipid value and included demographics, risk factors, and vascular measures. Correlations between lipid markers, vascular measures, and low-density lipoprotein (LDL) particle size and number were conducted. RESULTS There was a progressive increase in arterial thickness and stiffness across all three lipid ratios and non-HDL-C. The triglyceride to HDL-C (TG/HDL-C) ratio remained an independent predictor of arterial thickness and stiffness after adjusting for other cardiovascular risk factors. TG/HDL-C had the highest correlations with arterial stiffness and small, dense LDL. CONCLUSIONS Arterial stiffness is increased in youth with high lipid ratios with TG/HDL-C being the most consistent marker of vascular changes. These data suggest that identification of high TG/HDL-C in these individuals may lead to earlier intervention to prevent atherosclerotic cardiovascular disease.
Collapse
Affiliation(s)
- Sarah E Henson
- Cincinnati Children's Hospital Medical Center & the University of Cincinnati, USA (Drs Henson and Urbina).
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center & the University of Cincinnati, USA (Drs Henson and Urbina)
| |
Collapse
|
3
|
Stanesby O, Zhou Z, Fonseca R, Kidokoro T, Otahal P, Fraser BJ, Wu F, Juonala M, Viikari JSA, Raitakari OT, Tomkinson GR, Magnussen CG. Tracking of apolipoprotein B levels measured in childhood and adolescence: systematic review and meta-analysis. Eur J Pediatr 2024; 183:569-580. [PMID: 38051379 PMCID: PMC10912277 DOI: 10.1007/s00431-023-05350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
To quantify the tracking of apolipoprotein B (apoB) levels from childhood and adolescence and compare the tracking of apoB with low-density lipoprotein (LDL) cholesterol, a systematic search of MEDLINE, Embase, Web of Science, and Google Scholar was performed in October 2023 (PROSPERO protocol: CRD42022298663). Cohort studies that measured tracking of apoB from childhood/adolescence (< 19 years) with a minimum follow-up of 1 year, using tracking estimates such as correlation coefficients or tracking coefficients, were eligible. Pooled correlations were estimated using random-effects meta-analysis. Risk of bias was assessed with a review-specific tool. Ten studies of eight unique cohorts involving 4677 participants met the inclusion criteria. Tracking of apoB was observed (pooled r = 0.63; 95% confidence interval [CI] = 0.53-0.71; I2 = 96%) with no significant sources of heterogeneity identified. Data from five cohorts with tracking data for both lipids showed the degree of tracking was similar for apoB (pooled r = 0.59; 95% CI = 0.55-0.63) and LDL cholesterol (pooled r = 0.58; 95% CI = 0.47-0.68). Study risk of bias was moderate, mostly due to attrition and insufficient reporting. CONCLUSION ApoB levels track strongly from childhood, but do not surpass LDL cholesterol in this regard. While there is strong evidence that apoB is more effective at predicting ASCVD risk than LDL cholesterol in adults, there is currently insufficient evidence to support its increased utility in pediatric settings. This also applies to tracking data, where more comprehensive data are required. WHAT IS KNOWN • Apolipoprotein B is a known cause of atherosclerotic cardiovascular disease. • Apolipoprotein B levels are not typically measured in pediatric settings, where low-density lipoprotein cholesterol remains the primary lipid screening measure. WHAT IS NEW • This meta-analysis of 10 studies showed apolipoprotein B levels tracked strongly from childhood but did not exceed low-density lipoprotein cholesterol in this regard. • More comprehensive tracking data are needed to provide sufficient evidence for increased utility of apolipoprotein B in pediatric settings.
Collapse
Affiliation(s)
- Oliver Stanesby
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Tetsuhiro Kidokoro
- Research Institute for Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turkuand, Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
- Centre for Population Health Research, University of Turkuand, Turku University Hospital, Turku, Finland.
| |
Collapse
|
4
|
Wu F, Juonala M, Jacobs DR, Daniels SR, Kähönen M, Woo JG, Sinaiko AR, Viikari JSA, Bazzano LA, Burns TL, Steinberger J, Urbina EM, Venn AJ, Raitakari OT, Dwyer T, Magnussen CG. Childhood Non-HDL Cholesterol and LDL Cholesterol and Adult Atherosclerotic Cardiovascular Events. Circulation 2024; 149:217-226. [PMID: 38014550 DOI: 10.1161/circulationaha.123.064296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although low-density lipoprotein cholesterol (LDL-C) remains the primary cholesterol target in clinical practice in children and adults, non-high-density lipoprotein cholesterol (non-HDL-C) has been suggested as a more accurate measure of atherosclerotic cardiovascular disease (ASCVD) risk. We examined the associations of childhood non-HDL-C and LDL-C levels with adult ASCVD events and determined whether non-HDL-C has better utility than LDL-C in predicting adult ASCVD events. METHODS This prospective cohort study included 21 126 participants from the i3C Consortium (International Childhood Cardiovascular Cohorts). Proportional hazards regressions were used to estimate the risk for incident fatal and fatal/nonfatal ASCVD events associated with childhood non-HDL-C and LDL-C levels (age- and sex-specific z scores; concordant/discordant categories defined by guideline-recommended cutoffs), adjusted for sex, Black race, cohort, age at and calendar year of child measurement, body mass index, and systolic blood pressure. Predictive utility was determined by the C index. RESULTS After an average follow-up of 35 years, 153 fatal ASCVD events occurred in 21 126 participants (mean age at childhood visits, 11.9 years), and 352 fatal/nonfatal ASCVD events occurred in a subset of 11 296 participants who could be evaluated for this outcome. Childhood non-HDL-C and LDL-C levels were each associated with higher risk of fatal and fatal/nonfatal ASCVD events (hazard ratio ranged from 1.27 [95% CI, 1.14-1.41] to 1.35 [95% CI, 1.13-1.60] per unit increase in the risk factor z score). Non-HDL-C had better discriminative utility than LDL-C (difference in C index, 0.0054 [95% CI, 0.0006-0.0102] and 0.0038 [95% CI, 0.0008-0.0068] for fatal and fatal/nonfatal events, respectively). The discordant group with elevated non-HDL-C and normal LDL-C had a higher risk of ASCVD events compared with the concordant group with normal non-HDL-C and LDL-C (fatal events: hazard ratio, 1.90 [95% CI, 0.98-3.70]; fatal/nonfatal events: hazard ratio, 1.94 [95% CI, 1.23-3.06]). CONCLUSIONS Childhood non-HDL-C and LDL-C levels are associated with ASCVD events in midlife. Non-HDL-C is better than LDL-C in predicting adult ASCVD events, particularly among individuals who had normal LDL-C but elevated non-HDL-C. These findings suggest that both non-HDL-C and LDL-C are useful in identifying children at higher risk of ASCVD events, but non-HDL-C may provide added prognostic information when it is discordantly higher than the corresponding LDL-C and has the practical advantage of being determined without a fasting sample.
Collapse
Affiliation(s)
- Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (F.W., C.G.M.)
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia (F.W.)
| | - Markus Juonala
- Department of Medicine, University of Turku, Finland (M.J., J.S.J.V.)
- Division of Medicine, Turku University Hospital, Finland (M.J., J.S.J.V.)
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.)
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora (S.R.D.)
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Finland (M.K.)
- Department of Clinical Physiology, Tampere University Hospital, Finland (M.K.)
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, OH (J.G.W.)
| | - Alan R Sinaiko
- University of Minnesota Medical School, Minneapolis (A.R.S.)
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Finland (M.J., J.S.J.V.)
- Division of Medicine, Turku University Hospital, Finland (M.J., J.S.J.V.)
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.A.B.)
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.)
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis (J.S.)
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M.U.)
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.T.R., C.G.M.)
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland (O.T.R., C.G.M.)
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland (O.T.R.)
- InFLAMES Research Flagship, University of Turku, Finland (O.T.R.)
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
- The Nuffield Department of Women's & Reproductive Health, University of Oxford, UK (T.D.)
- Murdoch Children's Research Institute, Melbourne, Australia (T.D.)
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (F.W., C.G.M.)
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.T.R., C.G.M.)
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland (O.T.R., C.G.M.)
| |
Collapse
|
5
|
Meng Y, Niinikoski H, Rovio SP, Fraser BJ, Wu F, Jula A, Rönnemaa T, Viikari JSA, Raitakari OT, Pahkala K, Magnussen CG. The Influence of Dietary Counseling Over 20 Years on Tracking of Non-High-Density Lipoprotein Cholesterol from Infancy to Young Adulthood. J Pediatr 2024; 264:113776. [PMID: 37839509 DOI: 10.1016/j.jpeds.2023.113776] [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: 07/16/2023] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
This 26-year study found that non-high-density lipoprotein cholesterol (non-HDL-C) levels tracked from infancy to young adulthood suggesting early-life non-HDL-C could predict future levels. However, infancy-onset dietary counseling reduced the odds of maintaining at-risk non-HDL-C, highlighting the potential importance of early interventions in preventing cardiovascular risk associated with high pediatric non-HDL-C.
Collapse
Affiliation(s)
- Yaxing Meng
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia
| | - Harri Niinikoski
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Suvi P Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Tapani Rönnemaa
- Division of Medicine, Turku University Hospital, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland
| | - Jorma S A Viikari
- Division of Medicine, Turku University Hospital, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Paavo Nurmi Centre, Unit of Health and Physical Activity, University of Turku, Turku, Finland
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
| |
Collapse
|
6
|
Mihuta MS, Paul C, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Stoian D. Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children. Biomedicines 2023; 11:1841. [PMID: 37509481 PMCID: PMC10376407 DOI: 10.3390/biomedicines11071841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.
Collapse
Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andreea Borlea
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Dana Stoian
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| |
Collapse
|
7
|
Hyperlipidemia and Cardiovascular Risk in Children and Adolescents. Biomedicines 2023; 11:biomedicines11030809. [PMID: 36979789 PMCID: PMC10045454 DOI: 10.3390/biomedicines11030809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) represents the major cause of morbidity and mortality worldwide. The onset of the atherosclerosis process occurs during childhood and adolescence, subsequently leading to the onset of cardiovascular disease as young adults. Several cardiovascular risk factors can be identified in children and adolescents; however, hyperlipidemia, in conjunction with the global obesity epidemic, has emerged as the most prevalent, playing a key role in the development of ASCVD. Therefore, screening for hyperlipidemia is strongly recommended to detect high-risk children presenting with these disorders, as these patients deserve more intensive investigation and intervention. Treatment should be initiated as early as possible in order to reduce the risk of future ASCVD. In this review, we will discuss lipid metabolism and hyperlipidemia, focusing on correlations with cardiovascular risk and screening and therapeutic management to reduce or almost completely avoid the development of ASCVD.
Collapse
|
8
|
Močnik M, Marčun Varda N. Lipid Biomarkers and Atherosclerosis-Old and New in Cardiovascular Risk in Childhood. Int J Mol Sci 2023; 24:ijms24032237. [PMID: 36768558 PMCID: PMC9916711 DOI: 10.3390/ijms24032237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Lipids are a complex group of molecules in the body, essential as structural, functional and metabolic components. When disbalanced, they are regarded as a cardiovascular risk factor, traditionally in cholesterol level evaluation. However, due to their complex nature, much research is still needed for a comprehensive understanding of their role in atherosclerosis, especially in the young. Several new lipid biomarkers are emerging, some already researched to a point, such as lipoproteins and apolipoproteins. Other lipid molecules are also being increasingly researched, including oxidized forms due to oxidative inflammation in atherosclerosis, and sphingolipids. For many, even those less new, the atherogenic potential is not clear and no clinical recommendations are in place to aid the clinician in using them in everyday clinical practice. Moreover, lipids' involvement in atherogenesis in children has yet to be elucidated. This review summarizes the current knowledge on lipids as biomarkers of cardiovascular risk in the paediatric population.
Collapse
Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska Cesta 2, 2000 Maribor, Slovenia
- Correspondence:
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska Cesta 2, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
| |
Collapse
|
9
|
Mihuta MS, Stoian D, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Paul C. Evaluating the Arterial Stiffness as a Useful Tool in the Management of Obese Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020183. [PMID: 36832311 PMCID: PMC9955158 DOI: 10.3390/children10020183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
Childhood obesity speeds up the development of arterial stiffness and progressively increases the values of arterial pressure. The purpose of this study is to investigate the value of using pulse wave analysis (PWA) to measure arterial stiffness as a sign of vascular wall impairment in obese children. The research was focused on 60 subjects: 33 obese and 27 normal-weight. Ages ranged from 6 to 18 years old. PWA includes parameters such as pulse wave velocity (PWV), augmentation index (AIx), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP), heart rate, and central pulse pressure (cPP). The device used was a Mobil-O-Graph. Blood parameters were taken from the subject's medical history, not older than 6 months. A high BMI and a large waist circumference are linked to a high PWV. The levels of LDL-c, triglycerides (TG), non-HDL-c, TG/HDL-c ratio, and total cholesterol-HDL-c ratio significantly correlate to PWV, SBP, and cSBP. Alanine aminotransferase is a reliable predictor of PWV, AIx, SBP, DBP, and cDBP, while aspartate aminotransferase is a significant predictor of AIx, mean arterial pressure (MAP), cSBP, and cPP. 25-OH-Vitamin D negatively correlates with PWV, SBP, and MAP and significantly predicts the MAP. Cortisol and TSH levels are not significant to arterial stiffness in obese children without specific comorbidities and neither is fasting glucose in obese children without impaired glucose tolerance. We conclude that PWA contributes valuable data regarding patients' vascular health and should be considered a reliable tool in the management of obese children.
Collapse
Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dana Stoian
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Andreea Borlea
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| |
Collapse
|
10
|
Agbaje AO, Lloyd-Jones DM, Magnussen CG, Tuomainen TP. Cumulative dyslipidemia with arterial stiffness and carotid IMT progression in asymptomatic adolescents: A simulated intervention longitudinal study using temporal inverse allocation model. Atherosclerosis 2023; 364:39-48. [PMID: 36462968 DOI: 10.1016/j.atherosclerosis.2022.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS We aimed to examine the longitudinal associations of total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, and low-density lipoprotein cholesterol (LDL-C) with carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) progression. METHODS We studied 1779, 15-year-old participants from the Avon Longitudinal Study of Parents and Children, UK birth cohort, followed up for 9 years. Fasting TC, non-HDL-C, HDL-C, triglyceride, and LDL-C were measured at 15, 17, and 24 years and age-categorized as normal, elevated, and dyslipidemia based on National Heart, Lung, and Blood Institute lipid guidelines. cfPWV and cIMT were measured at 17 and 24 years. Associations were examined using linear mixed-effect models. To simulate the treatment of dyslipidemia we conducted temporal inverse allocation model analyses. RESULTS Among 1779 [49.9% female] participants, mean lipid levels and proportions at elevated or dyslipidemia categories increased from ages 15 through 24 years. Persistently elevated TC: effect estimate 0.026 mm; [95% CI 0.004 to 0.049; p = 0.024], elevated non-HDL-C, and elevated LDL-C were cumulatively associated with cIMT progression. Persistent borderline-low HDL-C: -0.027 mm; [-0.050 to -0.005; p = 0.019] and very-low HDL-C -0.035 mm; [-0.057 to -0.013; p = 0.002] levels were associated with cIMT progression. A temporal inverse allocation of elevated and dyslipidemic levels with normal lipid levels at age 17 years attenuated the associations of cumulative elevated TC, non-HDL-C, LDL-C, and low HDL-C with cIMT progression. Cumulative elevated lipids or dyslipidemia were not associated with cfPWV progression. CONCLUSIONS Late adolescence is key to preventing, halting, and reversing dyslipidemic-related preclinical atherosclerosis progression, warranting universal lipid screening in the general pediatric population.
Collapse
Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Costan G Magnussen
- Baker Heart and Diabetes Research Institute, Melbourne, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
11
|
Montazeri-Najafabady N, Dabbaghmanesh MH, Asmarian N, Rais Pour H. Age-, Sex-, and Puberty-Associated Reference Intervals for Lipid Profile in Iranian Children and Adolescents. Int J Endocrinol 2023; 2023:9143234. [PMID: 36876280 PMCID: PMC9984260 DOI: 10.1155/2023/9143234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 03/07/2023] Open
Abstract
Childhood dyslipidemia is considered a major worldwide health issue. Identification of children with dyslipidemia is notably essential for healthcare providers in establishing and releasing recommendations for the management and prevention of future CVD. In the present study, we provided reference values for the lipid profile from Kawar (a city in the south of Iran) cohort of healthy children and adolescents aged 9-18 years. 472 subjects (234 girls and 238 boys) contributed to the current prospective cohort study using a systematic random sample stratified by age. Fasting lipid levels were measured by enzymatic reagents. Dual-energyX-ray absorptiometry (DEXA) was used to evaluate puberty based on the Tanner stages. LMS Chart Maker and Excel software were used to construct the gender-specific reference plots showing the 3, 10, 25, 50, 75, 90, and 97th percentiles of BMI, cholesterol, TG, HDL, TC, LDL, and non-HDL. The outcomes revealed that concentrations of TC, LDL, and non-HDL were drastically greater in girls as compared to boys. TG increased with age in both genders, while HDL, TC, LDL, and non-HDL declined. We also observed that puberty was associated with higher lipid values in boys and girls except for TG in boys. Our study prepared age- and sex-specific reference intervals for the lipid profile in Iranian children and adolescents. Converted to age and gender percentiles, these reference intervals are expected to serve as an effective and consistent tool for doctors to identify dyslipidemia among children and adolescents.
Collapse
Affiliation(s)
| | | | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homeyra Rais Pour
- Department of Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
12
|
Circulating PCSK9 Linked to Dyslipidemia in Lebanese Schoolchildren. Metabolites 2022; 12:metabo12060504. [PMID: 35736437 PMCID: PMC9230653 DOI: 10.3390/metabo12060504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
In adults, elevated levels of circulating Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) have been associated with increased Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and worse cardiovascular outcomes. However, few studies analyzed the relation between PCSK9 and lipid parameters in pediatric populations. The aim of our study is to evaluate the distribution and the correlation of serum PCSK9 levels with lipid parameters in a sample of Lebanese school children. Using an immunofluorescence assay, we measured serum PCSK9 levels in 681 school children recruited from ten public and private Lebanese schools. We analyzed the association between PCSK9 and age, sex, Body Mass Index (BMI), and lipid parameters (total cholesterol (TC), LDL-C, TG, High-density lipoprotein cholesterol (HDL-C), non-HDL-C, and lipoprotein (a) (Lp(a)). Serum PCSK9 levels were significantly correlated with TC, LDL-C, and non-HDL-C (p value < 0.0001) but not with TG, HDL-C, and Lp(a). PCSK9 levels were also significantly higher in children with high TC, LDL-C, and non-HDL-C (p values = 0.0012, 0.0002, 0.001, respectively). No significant gender differences in PCSK9 were found. In addition, no significant associations between PCSK9 and both age and BMI percentiles were observed. In girls, no difference in PCSK9 values was observed according to menarche while in boys, testosterone levels were not significantly associated with PCSK9. Serum PCSK9 levels were significantly correlated with TC, LDL-C, and non-HDL-C levels. Further studies are needed to find if PCSK9 measurements have an additional value to predict future cardiovascular outcomes in pediatric populations.
Collapse
|
13
|
Drozd I, Weiskorn J, Lange K, Kordonouri O. Typ-1-Diabetes und kardiovaskuläre Risikofaktoren bei Kindern und Jugendlichen. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1713-2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie langfristigen kardiovaskulären Folgen des Typ-1-Diabetes determinieren die Lebenserwartung betroffener Kinder und Jugendlicher. Risikofaktoren für deren Entwicklung sind eine längere Diabetesdauer bzw. Diabetesmanifestation im frühen Lebensalter, Hypertonie, Rauchen, hoher BMI sowie Fettstoffwechselstörungen. Das Management der kardiovaskulären Risikofaktoren bei Kindern und Jugendlichen mit Typ-1-Diabetes beinhaltet zum einen Screeningsmaßnahmen zur frühzeitigen Aufdeckung der pathologischen Veränderungen und zum anderen eine Lebensstilanpassung im Sinne einer ausgewogenen, normokalorischen Ernährung, regelmäßiger Bewegung sowie ggf. einer medikamentösen lipid- bzw. blutdrucksenkenden Therapie.Die Leitlinien und Empfehlungen zur standardisierten Erkennung und Behandlung kardiovaskulärer Risikofaktoren bei jungen Menschen mit Typ-1-Diabetes sind bisher uneinheitlich formuliert und werden deshalb nicht immer im klinischen Alltag angewendet bzw. umgesetzt. Dies führt zu einer relevanten Unterversorgung dieser Patientengruppe. Dem gilt es mit mehr Forschungsansätzen und der Entwicklung eines universellen Prozederes zur Diagnostik und Therapie der kardiovaskulären Risikofaktoren entgegenzuwirken.
Collapse
Affiliation(s)
- Irena Drozd
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
- Medizinische Psychologie, MHH Hannover, Hannover, Germany
| | - Jantje Weiskorn
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Karin Lange
- Medizinische Psychologie, MHH Hannover, Hannover, Germany
| | - Olga Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| |
Collapse
|
14
|
Dyslipidemia Diagnosis and Treatment: Risk Stratification in Children and Adolescents. J Nutr Metab 2022; 2022:4782344. [PMID: 35237450 PMCID: PMC8885266 DOI: 10.1155/2022/4782344] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/27/2021] [Accepted: 01/18/2022] [Indexed: 12/21/2022] Open
Abstract
Dyslipidemias or dyslipoproteinemias are quantitative changes in total cholesterol concentration, respective fractions, or triglycerides in the plasma. Evidence supported that dyslipidemia in childhood is associated with atherosclerosis in adulthood, and early identification and treatment potentially reduce cardiovascular risk in adulthood, which is the principal cause of morbidity and mortality in developed countries. Dyslipidemias can result from primary lipoprotein metabolism changes due to different genetic causes (primary dyslipidemias) or as a consequence of exogenous factors or other pathologies (secondary dyslipidemias). Therefore, the combined dyslipidemias result from the association of important epigenetic and environmental influences with risk factors for cardiovascular disease. The criterion for lipid metabolism screening at young ages is not widely accepted and possibly follows a universal or directed screening strategy. Additionally, little is known about its long-term effects or possible risk-benefit despite the growing tendency to start pharmacological therapy. Therefore, this study aimed to review the available bibliography on dyslipidemia in pediatric age to present a practical and structured approach to dyslipidemia that focuses on screening, risk stratification for atherosclerotic disease, and therapeutic approach.
Collapse
|
15
|
Gao D, Zou Z, Li Y, Chen M, Ma Y, Chen L, Wang X, Yang Z, Dong Y, Ma J. Association between urinary phthalate metabolites and dyslipidemia in children: Results from a Chinese cohort study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 295:118632. [PMID: 34906593 DOI: 10.1016/j.envpol.2021.118632] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
Rising evidence of both experimental and epidemiological studies suggests that phthalate exposure may contribute to increased risks of metabolic disorders. But there is limited research on the childhood dyslipidemia. Our cohort study was conducted in Xiamen city, Fujian Province, China. A total of 829 children (mean age 8.5 years) were included with collection of urine, blood samples and demographic data in May 2018 and followed up once a year from 2018 to 2020. We performed adjusted log-binomial regressions to examine associations between sex-specific tertiles of seven phthalate metabolites and dyslipidemia in visit 1, as well as persistent dyslipidemia and occasional dyslipidemia. We also used generalized estimating equation models (GEE) to explore the relationships between log-transformed phthalate metabolites and lipid profiles. In adjusted models, the prevalence and RRs of dyslipidemia increased with tertile group of mono-n-butyl phthalate (MnBP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), and summed di-(2-ethylhexyl) phthalate (∑DEHP) metabolites with a dose-response relationship in visit 1, as well as persistent dyslipidemia. Higher MnBP, ∑LMWP, MEHHP, MEOHP, and ∑DEHP concentrations were also associated with higher levels of log-transformed triglycerides (TG). Boys were more vulnerable to phthalates exposure than girls. In conclusion, children in China were widely exposed to phthalates, and phthalates exposure during childhood might significantly increase the risk of dyslipidemia and a higher level of lipid profiles, particularly in boys.
Collapse
Affiliation(s)
- Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| |
Collapse
|
16
|
Mardi P, Abdi F, Ehsani A, Seif E, Djalalinia S, Heshmati J, Shahrestanaki E, Gorabi AM, Qorbani M. Is non-high-density lipoprotein associated with metabolic syndrome? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:957136. [PMID: 36176470 PMCID: PMC9514792 DOI: 10.3389/fendo.2022.957136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Novel atherogenic lipid indices, including non-high-density lipoprotein cholesterol (non-HDL-C) which is calculated by subtracting the HDL-C value from the total cholesterol level, atherogenic index (ratio between triglycerides (TG) and HDL-C concentrations (TG/HDL-C)), and Diff-C (calculated by subtracting low-density lipoprotein (LDL-C) from non-HDL-C), have been known as valuable predictors of dyslipidemia and subsequent cardiovascular diseases. Previous studies have reported the potential association of novel atherogenic lipid indices with metabolic syndrome (MetS). This meta-analysis aimed to assess the pooled association of novel atherogenic lipid indices with MetS or its components. METHODS A systematic search was conducted through PubMed, Scopus, and Web of Science (WoS) databases from January 2000 until March 2021 to evaluate the association of novel atherogenic lipid indices, including non-HDL-C, atherogenic index, and the difference between non-HDL-C and LDL-C (Diff-C) with MetS. Observational studies were included without any language restriction. As exclusive studies evaluating the association of non-HDL-C with metabolic syndrome (MetS) were eligible to be included in quantitative analyses, a random-effect meta-analysis was performed to pool the odds ratios (ORs). A stratified meta-analysis was performed based on the definition of MetS [Adult Treatment Panel (ATP) and International Diabetes Federation (IDF)] and the studied population. RESULTS Overall, 318 studies were retrieved from an initial systematic search. After screening, 18 and five studies were included in the qualitative and quantitative syntheses, respectively. Qualitative synthesis revealed an association between non-HDL-C, Diff-C, and atherogenic index with MetS and its components. Stratified meta-analysis showed that an increased non-HDL-C level was associated with an increased odds of MetS based on ATP criteria (OR: 3.77, 95% CI: 2.14-5.39) and IDF criteria (OR: 2.71, 95% CI: 1.98-3.44) in adults (OR: 3.53, 95% CI: 2.29-4.78) and in children (OR: 2.27, 95% CI: 1.65-2.90). CONCLUSION Novel atherogenic lipid indices, including atherogenic index, Diff-c, and non-HDL-C, are strongly associated with increased odds of MetS and its components. The indices could be considered as potential predictors of MetS and its components in clinical practice.
Collapse
Affiliation(s)
- Parham Mardi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Abdi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Amir Ehsani
- University of Medical Sciences, Tehran, Iran
| | - Ehsan Seif
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Heshmati
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Shahrestanaki
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Armita Mahdavi Gorabi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
- *Correspondence: Armita Mahdavi Gorabi, ; Mostafa Qorbani,
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Armita Mahdavi Gorabi, ; Mostafa Qorbani,
| |
Collapse
|
17
|
Jeong DY, Kim SH, Seo MY, Kang SY, Park MJ. Trends in Serum Lipid Profiles Among Korean Adolescents, 2007-2018. Diabetes Metab Syndr Obes 2021; 14:4189-4197. [PMID: 34675571 PMCID: PMC8504865 DOI: 10.2147/dmso.s326070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE An adverse lipid profile in adolescence often persists into adulthood, resulting in cardiovascular disease. We aimed to investigate the trends in the prevalence of adverse lipid profiles among Korean adolescents from 2007 to 2018. PATIENTS AND METHODS The data were obtained from 9044 adolescents aged 10-19 years who participated in the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2007 to 2018. Fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels were analyzed. RESULTS Significantly increasing trends in age-standardized prevalence of hypercholesterolemia [from 5.6% to 9.4% in boys (P = 0.004); from 8.1% to 12.4% in girls (P = 0.01)] and hyper-LDL-cholesterolemia [from 4.3% to 8.0% in boys (P = 0.003); from 6.6% to 9.7% in girls (P = 0.035)] were noted in both sexes. In contrast, the prevalence of hypo-HDL-cholesterolemia decreased significantly from 20.0% to 12.5% in boys (<0.001) and from 12.4% to 6.9% in girls (P < 0.001). There were no significant changes in the prevalence of hypertriglyceridemia and hyper-non-HDL-cholesterolemia in both sexes. Accordingly, the overall prevalence of dyslipidemia showed only a modest decline in boys (from 31.8% to 28.7%) and a stable trend in girls (from 28.9% to 28.2%). CONCLUSION The prevalence of hypercholesterolemia and hyper-LDL-cholesterolemia increased and that of hypo-HDL-cholesterolemia decreased among Korean adolescents over the recent 12 years. Further studies are needed to explain these trends and possible associations with lifestyle factors.
Collapse
Affiliation(s)
- Da-Young Jeong
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Shin-Hye Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Moon Young Seo
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Gyeonggi-do, Korea
| | - Sin Young Kang
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Mi Jung Park
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| |
Collapse
|
18
|
Armstrong MK, Fraser BJ, Hartiala O, Buscot MJ, Juonala M, Wu F, Koskinen J, Hutri-Kähönen N, Kähönen M, Laitinen TP, Lehtimäki T, Viikari JSA, Raitakari OT, Magnussen CG. Association of Non-High-Density Lipoprotein Cholesterol Measured in Adolescence, Young Adulthood, and Mid-Adulthood With Coronary Artery Calcification Measured in Mid-Adulthood. JAMA Cardiol 2021; 6:661-668. [PMID: 33502454 DOI: 10.1001/jamacardio.2020.7238] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the presence of coronary artery calcification (CAC), a marker of heart disease in adulthood. However, the relative importance of non-HDL-C levels at specific life stages for CAC remains unclear. Objective To identify the relative association of non-HDL-C measured at distinct life stages (adolescence, young adulthood, mid-adulthood) with the presence of CAC measured in mid-adulthood. Design, Setting, and Participants The Cardiovascular Risk in Young Finns Study is a population-based prospective cohort study that started in 1980 with follow-up over 28 years. Participants from 3 population centers (Kuopio, Tampere, and Turku in Finland) represent a convenience sample drawn from the 3 oldest cohorts at baseline (aged 12-18 years in 1980). Data were collected from September 1980 to August 2008. Analysis began February 2020. Exposures Non-HDL-C levels were measured at 3 life stages including adolescence (aged 12-18 years), young adulthood (aged 21-30 years), and mid-adulthood (aged 33-45 years). Main Outcomes and Measures In 2008, CAC was determined from computed tomography and dichotomized as 0 (no CAC, Agatston score = 0) and 1 (presence of CAC, Agatston score ≥1) for analysis. Using a bayesian relevant life course exposure model, the relative association was determined between non-HDL-C at each life stage and the presence of CAC in mid-adulthood. Results Of 589 participants, 327 (56%) were female. In a model adjusted for year of birth, sex, body mass index, systolic blood pressure, blood glucose level, smoking status, lipid-lowering and antihypertensive medication use, and family history of heart disease, cumulative exposure to non-HDL-C across all life stages was associated with CAC (odds ratio [OR], 1.50; 95% credible interval [CrI], 1.14-1.92). At each life stage, non-HDL-C was associated with CAC and exposure to non-HDL-C during adolescence had the strongest association (adolescence: OR, 1.16; 95% CrI, 1.01-1.46; young adulthood: OR, 1.14; 95% CrI, 1.01-1.43; mid-adulthood: OR, 1.12; 95% CrI, 1.01-1.34). Conclusions and Relevance These data suggest that elevated non-HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non-HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood, and greater awareness of the importance of elevated non-HDL-C in adolescence is needed.
Collapse
Affiliation(s)
- Matthew K Armstrong
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Olli Hartiala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Juha Koskinen
- Heart Center, Kymenlaakso Central Hospital, Kotka, Finland
| | - Nina Hutri-Kähönen
- Tampere University Hospital, Department of Pediatrics, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Tampere University Hospital, Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tomi P Laitinen
- Kuopio University Hospital, Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center-Tampere, Tampere University, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| |
Collapse
|
19
|
Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
Collapse
Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| |
Collapse
|
20
|
Li Y, Ma Y, Luo J, Jing J, Zhang X, Luo C, Wang H, Zhao H, Pan D, Luo M. Identifying reference values for serum lipids in Chinese children and adolescents aged 6-17 years old: A national multicenter study. J Clin Lipidol 2021; 15:477-487. [PMID: 33931376 DOI: 10.1016/j.jacl.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current reference values for pediatric dyslipidemia used in China were not developed based on local population studies and did not consider age and sex differences. OBJECTIVE In this study, we aimed to determine suitable reference values for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and non-high-density lipoprotein cholesterol (nonHDL-C) for Chinese children and adolescents using a national multicenter school-based study. METHODS A total of 15,830 students aged 6-17 years were recruited from seven provinces of China. Age- and sex-specific percentile values for each lipid indicator were derived based on levels measured in the fasting state, and percentile curves of each indicator were plotted using the LMS method. RESULTS Serum lipid levels varied considerably with age in both sexes. Among boys, the cut-off value for high TC, nonHDL-C, LDL-C, and TG, based on the value of the 95th percentiles, ranged from 4.58 to 5.39, 3.34 to 3.99, 2.69 to 3.31, and 1.22 to 1.83 mmol/L, respectively; among girls, the cut-off value for high TC, nonHDL-C, LDL-C, and TC ranged from 5.01 to 5.39, 3.66 to 3.97, 2.97 to 3.32, and 1.41 to 1.93 mmol/L, respectively. The cut-point for low HDL-C ranged from 0.84 to 1.08 mmol/L in boys and from 0.89 to 1.04 mmol/L in girls. CONCLUSION These findings may help to determine age- and sex-specific reference values for serum lipids among Chinese children and adolescents and provide valuable guidance for screening of dyslipidemia.
Collapse
Affiliation(s)
- Yamei Li
- Xiangya School of Public Health, Central South University, No.238 Shang Ma Yuan Ling Road, Changsha 410008, China.
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| | - Jiayou Luo
- Xiangya School of Public Health, Central South University, No.238 Shang Ma Yuan Ling Road, Changsha 410008, China.
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Xin Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Chunyan Luo
- Shanghai Municipal Center for Disease Control and Prevention & Shanghai Institutes of Preventive Medicine, Shanghai, China.
| | - Hong Wang
- Chongqing Medical University, Chongqing, China.
| | | | - Dehong Pan
- Liaoning Health Supervision Bureau, Shenyang, China.
| | - Miyang Luo
- Xiangya School of Public Health, Central South University, No.238 Shang Ma Yuan Ling Road, Changsha 410008, China.
| |
Collapse
|
21
|
Czeck MA, Northrop EF, Evanoff NG, Dengel DR, Rudser KD, Kelly AS, Ryder JR. Relationship of Apolipoproteins with Subclinical Cardiovascular Risk in Youth. J Pediatr 2020; 227:199-203.e1. [PMID: 32795477 PMCID: PMC7686115 DOI: 10.1016/j.jpeds.2020.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the association of apolipoproteins with arterial stiffness and carotid artery structure in children and adolescents. STUDY DESIGN A total of 338 children and adolescents (178 female) with a mean age 13.0 ± 2.8 years were examined. Apolipoproteins (AI, AII, B100, CII, CIII, and E) were measured via human apolipoprotein magnetic bead panel. Applanation tonometry determined pulse wave velocity and ultrasound imaging measured carotid intima-media thickness. Dual X-ray absorptiometry measured total body fat percent. Linear regression models were adjusted for Tanner stage, sex, and race with further adjustments for body fat percent. Linear regression models also examined the interaction between Tanner stage and apolipoproteins. RESULTS There was a significant positive association between pulse wave velocity and apolipoproteins: AI (0.015 m/s/10 μg/mL [CI 0.005-0.026], P = .003), AII (0.036 m/s/10 μg/mL [0.017-0.056], P < .001), B100 (0.009 m/s/10 μg/mL [0.002-0.016], P = .012), E (0.158 m/s/10 μg/mL [0.080-0.235], P < .001), and CIII:CII (0.033/μg/mL [0.014-0.052], P < .001). After we added body fat percent to the models, pulse wave velocity (PWV) remained positively associated with greater levels of apolipoproteins: AI, AII, B100, E, and CIII:CII. Both with and without the adjustment for body fat percent, there were no significant associations between any apolipoprotein and carotid intima-media thickness. There were no significant interactions between Tanner stage and apolipoproteins. CONCLUSIONS These findings suggest that greater levels of apolipoprotein AII, E, and CIII:CII are associated with increased arterial stiffness in children and adolescents, both with and without adjusting for percent body fat. These specific apolipoproteins may be useful as biomarkers of cardiovascular risk.
Collapse
Affiliation(s)
- Madeline A Czeck
- School of Kinesiology, University of Minnesota, Minneapolis, MN.
| | - Elise F Northrop
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Nicholas G Evanoff
- School of Kinesiology, University of Minnesota, Minneapolis, MN; Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, MN; Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Kyle D Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN; Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
22
|
Shin JH, Cheong JI, Cheuh HW, Yoo JH. Limitations of current screening methods for lipid disorders in Korean adolescents and a proposal for an effective detection method: a nationwide, cross-sectional study. Ann Pediatr Endocrinol Metab 2020; 25:265-271. [PMID: 33401883 PMCID: PMC7788341 DOI: 10.6065/apem.2040098.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the limitations of current screening methods for lipid disorders and to suggest a new method that is effective for use in Korean adolescents. METHODS Data from the 6th Korea National Health and Nutrition Examination Survey (2013-2015) were analyzed. The diagnostic validity (sensitivity and specificity) of various cardiovascular risk factors currently used for lipid disorder screening was investigated, as was the diagnostic validity of non-HDL-cholesterol ≥145 mg/dL as a screening tool. RESULTS The prevalence of dyslipidemia and familial hypercholesterolemia (FH) among Korean adolescents was 20.4%±1.0% and 0.8%±0.3%, respectively. The current standard screening methods identified only 5.9%±1.4% and 30.3%±17.2% of the total number of dyslipidemia and FH cases, respectively. The diagnostic sensitivity and specificity of lipid profile analysis for dyslipidemia among obese adolescents were 19.5%±2.3% and 93.6%±0.8% and for FH were 30.3%±17.2% and 91.1%±0.8%, respectively. When adolescents with obesity, hypertension, or a family history of dyslipidemia or cardiocerebrovascular disease for over 3 generations were included in the screening, diagnostic sensitivity increased to 68.4%±2.8% for dyslipidemia and 83.5%±2.7% for FH. Universal screening of all adolescents based on non-HDL-cholesterol levels had sensitivities of 30.2%±2.7% and 100%, and specificities of 99.2%±0.3% and 94%±0.6% for dyslipidemia and FH, respectively. CONCLUSION New screening methods should be considered for early diagnosis and treatment of lipid disorders in Korean adolescents.
Collapse
Affiliation(s)
- Jung Hyun Shin
- Department of Pediatrics, Good Moonhwa Hospital, Busan, Korea
| | - Ji In Cheong
- Department of Pediatrics, College of Medicine, Dong-A University, Busan, Korea
| | - Hee Won Cheuh
- Department of Pediatrics, College of Medicine, Dong-A University, Busan, Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, College of Medicine, Dong-A University, Busan, Korea,Address for correspondence: Jae-Ho Yoo, MD, PhD Department of Pediatrics, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-5124 Fax: +82-51-242-2765 E-mail:
| |
Collapse
|
23
|
Hari P, Khandelwal P, Smoyer WE. Dyslipidemia and cardiovascular health in childhood nephrotic syndrome. Pediatr Nephrol 2020; 35:1601-1619. [PMID: 31302760 DOI: 10.1007/s00467-019-04301-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022]
Abstract
Children with steroid-resistant nephrotic syndrome (SRNS) are exposed to multiple cardiovascular risk factors predisposing them to accelerated atherosclerosis. This risk is negligible in steroid-sensitive nephrotic syndrome, but a substantial proportion of children with SRNS progress to chronic kidney disease, exacerbating the already existing cardiovascular risk. While dyslipidemia is an established modifiable risk factor for cardiovascular disease in adults with NS, it is uncertain to what extent analogous risks exist for children. There is increasing evidence of accelerated atherosclerosis in children with persistently high lipid levels, especially in refractory NS. Abnormalities of lipid metabolism in NS include hypertriglyceridemia and hypercholesterolemia due to elevated apolipoprotein B-containing lipoproteins, decreased lipoprotein lipase and hepatic lipase activity, increased hepatic PCSK9 levels, and reduced hepatic uptake of high-density lipoprotein. Existing guidelines for the management of dyslipidemia in children may be adapted to target lower lipid levels in children with NS, but they will most likely require both lifestyle modifications and pharmacological therapy. While there is a lack of data from randomized controlled trials in children with NS demonstrating the benefit of lipid-lowering drugs, therapies including statins, bile acid sequestrants, fibrates, ezetimibe, and LDL apheresis have all been suggested and/or utilized. However, concerns with the use of lipid-lowering drugs in children include unclear side effect profiles and unknown long-term impacts on neurological development and puberty. The recent introduction of anti-PCSK9 monoclonal antibodies and other therapies targeted to the molecular mechanisms of lipid transport disrupted in NS holds promise for the future treatment of dyslipidemia in NS.
Collapse
Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - William E Smoyer
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
24
|
Khoury M, Kavey REW, St Pierre J, McCrindle BW. Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology. Can J Cardiol 2020; 36:1417-1428. [PMID: 32679170 PMCID: PMC7358764 DOI: 10.1016/j.cjca.2020.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.
Collapse
Affiliation(s)
- Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Rae-Ellen W. Kavey
- Preventive Cardiology–Lipid Clinic, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Julie St Pierre
- Department of Pediatrics, McGill University, Clinique 180, Montréal, Québec, Canada
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Kostopoulou E, Bosdou JK, Anagnostis P, Stevenson JC, Goulis DG. Cardiovascular Complications in Patients with Turner's Syndrome. Curr Pharm Des 2020; 26:5650-5659. [PMID: 32473616 DOI: 10.2174/1381612826666200531152459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/07/2020] [Indexed: 01/15/2023]
Abstract
Turner's or Turner syndrome (TS) is the most prevalent chromosomal abnormality in live female births. Patients with TS are predisposed to an increased risk of cardiovascular diseases (CVD), mainly due to the frequently observed congenital structural cardiovascular defects, such as valvular and aortic abnormalities (coarctation, dilatation, and dissection). The increased prevalence of cardiometabolic risk factors, such as arterial hypertension, insulin resistance, diabetes mellitus, dyslipidaemia, central obesity, and increased carotid intima-media thickness, also contribute to increased morbidity and mortality in TS patients. Menopausal hormone therapy (MHT) is the treatment of choice, combined with growth hormone (GH). Although MHT may, in general, ameliorate CVD risk factors, its effect on CVD mortality in TS has not yet been established. The exact effect of GH on these parameters has not been clarified. Specific considerations should be provided in TS cases during pregnancy, due to the higher risk of CVD complications, such as aortic dissection. Optimal cardiovascular monitoring, including physical examination, electrocardiogram, CVD risk factor assessment, and transthoracic echocardiography, is recommended. Moreover, the cardiac magnetic resonance from the age of 12 years is recommended due to the high risk of aortic aneurysm and other anatomical vascular complications.
Collapse
Affiliation(s)
- Eirini Kostopoulou
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University of Patras School of Medicine, Patras, 26500, Greece
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, United Kingdom
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
26
|
Vesa CM, Popa L, Popa AR, Rus M, Zaha AA, Bungau S, Tit DM, Corb Aron RA, Zaha DC. Current Data Regarding the Relationship between Type 2 Diabetes Mellitus and Cardiovascular Risk Factors. Diagnostics (Basel) 2020; 10:E314. [PMID: 32429441 PMCID: PMC7277953 DOI: 10.3390/diagnostics10050314] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Reducing cardiovascular risk (CVR) is the main focus of diabetes mellitus (DM) management nowadays. Complex pathogenic mechanisms that are the subject of this review lead to early and severe atherosclerosis in DM patients. Although it is not a cardiovascular disease equivalent at the moment of diagnosis, DM subjects are affected by numerous cardiovascular complications, such as acute coronary syndrome, stroke, or peripheral artery disease, as the disease duration increases. Therefore, early therapeutic intervention is mandatory and recent guidelines focus on intensive CVR factor management: hyperglycaemia, hypertension, and dyslipidaemia. Most important, the appearance of oral or injectable antidiabetic medication such as SGLT-2 inhibitors or GLP-1 agonists has proven that an antidiabetic drug not only reduces glycaemia, but also reduces CVR by complex mechanisms. A profound understanding of intimate mechanisms that generate atherosclerosis in DM and ways to inhibit or delay them are of the utmost importance in a society where cardiovascular morbidity and mortality are predominant.
Collapse
Affiliation(s)
- Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.M.V.); (R.A.C.A.); (D.C.Z.)
| | - Loredana Popa
- Department II of Internal Medicine, Clinical County Emergency Hospital of Oradea, 410169 Oradea; Romania; (L.P.); (A.R.P.); (M.R.)
| | - Amorin Remus Popa
- Department II of Internal Medicine, Clinical County Emergency Hospital of Oradea, 410169 Oradea; Romania; (L.P.); (A.R.P.); (M.R.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Marius Rus
- Department II of Internal Medicine, Clinical County Emergency Hospital of Oradea, 410169 Oradea; Romania; (L.P.); (A.R.P.); (M.R.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Andreea Atena Zaha
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400000 Cluj Napoca, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Raluca Anca Corb Aron
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.M.V.); (R.A.C.A.); (D.C.Z.)
| | - Dana Carmen Zaha
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.M.V.); (R.A.C.A.); (D.C.Z.)
| |
Collapse
|
27
|
Olabode OP, Akinlade OM, Babatunde AS, Abdulazeez MI, Biliaminu SA, Oyabambi AO, Olatunji VA, Soladoye AO, Olatunji LA. Triglyceride/HDL-cholesterol ratio and plasminogen activator inhibitor-1 independently predict high pulse pressure in sickle cell trait and disease. Arch Physiol Biochem 2020; 126:166-171. [PMID: 30145922 DOI: 10.1080/13813455.2018.1499118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We hypothesised that TG/HDL-C ratio and PAI-1 would be associated with high pulse pressure (PP) in young adults with sickle cell trait (SCT) and sickle cell disease (SCD). We compared the clinical, biochemical, and cardiometabolic parameters among individuals with normal genotype (HbAA; n = 60), SCT (HbAS; n = 60), and SCD (HbSS; n = 60), all in steady state. Using multivariate linear regression analysis, high PP was positively related to TG/HDL-C ratio in SCT (β = 0.307; p = .014) and PAI-1 (β = 0.499; p = .001) in SCD. The curve of receiver operating characteristic also showed that TG/HDL-C ratio and PAI-1 are efficient predictors of high PP in SCT carriers and SCD patients, respectively. This study suggests that increased levels of TG/HDL-C ratio and PAI-1 may be salient risk factors that would promote the development of arterial stiffness and other CVD in SCT carriers and SCD patients.
Collapse
Affiliation(s)
- Olatunde P Olabode
- HOPE Cardiometabolic Research Team, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olawale M Akinlade
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
| | - Abiola S Babatunde
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Ilorin, Nigeria
| | - Musbau I Abdulazeez
- Department of Chemical Pathology and Immunology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Sikiru A Biliaminu
- Department of Chemical Pathology and Immunology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adewumi O Oyabambi
- HOPE Cardiometabolic Research Team, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Victoria A Olatunji
- HOPE Cardiometabolic Research Team, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ayodele O Soladoye
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Lawrence A Olatunji
- HOPE Cardiometabolic Research Team, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| |
Collapse
|
28
|
Sivanesan H, Vanderloo LM, Keown-Stoneman CDG, Parkin PC, Maguire JL, Birken CS. The association between screen time and cardiometabolic risk in young children. Int J Behav Nutr Phys Act 2020; 17:41. [PMID: 32345327 PMCID: PMC7189472 DOI: 10.1186/s12966-020-00943-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/28/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES While studies exist on the association between screen time and cardiometabolic risk among adolescents, research examining the effect of screen time on cardiometabolic risk in young children is lacking. The primary objective of this study was to examine the association between daily screen time and cardiometabolic risk (CMR) [sum of age- and sex-standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein (HDL) cholesterol divided by the square root of five] in young children. Secondary objectives included examining individual CMR risk factors, including waist-to-height ratio and non high-density lipoprotein (non-HDL) cholesterol, as well as the individual cut-offs of these risk factors. Additional analyses include examining the association between screen time and CMR by handheld/non-handheld devices. METHODS A study was conducted among young children 3 to 6 years from the TARGet Kids! practice-based research network in Toronto and Montreal, Canada. Children with one or more measures of screen time and CMR were included in this study. Generalized estimating equation (GEE) multivariable linear regressions and multivariable logistic regressions, using published cut-offs, were conducted to evaluate these associations. RESULTS Data from 1317 children [mean age 52 months (SD = 13.36), 44.34% female] were included for analyses. There was no evidence of associations between screen time and total CMR score or individual risk factors (p > 0.05) after adjusting for confounders. A statistically significant, but small association between daily screen time and non-HDL cholesterol was found (B = 0.046; CI = [0.017 to 0.075]; p = 0.002. CONCLUSIONS Though no relationship was reported between daily screen time and the majority of CMR factors in early childhood, there was an association between daily screen time and non-HDL cholesterol. As the relationship between daily screen time and CMR factors may not be apparent in early childhood, studies to evaluate longer-term cardiometabolic effects of screen time are needed. Although there is an evidence-based rationale to reduce screen time in early childhood, prevention of cardiometabolic risk may not be the primary driver.
Collapse
Affiliation(s)
- Harunya Sivanesan
- Master of Public Health, Epidemiology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Leigh M Vanderloo
- The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
| | - Charles D G Keown-Stoneman
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.,The Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
29
|
Juonala M, Wu F, Sinaiko A, Woo JG, Urbina EM, Jacobs D, Steinberger J, Prineas R, Koskinen J, Sabin MA, Burgner DP, Burns TL, Bazzano L, Venn A, Viikari JS, Hutri-Kähönen N, Daniels SR, Dwyer T, Raitakari OT, Magnussen CG. Non-HDL Cholesterol Levels in Childhood and Carotid Intima-Media Thickness in Adulthood. Pediatrics 2020; 145:peds.2019-2114. [PMID: 32209701 PMCID: PMC7111486 DOI: 10.1542/peds.2019-2114] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Elevated non-high-density lipoprotein cholesterol (HDL-C) levels are used to identify children at increased cardiovascular risk, but the use of non-HDL-C in childhood to predict atherosclerosis is unclear. We examined whether the National Heart, Lung, and Blood Institute classification of youth non-HDL-C status predicts high common carotid artery intima-media thickness in adulthood. METHODS We analyzed data from 4 prospective cohorts among 4582 children aged 3 to 19 years who were remeasured as adults (mean follow-up of 26 years). Non-HDL-C status in youth and adulthood was classified according to cut points of the National Heart, Lung, and Blood Institute and the National Cholesterol Education Program Adult Treatment Panel III. High carotid intima-media thickness (cIMT) in adulthood was defined as at or above the study visit-, age-, sex-, race-, and cohort-specific 90th percentile of intima-media thickness. RESULTS In a log-binomial regression analysis adjusted with age at baseline, sex, cohort, length of follow-up, baseline BMI, and systolic blood pressure, children with dyslipidemic non-HDL-C were at increased risk of high cIMT in adulthood (relative risk [RR], 1.29; 95% confidence interval [CI], 1.07-1.55). Compared with the persistent normal group, the persistent dyslipidemia group (RR, 1.80; 95% CI, 1.37-2.37) and incident dyslipidemia (normal to dyslipidemia) groups (RR, 1.45; 95% CI, 1.07-1.96) had increased risk of high cIMT in adulthood, but the risk was attenuated for the resolution (dyslipidemia to normal) group (RR, 1.17; 95% CI, 0.97-1.41). CONCLUSIONS Dyslipidemic non-HDL-C levels predict youth at risk for developing high cIMT in adulthood. Those who resolve their non-HDL-C dyslipidemia by adulthood have normalized risk of developing high cIMT in adulthood.
Collapse
Affiliation(s)
- Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, .,Contributed equally as co-first authors
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia;,Contributed equally as co-first authors
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jessica G. Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati and
| | - Elaine M. Urbina
- Division of Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - David Jacobs
- Division of Epidemiology and Community Health, School of Public Health and
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Ronald Prineas
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston‐Salem, North Carolina
| | - Juha Koskinen
- Heart Center, Kymenlaakso Central Hospital, Kotka, Finland
| | - Matthew A. Sabin
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - David P. Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Trudy L. Burns
- Department of Pediatrics, University of Melbourne, Parkville, Australia;,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Lydia Bazzano
- Departments of Epidemiology and Biostatistics and Bioinformatics, Tulane University Health Sciences Center, Tulane University, New Orleans, Louisiana
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jorma S.A. Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Stephen R. Daniels
- Department of Pediatrics, Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado; and
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, and,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Costan G. Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland;,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
30
|
Jones LK, Gidding SS, Seaton TL, Goldberg A, Gregor C, Sturm AC, Brownson RC, Rahm AK, Williams MS. Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol. Res Social Adm Pharm 2020; 16:390-395. [PMID: 31229402 PMCID: PMC6911646 DOI: 10.1016/j.sapharm.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) affects more than one million Americans, and most individuals have not been formally diagnosed with the condition. Individuals with FH have markedly elevated serum low-density lipoprotein cholesterol (LDL-C) levels from birth that substantially increase their risk for early-onset cardiovascular (CV) events. Guideline-recommended treatments exist to lower LDL-C and reduce the risk of CV events in individuals with FH and hypercholesterolemia. This study seeks to address a significant gap in the care of individuals with FH by systematically developing an effective approach to increase the adoption of guideline-recommended treatments for FH. METHODS This developmental study will consist of three aims: 1) determine the barriers to and facilitators of treatment of FH; 2) develop a list of potential implementation strategies to promote the adoption of guideline-recommended treatment of individuals with FH, and 3) pilot one implementation strategy from Aim 2 in one health care system to evaluate implementation outcomes of the strategy. The Practical, Robust Implementation and Sustainability Model will guide this project, including the development of interview questions, implementation strategies, and evaluation of the implementation strategy. The implementation outcomes include: of individuals targeted by the implementation strategy, how many are impacted by it (reach), measure the change in knowledge, attitude, and behavior that is impacted by the implementation strategy (effectiveness), in settings targeted by the implementation strategy, how many adopt it (adoption), and fidelity and cost of the implementation strategy (implementation). Data sources will include electronic health records, administrative databases, surveys, and semi-structured interviews. DISCUSSION The inclusion of patient and organizational stakeholder experiences is a critically important step in developing efficient and effective implementation strategies. Additionally, perspectives from a variety of geographic areas and cultural perspectives should increase feasibility and fidelity of the interventional approach to improve adoption of guideline-recommended practices for FH care.
Collapse
Affiliation(s)
- Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA.
| | | | - Terry L Seaton
- St. Louis College of Pharmacy, St. Louis, MO, USA; Mercy Clinic-East Communities, St. Louis, MO, USA
| | - Anne Goldberg
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Department of Surgery (Division of Public Health Sciences), Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO, USA
| | | | | |
Collapse
|
31
|
Vitamin B2 and Folate Concentrations are Associated with ARA, EPA and DHA Fatty Acids in Red Blood Cells of Brazilian Children and Adolescents. Nutrients 2019; 11:nu11122918. [PMID: 31810311 PMCID: PMC6950420 DOI: 10.3390/nu11122918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
Vitamins B2, B6, B12, and folate are essential for methylation reactions and possibly influence the transport of polyunsaturated fatty acids in plasma and red blood cells (RBC). Associations between B-vitamin biomarkers and fatty acid (FA) profile were analyzed in Brazilian children and adolescents. This cross-sectional study included 249 children and adolescents, aged 9–13 years old. Dietary intake was assessed by the food frequency questionnaire and the healthy eating index (HEI). Biomarkers for vitamins B2, B6, B12, and folate were measured in plasma. The FA profile and the metabolites of one-carbon metabolism were measured in RBC. Associations were tested with multiple linear regression models. An increase of 1 nmol/L in vitamin B2 was associated with an increase of 0.19 mg/dL of EPA, 0.20 mg/dL of ARA, and 0.25 mg/dL of DHA in RBC. An increase of 1 ng/mL in plasma folate was associated with an increase of 0.14 mg/dL of EPA, 0.22 mg/dL of ARA, and 0.21 mg/dL of DHA in RBC. These findings highlight the importance of an adequate intake of vitamin B2 and folate in childhood, since they may improve the FA profile in RBCs and may help prevent cardiovascular disease.
Collapse
|
32
|
Kosteria I, Schwandt A, Davis E, Jali S, Prieto M, Rottembourg D. Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database. Diabet Med 2019; 36:1294-1303. [PMID: 30972800 DOI: 10.1111/dme.13963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
AIMS To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus. METHODS A cross-sectional analysis of the lipid profile of children aged ≤ 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol ≥2.6 mmol/l or non-HDL cholesterol ≥3.1 mmol/l. LDL and non-HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA1c and BMI-standard deviation score group, region, and common interactions between age, sex, HbA1c and BMI. RESULTS This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA1c and BMI. LDL and non-HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37-2.41), P<0.001; non-HDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78-2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol ≥2.6 mmol/l [0.89 (95% CI 0.82-0.97)] and non-HDL cholesterol ≥3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments. CONCLUSIONS Our results indicate that pump therapy is associated with a better lipid profile.
Collapse
Affiliation(s)
- I Kosteria
- Diabetes Centre, Division of Endocrinology, Diabetes and Metabolism, First Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - E Davis
- Centre for Child Health Research, Telethon Kids Institute, University of Western, Perth, Australia
| | - S Jali
- J. N. Medical College (KAHER) and the KLE Diabetes Centre, KLES Dr Prabhakar Kore Hospital, Belgaum, India
| | - M Prieto
- Hospital de Pediatria Garrahan, Buenos Aires, Argentina
| | - D Rottembourg
- Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
| |
Collapse
|
33
|
Jones LK, Kulchak Rahm A, Manickam K, Butry L, Lazzeri A, Corcoran T, Komar D, Josyula NS, Pendergrass SA, Sturm AC, Murray MF. Healthcare Utilization and Patients' Perspectives After Receiving a Positive Genetic Test for Familial Hypercholesterolemia. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002146. [PMID: 30354341 DOI: 10.1161/circgen.118.002146] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The MyCode Community Health Initiative (MyCode) is returning actionable results from whole exome sequencing. Familial hypercholesterolemia (FH) is an inherited condition characterized by premature cardiovascular disease. METHODS We used multiple methods to assess care in 28 MyCode participants who received FH results. Chart reviews were conducted on 23 individuals in the sample and 7 individuals participated semistructured interviews. RESULTS Chart reviews for 23 individuals with a Geisinger primary care provider found that 4 individuals (17% of 23) were at LDL-C (low-density lipoprotein cholesterol) goal (of either LDL-C <100 mg/dL for primary prevention and LDL-C <70 mg/dL for secondary prevention) and 17 individuals (74% of 23) were prescribed lipid-lowering therapy before genetic result disclosure. After disclosure of the genetic test result, 5 individuals (22% of 23) met their LDL-C goal and 18 individuals (78% of 23) were prescribed lipid-lowering therapy. Follow-up care about this result was not documented for 4 individuals (17% of 23). Changes to intensity of medication management were made for 8 individuals (47% of 17 individuals previously prescribed lipid-lowering therapy). Interviewed individuals (n=7) were not surprised by their result as all knew they had high cholesterol; however, individuals did not seem to discern FH as a separate condition from their high cholesterol. CONCLUSIONS Among individuals receiving genetic diagnosis of FH, >25% had no changes to lipid-lowering therapy, despite not being at LDL-C goal and learning their high cholesterol is related to a genetic condition requiring more aggressive treatment. Individuals and clinicians may have an inadequate understanding of FH as a distinct condition requiring enhanced medical management.
Collapse
Affiliation(s)
- Laney K Jones
- Center for Pharmacy Innovation and Outcomes (L.K.J.)
| | - Alanna Kulchak Rahm
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Kandamurugu Manickam
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Loren Butry
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Amanda Lazzeri
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Timothy Corcoran
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Daniel Komar
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Navya S Josyula
- Biomedical and Translational Informatics Institute (N.S.J., S.A.P.)
| | | | - Amy C Sturm
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Michael F Murray
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.).,Geisinger, Danville, PA. Yale Center for Genomic Health, New Haven, CT (M.F.M.)
| |
Collapse
|
34
|
Bonito PD, Licenziati MR, Baroni MG, Maffeis C, Morandi A, Manco M, Miraglia Del Giudice E, Sessa AD, Campana G, Moio N, Gilardini L, Chiesa C, Pacifico L, Simone GD, Valerio G. The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines. Eur J Prev Cardiol 2019; 27:8-15. [PMID: 31387383 DOI: 10.1177/2047487319868326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH. OBJECTIVES We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile. METHODS A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth. RESULTS Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% (p = 0.008) as compared with ESH-/AAP-. CONCLUSIONS The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.
Collapse
Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, 'S. Maria delle Grazie', Pozzuoli Hospital, Naples, Italy
| | | | - Marco G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | - Anita Morandi
- Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | | | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Nicola Moio
- Department of Cardiology, 'S. Maria delle Grazie', Pozzuoli, Naples, Italy
| | - Luisa Gilardini
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences and Rehabilitation, Milan, Italy
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni de Simone
- Hypertension Research Centre and Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giuliana Valerio
- Department of Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, Italy
| | | |
Collapse
|
35
|
Heyden JCVD, Birnie E, Bovenberg SA, Dekker P, Veeze HJ, Mul D, Aanstoot HJ. Losing Track of Lipids in Children and Adolescents with Type 1 Diabetes: Towards Individualized Patient Care. Exp Clin Endocrinol Diabetes 2019; 129:510-518. [PMID: 31272109 DOI: 10.1055/a-0950-9677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To assess 1) the prevalence of children and adolescents with type 1 diabetes (T1D) changing from low-risk into borderline-high-risk lipid levels or from borderline-high-risk into high-risk lipid levels ('lose track of lipids') and 2) the power of a risk score including the determinants HbA1c, body mass index (BMI), gender, age, diabetes duration and ethnicity in predicting which patients lose track of lipids. METHODS 651 children and adolescents with T1D were included in this longitudinal retrospective cohort study. Lipid dynamics and the impact of the risk score on losing track of lipids were evaluated. Kaplan-Meier analysis was used to estimate screening intervals. RESULTS 31-43% percent of the patients had lost track of one or more lipids at the next lipid measurement. This happened more frequently in patients with a low-risk lipid level at start. Depending on the lipid parameter, 5% of patients with low-risk lipid levels lost track of lipids after 13-23 months. The risk score based on concomitant information on the determinants was moderately able to predict which patients would lose track of lipids on the short term. CONCLUSIONS A considerable number of children and adolescents with T1D loses track of lipids and does so within a 2-year screening interval. The predictive power of a risk score including age, BMI, gender, HbA1c, diabetes duration and ethnicity is only moderate. Future research should focus on another approach to the determinants used in this study or other determinants predictive of losing track of lipids on the short term.
Collapse
Affiliation(s)
- Josine C van der Heyden
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands.,Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Erwin Birnie
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands.,Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sarah A Bovenberg
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Pim Dekker
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Henk J Veeze
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Dick Mul
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| |
Collapse
|
36
|
Perak AM, Ning H, Kit BK, de Ferranti SD, Van Horn LV, Wilkins JT, Lloyd-Jones DM. Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016. JAMA 2019; 321:1895-1905. [PMID: 31112258 PMCID: PMC6537842 DOI: 10.1001/jama.2019.4984] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
Abstract
Importance Favorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors. Objective To analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016. Design, Setting, and Participants Serial cross-sectional analysis of US population-weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Surveys for 1999 through 2016. Linear temporal trends were analyzed using multivariable regression models with regression coefficients (β) reported as change per 1 year. Exposures Survey year; examined periods spanned 10 to 18 years based on data availability. Main Outcomes and Measures Age- and race/ethnicity-adjusted mean levels of high-density lipoprotein (HDL), non-HDL, and total cholesterol. Among fasting adolescents (aged 12-19 years), mean levels of low-density lipoprotein cholesterol, geometric mean levels of triglycerides, and mean levels of apolipoprotein B. Prevalence of ideal and adverse (vs borderline) levels of lipids and apolipoprotein B per pediatric lipid guidelines. Results In total, 26 047 youths were included (weighted mean age, 12.4 years; female, 51%). Among all youths, the adjusted mean total cholesterol level declined from 164 mg/dL (95% CI, 161 to 167 mg/dL) in 1999-2000 to 155 mg/dL (95% CI, 154 to 157 mg/dL) in 2015-2016 (β for linear trend, -0.6 mg/dL [95% CI, -0.7 to -0.4 mg/dL] per year). Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7 to 53.3 mg/dL) in 2007-2008 to 55.0 mg/dL (95% CI, 53.8 to 56.3 mg/dL) in 2015-2016 (β, 0.2 mg/dL [95% CI, 0.1 to 0.4 mg/dL] per year) and non-HDL cholesterol decreased from 108 mg/dL (95% CI, 106 to 110 mg/dL) to 100 mg/dL (95% CI, 99 to 102 mg/dL) during the same years (β, -0.9 mg/dL [95% CI, -1.2 to -0.6 mg/dL] per year). Among fasting adolescents, geometric mean levels of triglycerides declined from 78 mg/dL (95% CI, 74 to 82 mg/dL) in 1999-2000 to 63 mg/dL (95% CI, 58 to 68 mg/dL) in 2013-2014 (log-transformed β, -0.015 [95% CI, -0.020 to -0.010] per year), mean levels of low-density lipoprotein cholesterol declined from 92 mg/dL (95% CI, 89 to 95 mg/dL) to 86 mg/dL (95% CI, 83 to 90 mg/dL) during the same years (β, -0.4 mg/dL [95% CI, -0.7 to -0.2 mg/dL] per year), and mean levels of apolipoprotein B declined from 70 mg/dL (95% CI, 68 to 72 mg/dL) in 2005-2006 to 67 mg/dL (95% CI, 65 to 70 mg/dL) in 2013-2014 (β, -0.4 mg/dL [95% CI, -0.7 to -0.04 mg/dL] per year). Favorable trends were generally also observed in the prevalence of ideal and adverse levels. By the end of the study period, 51.4% (95% CI, 48.5% to 54.2%) of all youths had ideal levels for HDL, non-HDL, and total cholesterol; among adolescents, 46.8% (95% CI, 40.9% to 52.6%) had ideal levels for all lipids and apolipoprotein B, whereas 15.2% (95% CI, 13.1% to 17.3%) of children aged 6 to 11 years and 25.2% (95% CI, 22.2% to 28.2%) of adolescents aged 12 to 19 years had at least 1 adverse level. Conclusions and Relevance Between 1999 and 2016, favorable trends were observed in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.
Collapse
Affiliation(s)
- Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian K. Kit
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda V. Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T. Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
37
|
Saadé C, Sleilaty G, Gannagé-Yared MH. Longitudinal changes of lipid profile in the Lebanese pediatric population. Lipids Health Dis 2019; 18:48. [PMID: 30744653 PMCID: PMC6371449 DOI: 10.1186/s12944-019-0991-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background Few studies looked at the prevalence of dyslipidemia in pediatric Middle-Eastern countries. In addition, worldwide longitudinal changes of lipid profile is not well documented. The purpose of this study is to look at the longitudinal changes of lipid parameters in Lebanese school-age children. Materials and methods A total of 97 subjects (41 girls and 56 boys) aged between 11 and 21 years were included in this study. The subjects were selected among 339 school-age children with a previous abnormal lipid profile who were recruited from 10 schools of varying socio-economic levels (SEL). A fasting lipid profile [total cholesterol (TC), triglycerides (TG) and HDL-cholesterol (HDL-C)] was performed. Non-HDL-cholesterol (Non-HDL-C) was calculated. Weight and height were measured under the same conditions, and BMI percentiles were calculated. A multivariate covariance analysis model (MANCOVA) was used with TG, HDL-C and non-HDL-C as dependent variables with additional post-MANCOVA F tests. Results The age of the current cohort is 16.5 ± 2.9 years with no significant difference according to gender. The current lipid profile was obtained 3.1 ± 0.7 years following the initial one, with 53.6% of the subjects having it normalized. TC, TG, and non-HDL-C decreased significantly over time in girls, while only TG decreased significantly in boys. No significant changes were observed for HDL-C. Using MANCOVA, a significant time by age interaction was observed (p < 0.0001), while gender, BMI and SEL were found not to be significant. Post-hoc F tests showed that the time by age interaction was driven by TG (p = 0.03) and non-HDL-C (p < 0.001), the larger effect being observed in younger children. Conclusion A high proportion of school-age children normalize their abnormal lipid profile with time. Screening for lipid disorders could be postponed until post puberty age.
Collapse
Affiliation(s)
- Chloé Saadé
- Endocrinology Department, Faculty of Medicine, Saint Joseph University, Saint-Joseph, Beirut, Lebanon
| | - Ghassan Sleilaty
- Biostatistics Department, Faculty of Medicine, Saint Joseph University, Saint-Joseph, Beirut, Lebanon
| | - Marie-Hélène Gannagé-Yared
- Endocrinology Department, Faculty of Medicine, Saint Joseph University, Saint-Joseph, Beirut, Lebanon. .,Division of Endocrinology, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| |
Collapse
|
38
|
Filgueiras MDS, Vieira SA, Ribeiro AQ, de Novaes JF. FAMILY HISTORY IS ASSOCIATED WITH THE PRESENCE OF DYSLIPIDEMIA IN PRE-SCHOOL CHILDREN. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2019; 37:41-48. [PMID: 30066825 PMCID: PMC6362368 DOI: 10.1590/1984-0462/;2019;37;1;00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the association between family history and the presence of dyslipidemia in children. METHODS A cross-sectional study with 257 children aged 4 to 7 years old from Viçosa, Minas Gerais, Southeast Brazil. Nutritional status and lipid profile (total cholesterol, cholesterol fractions, and triglyceride) assessments and an active search for a family history of dyslipidemia in parents were carried out. Pearson's chi-square test was used to identify associations, and Student's t-test was used to compare means. A Poisson regression analysis was performed to assess the independent association between family history and the presence of dyslipidemia in children. A significance level of 5% was adopted. RESULTS Children of parents with dyslipidemia had higher serum concentrations of total cholesterol and triglycerides. In a regression analysis after adjustments, the presence of dyslipidemia in the father or in the mother (OR: 2.43; 95%CI 1.12-5.27), as well as the presence of dyslipidemia in both the father and the mother (OR: 5.62; 95%CI 2.27-13.92) were associated with hypertriglyceridemia in children. Children of parents with dyslipidemia had a higher prevalence of elevated low-density lipoproteins (LDL-c) (OR: 1.52; 95%CI 1.18-1.97). CONCLUSIONS An investigation of the family history of dyslipidemia should be made as part of the protocol to verify the presence of hypertriglyceridemia and dyslipidemia in children.
Collapse
|
39
|
Angoorani P, Khademian M, Ejtahed HS, Heshmat R, Motlagh ME, Vafaeenia M, Shafiee G, Mahdivi-Gorabi A, Qorbani M, Kelishadi R. Are non-high-density lipoprotein fractions associated with pediatric metabolic syndrome? The CASPIAN-V study. Lipids Health Dis 2018; 17:257. [PMID: 30428934 PMCID: PMC6236929 DOI: 10.1186/s12944-018-0895-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-high-density lipoprotein cholesterol (non-HDL-C) is considered as a valuable predictor for dyslipidemia and subclinical atherosclerosis which can be an appropriate index for identifying individuals with metabolic syndrome (MetS). OBJECTIVE To evaluate the association between non-HDL-C MetS and determine the optimal cut-points of non-HDL-C fractions for identifying MetS in Iranian children and adolescents. METHODS This nationwide study was conducted in the framework of the fifth survey of a national school-based surveillance program on children and adolescents aged 7-18 years. MetS was defined by the Adult Treatment Panel III (ATP III) criteria modified for the pediatric age group. The analysis of receiver operating characteristic (ROC) curve was applied to determine the optimal cut-points of non-HDL-C, difference between non-HDL-C and LDL-C (Diff-C) and triglycerides (TG) to HDL-C ratio (TG/HDL-C) for the prediction of MetS. RESULTS Overall, the study participants consisted of 3843 students (52.3% boys) with mean (±SD) age of 12.28 (3.1) years. The odds of high LDL-C, low HDL-C and MetS were increased in subjects with higher non-HDL-C, Diff-C and TG/HDL-C (P < 0.05). Non-HDL-C, Diff-C and TG/HDL-C cut-off points for predicting MetS were 120.5 mg/dl (sensitivity: 44%, specificity: 73%), 19.9 mg/dl (sensitivity: 85%, specificity: 75%) and 2.53 (sensitivity: 82%, specificity: 79%), respectively. CONCLUSIONS This study revealed a strong association between surrogates for serum lipid profile including non-HDL-C, TG/HDL-C and Diff-C and pediatric MetS. Our findings suggest that age- and gender-specific reference values of these markers were appropriate for both risk classification and long-term control of cardiovascular events in clinical assessments.
Collapse
Affiliation(s)
- Pooneh Angoorani
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Khademian
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Hezar-Jarib Ave, Isfahan, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahya Vafaeenia
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Armita Mahdivi-Gorabi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Hezar-Jarib Ave, Isfahan, Iran.
| |
Collapse
|
40
|
Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting. Adv Prev Med 2018; 2018:5474838. [PMID: 30009058 PMCID: PMC6020661 DOI: 10.1155/2018/5474838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/20/2018] [Indexed: 01/24/2023] Open
Abstract
The feasibility of “point-of-care” screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9–18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal “point-of care” non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.
Collapse
|
41
|
Kelley JC, Gutmark-Little I, Backeljauw P, Bamba V. Increased Non-High-Density Lipoprotein Cholesterol in Children and Young Adults with Turner Syndrome Is Not Explained By BMI Alone. Horm Res Paediatr 2018; 88:208-214. [PMID: 28768282 DOI: 10.1159/000477761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/23/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Turner syndrome (TS) is associated with an increased risk of cardiovascular disease. Non-high-density lipoprotein cholesterol (non-HDL-C) is a convenient measure of atherogenicity (normal concentration <120 mg/dL) but has not been investigated in TS. We aim to evaluate non-HDL-C patterns in a cohort of pediatric and young adult females with TS. METHODS A retrospective chart review was used to obtain demographics, body composition, genetic reports, and lipid profiles in females with TS. RESULTS Lipid profiles were assessed in 158 females (mean age 13.6 years). Mean non-HDL-C was 118.9 mg/dL (±32.0); the prevalence of high non-HDL-C (≥144 mg/dL) was 17.7% (n = 28). In TS females aged 8-17 years (n = 46), the prevalence of high non-HDL-C was 23.9% (95% CI 11.1-36.7; n = 11) between 2011 and 2012, compared to 9.2% (95% CI 5.6-14.1) in females of the same age in the general population reported in the National Health and Nutrition Examination Survey (NHANES) dataset (p < 0.005). Body mass index (BMI) accounted for only 6% of variance in non-HDL-C values (β coefficient = 1.31, p < 0.05). CONCLUSIONS Children and adolescents aged 8-17 years with TS appear to have a greater prevalence of adverse non-HDL-C levels compared to the general adolescent population. The prevalence of high non-HDL-C was not fully explained by BMI.
Collapse
Affiliation(s)
- Jennifer C Kelley
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Iris Gutmark-Little
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philippe Backeljauw
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vaneeta Bamba
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
42
|
Strand MF, Fredriksen PM, Hjelle OP, Lindberg M. Reference intervals for serum lipids and prevalence of dyslipidaemia in 6-12-year-old children: The Health Oriented Pedagogical Project (HOPP). Scand J Public Health 2018; 46:21-27. [PMID: 29754571 DOI: 10.1177/1403494818767824] [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] [Indexed: 11/16/2022]
Abstract
AIMS Elevated serum lipid concentrations in childhood are thought to be risk factors for the development of cardiovascular disease later in life. The present study aims to provide age- and gender-related reference intervals for total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and non-HDL cholesterol in healthy school children. We also investigated the prevalence of dyslipidaemia using the published criteria for these biomarkers. METHODS Venous blood and anthropometric data were collected from 1340 children in the HOPP study, aged between 6 and 12 years. Age- and gender-related reference intervals (2.5th and 97.5th percentiles) were established according to the IFCC recommendations, using the software RefVal 4.10. RESULTS Gender differences were observed for total cholesterol and non-HDL cholesterol, but not for HDL cholesterol. Age differences were observed for total cholesterol. The reference intervals were in the range of 3.1-5.9 mmol/L for total cholesterol, 1.0-2.4 mmol/L for HDL cholesterol and 1.4-4.2 mmol/L for non-HDL cholesterol. Dyslipidaemia prevalence was as follows: increased TC 9.6%, decreased HDL 1.6%, and increased non-HDL 5.6%. CONCLUSIONS Age- and gender-related reference intervals in a Norwegian population are similar to those reported in other countries. The prevalence of dyslipidaemia among Norwegian children is significant, emphasising the importance of appropriate reference intervals in clinical practice.
Collapse
Affiliation(s)
| | | | - Ole Petter Hjelle
- 1 Department of Health Sciences, Kristiania University College, Norway
| | | |
Collapse
|
43
|
Li KJ, Borresen EC, Jenkins-Puccetti N, Luckasen G, Ryan EP. Navy Bean and Rice Bran Intake Alters the Plasma Metabolome of Children at Risk for Cardiovascular Disease. Front Nutr 2018; 4:71. [PMID: 29404331 PMCID: PMC5786740 DOI: 10.3389/fnut.2017.00071] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022] Open
Abstract
Abnormal cholesterol in childhood predicts cardiovascular disease (CVD) risk in adulthood. Navy beans and rice bran have demonstrated efficacy in regulating blood lipids in adults and children; however, their effects on modulating the child plasma metabolome has not been investigated and warrants investigation. A pilot, randomized-controlled, clinical trial was conducted in 38 children (10 ± 0.8 years old) with abnormal cholesterol. Participants consumed a snack for 4 weeks containing either: no navy bean or rice bran (control); 17.5 g/day cooked navy bean powder; 15 g/day heat-stabilized rice bran; or 9 g/day navy beans and 8 g/day rice bran. Plasma metabolites were extracted using 80% methanol for global, non-targeted metabolic profiling via ultra-high performance liquid-chromatography tandem mass spectrometry. Differences in plasma metabolite levels after 4 weeks of dietary intervention compared to control and baseline were analyzed using analysis of variance and Welch's t-tests (p ≤ 0.05). Navy bean and/or rice bran consumption influenced 71 plasma compounds compared to control (p ≤ 0.05), with lipids representing 46% of the total plasma metabolome. Significant changes were determined for 18 plasma lipids in the navy bean group and 10 plasma lipids for the rice bran group compared to control, and 48 lipids in the navy bean group and 40 in the rice bran group compared to baseline. These results support the hypothesis that consumption of these foods impact blood lipid metabolism with implications for reducing CVD risk in children. Complementary and distinct lipid pathways were affected by the diet groups, including acylcarnitines and lysolipids (navy bean), sphingolipids (rice bran), and phospholipids (navy bean + rice bran). Navy bean consumption decreased free fatty acids associated with metabolic diseases (palmitate and arachidonate) and increased the relative abundance of endogenous anti-inflammatory lipids (endocannabinoids, N-linoleoylglycine, 12,13-diHOME). Several diet-derived amino acids, phytochemicals, and cofactors/vitamins with cardioprotective properties were increased compared to control and/or baseline, including 6-oxopiperidine-2-carboxylate (1.87-fold), N-methylpipecolate (1.89-fold), trigonelline (4.44- to 7.75-fold), S-methylcysteine (2.12-fold) (navy bean), salicylate (2.74-fold), and pyridoxal (3.35- to 3.96-fold) (rice bran). Findings from this pilot study support the need for investigating the effects of these foods for longer durations to reduce CVD risk. TRIAL REGISTRATION clinicaltrials.gov (identifier NCT01911390).
Collapse
Affiliation(s)
- Katherine J. Li
- Nutrition and Toxicology Laboratory, Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Erica C. Borresen
- Nutrition and Toxicology Laboratory, Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - NaNet Jenkins-Puccetti
- Medical Center of the Rockies, University of Colorado Health Research – Northern Region, Loveland, CO, United States
| | - Gary Luckasen
- Medical Center of the Rockies, University of Colorado Health Research – Northern Region, Loveland, CO, United States
| | - Elizabeth P. Ryan
- Nutrition and Toxicology Laboratory, Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| |
Collapse
|
44
|
Sriram S, St Sauver JL, Jacobson DJ, Fan C, Lynch BA, Cristiani V, Kullo IJ, Lteif AN, Kumar S. Temporal trends in lipid testing among children and adolescents: A population based study. Prev Med Rep 2017; 8:267-272. [PMID: 29204335 PMCID: PMC5705799 DOI: 10.1016/j.pmedr.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Unfavorable lipid levels during childhood are associated with subsequent development of atherosclerotic cardiovascular disease. The American Academy of Pediatrics and National Heart, Lung and Blood Institute in 2011 recommended universal lipid screening for children between ages 9–11 years and between ages 17–21 years. The objective of the study was to determine temporal trends in lipid testing among children and young adults in a mid-western population. The Rochester Epidemiology Project database was used to identify lipid testing in ages 2–21 years (n = 51,176) in the Olmsted County population from January 1, 2008 through December 31, 2014. Generalized estimating equations with Poisson distribution were used to test for temporal trends in lipid testing across the age groups. There was modest increase in lipid testing in children in the age groups, 9–11 years and 17–21 years (1.5% in 2008 to 2.2% in 2014, P < 0.001 and 4.4% in 2008 to 4.6% in 2014, P = 0.02, respectively). There was a significant decrease in proportion of 17–21 year olds with elevated total cholesterol (16.2% in 2008 to 11.6% in 2014; P = 0.01) and non-high density lipoprotein cholesterol (22.6% in 2008 to 12.6% in 2014; P < 0.001). In this population-based study, rates of lipid testing increased minimally only in the last six years. Further longitudinal studies are warranted to improve guideline dissemination and address attitudes, practices and barriers to lipid testing in children and young adults. In 2011, universal lipid screening was recommended for children and young adults. We investigated temporal trends in lipid testing in a mid-western community. There was only a minimal increase in rates of lipid testing. There is need for improve guideline dissemination and implementation.
Collapse
Key Words
- ASCVD, atherosclerotic cardiovascular disease
- Children
- Dyslipidemia
- HDL, high density lipoprotein
- HDL-C, high density lipoprotein cholesterol
- Hypercholesterolemia
- LDL-C, low density lipoprotein cholesterol
- Lipids
- NCEP, National Cholesterol Education Program
- NHANES, National Health and Nutrition Examination Survey
- NHLBI, National Heart, Lung, and Blood Institute
- REP, Rochester Epidemiology Project
- Screening
- TC, total cholesterol
- mg/dL, milligrams/deciliters
- non-HDL-C, non high density lipoprotein cholesterol
Collapse
Affiliation(s)
- Swetha Sriram
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.,Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Debra J Jacobson
- Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Chun Fan
- Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Brian A Lynch
- Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Valeria Cristiani
- Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
45
|
How Low to Go With Glucose, Cholesterol, and Blood Pressure in Primary Prevention of CVD. J Am Coll Cardiol 2017; 70:2171-2185. [DOI: 10.1016/j.jacc.2017.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022]
|
46
|
Moghadasi M, Kelishadi R, Marateb HR, Haghjooy Javanmard S, Mansourian M, Heshmat R, Esmaeil Motlagh M. Logic Regression Analysis of Gene Polymorphisms and HDL Levels in a Nationally Representative Sample of Iranian Adolescents: The CASPIAN-III Study. Int J Endocrinol Metab 2017; 15:e14037. [PMID: 30805016 PMCID: PMC6372018 DOI: 10.5812/ijem.14037] [Citation(s) in RCA: 2] [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: 11/24/2016] [Accepted: 07/01/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To investigate the associations of genetic polymorphism with high-density lipoprotein-cholesterol (HDL-C) levels in Iranian adolescents. METHODS This multicentre study was conducted on 10 - 18 year-old students from 27 provinces in Iran. Logic regression approach was used to determine the main effects and interactions of polymorphisms related to HDL-C levels. RESULTS The rs708272 polymorphism was significantly related to HDL-C levels. Moreover, rs708272 increased HDL-C levels and had a protective effect on HDL-C. The interaction of rs2230808 and rs5880 polymorphisms as well as the interaction of rs320 and rs708272 polymorphisms were associated with lower HDL-C levels. Furthermore, the interaction of rs320 and rs1801177 polymorphisms was associated with lower HDL-C levels. CONCLUSIONS We found that not only single SNPs, but also interactions of several SNPs affect HDL-C levels. Given the high prevalence of low HDL-C in Middle Eastern populations, further genetic studies are required for detailed analysis.
Collapse
Affiliation(s)
- Mehri Moghadasi
- Student Research Center, Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Pediatrics Department, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Marateb
- Biomedical Engineering Department, Faculty of Engineering, University of Isfahan, Isfahan, Iran
- Department of Automatic Control, Biomedical Engineering Research Center, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Barcelona, Spain
| | | | - Marjan Mansourian
- Pediatrics Department, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Physiology Department, Applied Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Biostatistics and Epidemiology Department, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Corresponding author: Marjan Mansourian, Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Hezarjarib St, Isfahan, Iran. Tel: +98-3137923256, Fax: +98-3136687898, E-mail:
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
47
|
Levenson AE, Milliren CE, Biddinger SB, Ebbeling CB, Feldman HA, Ludwig DS, de Ferranti SD. Calorically restricted diets decrease PCSK9 in overweight adolescents. Nutr Metab Cardiovasc Dis 2017; 27:342-349. [PMID: 28228332 PMCID: PMC5410867 DOI: 10.1016/j.numecd.2016.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Nutritional therapy is the first line approach to treatment of hyperlipidemia in childhood. Proprotein convertase subtilisin kexin type 9 (PCSK9) is a key regulator of plasma cholesterol levels and a target of novel lipid-lowering pharmacotherapies. We examined the effects of an intensive nutritional intervention on PCSK9 levels in overweight adolescents with cardiovascular disease (CVD) risk factors. METHODS AND RESULTS Twenty seven obese and overweight adolescents with CVD risk factors were assigned to either a low fat or low glycemic load diet. During an 8-week "Intensive Phase," assigned meals were delivered to the home, and all participants received weekly in-person home nutrition counseling and phone calls. The subjects then underwent a 4-month "Maintenance Phase" without food provision and with no in-person contact. Anthropometric measurements, laboratory data, and serum PCSK9 protein levels were measured at baseline, 8 weeks, and 6 months. PCSK9 decreased by 16.5% at 8 weeks (201.2 ± 56.3 vs 165.6 ± 58.4 ng/mL; p < 0.001); PCSK9 levels returned to baseline levels at 6 months, after the Maintenance Phase. Change in PCSK9 was associated with change in fasting insulin, HOMA-IR, and AUC insulin, independent of weight loss. CONCLUSIONS PCSK9 decreased in youth participating in an intensive dietary intervention. Change in HOMA-IR was associated with change in PCSK9, independent of weight loss, suggesting an important relationship with insulin sensitivity. ClinicalTrials.gov Identifier: NCT01080339.
Collapse
Affiliation(s)
- A E Levenson
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - C E Milliren
- Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - S B Biddinger
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - C B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
| | - H A Feldman
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - D S Ludwig
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
| | - S D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
48
|
Kubo T, Takahashi K, Furujo M, Hyodo Y, Tsuchiya H, Hattori M, Fujinaga S, Urayama K. Usefulness of non-fasting lipid parameters in children. J Pediatr Endocrinol Metab 2017; 30:77-83. [PMID: 27977407 DOI: 10.1515/jpem-2016-0271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study assessed whether non-fasting lipid markers could be substituted for fasting markers in screening for dyslipidemia, whether direct measurement of non-fasting low-density lipoprotein cholesterol [LDL-C (D)] could be substituted for the calculation of fasting LDL-C [LDL-C (F)], and the utility of measuring non-high-density lipoprotein cholesterol (non-HDL-C). METHODS In 33 children, the lipid profile was measured in the non-fasting and fasting states within 24 h. Correlations were examined between non-fasting LDL-C (D) or non-HDL-C levels and fasting LDL-C (F) levels. RESULTS Non-fasting triglyceride (TG), total cholesterol (TC), HDL-C, LDL-C (D), and non-HDL-C levels were all significantly higher than the fasting levels, but the mean difference was within 10% (except for TG). Non-fasting LDL-C (D) and non-HDL-C levels were strongly correlated with the fasting LDL-C (F) levels. CONCLUSIONS In conclusion, except for TG, non-fasting lipid parameters are useful when screening children for dyslipidemia. Direct measurement of non-fasting LDL-C and calculation of non-fasting non-HDL-C could replace the calculation of fasting LDL-C because of convenience.
Collapse
|
49
|
Abe Y. Difference in Serum Non-High-Density Lipoprotein Cholesterol Levels in terms of Sex, Age, and Physique in Children and Adolescents. J Atheroscler Thromb 2016; 23:1311-1312. [PMID: 27784861 PMCID: PMC5221493 DOI: 10.5551/jat.ed060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yuriko Abe
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| |
Collapse
|
50
|
Agirbasli M, Tanrikulu AM, Berenson GS. Metabolic Syndrome: Bridging the Gap from Childhood to Adulthood. Cardiovasc Ther 2016; 34:30-6. [PMID: 26588351 DOI: 10.1111/1755-5922.12165] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Childhood and adolescence are particularly vulnerable periods of life to the effects of cardiometabolic risk and later development of atherosclerosis, hypertension, and diabetes mellitus. Developing countries with limited resources suffer most heavily from the consequences of cardiometabolic risk in children and its future implications to the global health burden. A better understanding of mechanisms leading to cardiometabolic risk in early life may lead to more effective prevention and intervention strategies to reduce metabolic stress in children and later disease. Longitudinal "tracking" studies of cardiometabolic risk in children provide a tremendous global resource to direct prevention strategies for cardiovascular disease. In this review, we will summarize the pathophysiology, existing definitions for cardiometabolic risk components in children. Screening and identifying children and adolescents of high cardiometabolic risk and encouraging them and their families through healthy lifestyle changes should be implemented to as a global public health strategy.
Collapse
Affiliation(s)
- Mehmet Agirbasli
- Department of Cardiology, Medeniyet University Medical School, Istanbul, Turkey
| | - Azra M Tanrikulu
- Department of Cardiology, Maltepe State Hospital, Istanbul, Turkey
| | - Gerald S Berenson
- Bogalusa Heart Study, Tulane Center of Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|