1
|
Zhao CH. The association between the single-nucleotide polymorphism of site rs1333040 in region 9p21 and the risk of coronary heart disease in Chinese population. Acta Cardiol 2024:1-10. [PMID: 39145594 DOI: 10.1080/00015385.2024.2391132] [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: 07/03/2023] [Revised: 02/26/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Rs1333040 is the single-nucleotide polymorphisms (SNP) related with coronary heart disease (CHD). The aim of the present study is to examine the association between rs1333040 polymorphism genotypes and CHD and to further explore the molecular mechanism in Chinese population. METHODS A case-control study was used in this study, including 500 CHD patients and 500 control subjects. CHD patients and controls were distinguished by coronary angiography. Genotypes of rs1333040 were determined on the Agena MassARRAY system. Statistical analysis was conducted by SPSS (Ver 16.0) and plink (Ver. 1.07, Shaun Purcell). RESULTS Fisher's exact test by plink indicated a significant difference in the allele distribution between cases and controls, the allele T may be associated with a higher risk of CHD (p = 0.012, odds ratio (OR) = 1.258). The serum levels of low-density lipoprotein cholesterol (LDL-C) (p = 0.029) and Gensini score (p = 0.008) distributed differently in patients with various alleles. In the recessive model, the levels of high-density lipoprotein (HDL) and apolipoprotein A (ApoA) were higher in the TC + CC genotype than in the TT genotype. The TC + TT genotype was found to be risk factors against CHD in a dominant model (OR = 1.278, p = 0.014). The TC + TT genotype along with multiple risk factors significantly positively correlated with the risk of CHD. CONCLUSIONS The present study investigates the association between the rs1333040 polymorphism genotypes and CHD. The T allele of rs1333040 is the susceptibility site of CHD. The interaction between SNP and various risk factors plays an important role in the development of CHD.
Collapse
Affiliation(s)
- Chen-Hui Zhao
- Department of Cardiovascular Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
| |
Collapse
|
2
|
Guo F, Chen X, Howland S, Maldonado LE, Powell S, Gauderman WJ, McConnell R, Yan M, Whitfield L, Li Y, Bastain TM, Breton CV, Hodis HN, Farzan SF. Association Between Cardiovascular Health and Subclinical Atherosclerosis Among Young Adults Using the American Heart Association's "Life's Essential 8" Metrics. J Am Heart Assoc 2024; 13:e033990. [PMID: 39077816 DOI: 10.1161/jaha.123.033990] [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: 03/14/2024] [Accepted: 05/29/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND This study investigated the association of American Heart Association's cardiovascular health guidelines Life's Essential 8 (LE8) and Life's Simple 7 (LS7) with carotid artery outcomes among young adults. METHODS AND RESULTS This cross-sectional study included 240 young adults (age 24.2±1.6 years) who underwent a carotid ultrasound between 2018 and 2022. LE8 score was calculated from 4 health factors (body mass index, non-high-density lipoprotein cholesterol, fasting glucose, and blood pressure), and 4 health behaviors (dietary intake, physical activity, tobacco use, and sleep). LS7 was calculated from 7 metrics (all LE8 metrics, except for sleep) with a simpler algorithm. Higher LE8 and LS7 scores both indicate better health and better adherence to American Heart Association guidelines. Carotid artery outcomes included carotid artery intima-media thickness, arterial stiffness (eg, distensibility), and echogenicity determined by grayscale median of the intima media complex. Results of linear regression analyses, adjusting for age, sex, ethnicity, and parents' highest degree, indicated that a 1-SD increase in LE8 score was associated with 12.14 μm lower carotid artery intima-media thickness (95% CI, -20.93 to 3.35), 1.17 (10-6×m2/N) greater distensibility (95% CI, 0.09-2.24), suggesting less arterial stiffness, and 2.66 μm greater grayscale median of the intima media complex (95% CI, 0.58-4.75), suggesting less lipid deposition. Analyses using LS7 score demonstrated comparable findings. Health factor metrics demonstrated stronger association with carotid artery outcomes, as compared with behavior metrics. CONCLUSIONS Greater adherence to the American Heart Association's cardiovascular health guidelines is associated with lower risk for subclinical atherosclerosis in young adults. LE8 and LS7 demonstrated comparable associations with carotid artery outcomes.
Collapse
Affiliation(s)
- Fangqi Guo
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Xinci Chen
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Steve Howland
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Luis E Maldonado
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Sydney Powell
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - W James Gauderman
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Mingzhu Yan
- Atherosclerosis Research Unit University of Southern California Los Angeles CA USA
| | - Lora Whitfield
- Atherosclerosis Research Unit University of Southern California Los Angeles CA USA
| | - Yanjie Li
- Atherosclerosis Research Unit University of Southern California Los Angeles CA USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Howard N Hodis
- Atherosclerosis Research Unit University of Southern California Los Angeles CA USA
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine University of Southern California Los Angeles CA USA
| |
Collapse
|
3
|
Pan P, Yang Y, He S, Zhao G, Chen XP. The effects of initial and subsequent overweight or obesity on hypertension in the middle age. J Clin Hypertens (Greenwich) 2024; 26:525-531. [PMID: 38552194 PMCID: PMC11088430 DOI: 10.1111/jch.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
The aims of our study were to examine whether initial or subsequent adiposity status had a greater effect on hypertension. We collected data in 1992 and again in 2007 from the same group of 597 individuals in the middle age. The subjects were classified into four groups: individuals with a normal body mass index (BMI) in 1992 and 2007 were in Group I; those with a normal BMI in 1992, but became overweight or obese in 2007 were in Group II; those who were overweight or obese in 1992, but had a normal BMI in 2007 were in Group III; and those who were overweight or obese in 1992 and 2007 were in Group IV. Their demographic data were recorded. The relationship between adiposity status and hypertension was analyzed using logistic regression model. The cumulative incidence of hypertension was 35.5%, 56.3%, 50.0%, and 65.1% for Group I to IV, respectively. Compared with Group I, after adjusted factors, the hazard ratio (HR) was 1.80 for Group II (P = .001), 1.40 for Group III (P = .150), and 2.31 for Group IV (P < .001). Adiposity status in 2007 could predict hypertension (OR = 2.5, P < .001), as opposed to the initial adiposity status (P = .148). Subsequently adiposity status could have major effects on hypertension. Our society is very short of public health resources, particularly in developing countries, we should pay more attention to current adiposity status and encourage middle-aged people to lose weight.
Collapse
Affiliation(s)
- Pei Pan
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yang
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Sen He
- Department of Cardiovascular, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Zhao
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Ping Chen
- Department of Cardiovascular, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
4
|
Messner A, Nairz J, Kiechl S, Winder B, Pechlaner R, Geiger R, Knoflach M, Kiechl-Kohlendorfer U. Comparison of body mass index and fat mass index to classify body composition in adolescents-The EVA4YOU study. Eur J Pediatr 2024; 183:2203-2214. [PMID: 38386029 PMCID: PMC11035421 DOI: 10.1007/s00431-024-05474-x] [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: 01/15/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
The objectives of this study were to develop age- and sex-specific reference percentiles for fat mass index (FMI) and fat-free mass index (FFMI) in adolescents aged 14 to 19 years and to determine differences in overweight/obesity classification by FMI and body mass index (BMI). The EVA4YOU study is a single-center cross-sectional study conducted in western Austria. Cardiovascular risks including anthropometric measurements and bioelectrical impedance analysis were assessed in adolescents (mean age 17 years). FMI and FFMI were calculated as the ratio of fat mass (FM) and fat-free mass (FFM) to the square of height and compared to study population-specific BMI percentiles. One thousand four hundred twenty-two adolescents were included in the analysis. Girls had a significantly higher mean FM and FMI and a significantly lower mean FFM, FFMI (p < 0.001, each), and mean BMI (p = 0.020) than boys. Body composition classification by FMI and BMI percentiles shows a concordance for the < 75th and > 97th percentile, but a significant difference in percentile rank classifications between these two cut-off values (all p < 0.05). Based on FMI, 15.5% (221/1422) of the whole population and 29.4% (92/313) of those between the 75th and 97th percentiles are classified one category higher or lower than those assigned by BMI. CONCLUSION Classification of normal or pathologic body composition based on BMI and FMI shows good accordance in the clearly normal or pathologic range. In an intermediate range, FMI reclassifies categories based on BMI in more than a quarter of adolescents. Cut-off values to differentiate normal from pathologic FMI values on a biological basis are needed. TRIAL REGISTRATION The study is registered at www. CLINICALTRIALS gov (Identifier: NCT04598685; Date of registration: October 22, 2020). WHAT IS KNOWN • Chronic non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with major risk factors including unhealthy diets, harmful behaviors, and obesity. Obesity in children and adolescents is a key risk factor for later NCDs, which is commonly measured by Body Mass Index (BMI). • BMI can be misleading as it doesn't distinguish between fat mass (FM) and fat-free mass (FFM), leading to potential misclassification of obesity in children. Previous studies have already suggested the use of the Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) as a more accurate measures of body composition. WHAT IS NEW • This study adds the first age- and sex-specific reference values for FMI and FFMI in Austrian adolescents using bioelectrical impedance analysis (BIA) as a safe and secure measurement method of a large representative cohort. • We found percentile misclassification between BMI and FMI when categorizing for obesity, especially in intermediate categories of body composition. Furthermore, when comparing the new reference values for FMI and FFMI to existing ones from the US, UK, and Germany we could show a good alignment within the European cohorts and major differences with American values, indicating and confirming the difference of FMI and FFMI for different populations of different ethnical background, living on different continents.
Collapse
Affiliation(s)
- Alex Messner
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Pediatrics II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Johannes Nairz
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Pediatrics II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophia Kiechl
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Bernhard Winder
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Vascular Surgery, Feldkirch Hospital, Feldkirch, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria.
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | | |
Collapse
|
5
|
Farahani F, Rodriguez JA, Wukich DK, Zide JR, Riccio AI. Obesity Increases Risk for Wound Complications After Pediatric Foot Surgery: A Retrospective Cohort Review Using the NSQIP-Pediatric Database. J Pediatr Orthop 2024; 44:117-123. [PMID: 37981899 DOI: 10.1097/bpo.0000000000002566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND As the incidence of childhood obesity continues to rise, so too does the number of obese children who undergo foot surgery. As the childhood obesity epidemic rolls on, pediatric orthopaedic surgeons will encounter obese patients with even greater frequency. Therefore, a comprehensive understanding of the risks associated with obesity is valuable to maximize patient safety. The purpose of this study is to retrospectively evaluate the relationship between obesity and postoperative outcomes in patients undergoing pediatric foot surgery across multiple institutions using a large national database. METHODS Pediatric patients who had undergone foot surgery were retrospectively identified using the American College of Surgeons 2012-2017 Pediatric National Surgical Quality Improvement (ACS-NSQIP-Pediatric) database by cross-referencing reconstructive foot-specific CPT codes with ICD-9/ICD-10 diagnosis codes. Center for Disease Control BMI-to-age growth charts were used to stratify patients into normal-weight and obese cohorts. Univariate and multivariate analyses were performed to describe and assess outcomes in obese compared with normal-weight patients. RESULTS Of the 3924 patients identified, 1063 (27.1%) were obese. Compared with normal-weight patients, obese patients were more often male (64.7% vs. 58.7%; P =0.001) and taller (56.3 vs. 51.3 inches; P <0.001). Obese patients had significantly higher rates of overall postoperative complications (3.01% vs. 1.32%; P =0.001) and wound dehiscence (1.41% vs. 0.59%; P =0.039). Multivariate analysis found that obesity was an independent predictor of both wound dehiscence [adjusted odds ratio (OR)=2.16; 95% CI=1.05-4.50; P =0.037] and surgical site infection (adjusted OR=3.03; 95% CI=1.39-6.61; P =0.005). Subgroup analysis of patients undergoing clubfoot capsular release procedures identified that obese patients had a higher rate of wound dehiscence (3.39% vs. 0.51%; P =0.039) compared with normal-weight patients. In multivariate analysis, obesity was an independent predictor of dehiscence (adjusted OR=5.71; 95% CI=1.46-22.31; P =0.012) in this procedure group. There were no differences in complication rates between obese and normal-weight patients in a subgroup analysis of tarsal coalition procedures or clubfoot tibialis anterior tendon transfer procedures. CONCLUSION Obese children undergoing foot surgery had higher overall complication rates, wound complications, and surgical site infections compared with children of normal weight. As the incidence of childhood obesity continues to rise, this information may be useful in assessing and discussing surgical risks with patients and their families. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Farzam Farahani
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joel A Rodriguez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacob R Zide
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center, Dallas, Dallas, TX
| | - Anthony I Riccio
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX
| |
Collapse
|
6
|
Arriaga-Cázares HE, Vega-Morales D, Moreno-Treviño CA, Juarez-Juarez JL, Pérez-Arizmendi CA, Martagón-Rosado AJ. Comparison of Two Strategies for Hypercholesterolemia Detection through Point-of-Care Testing. Diagnostics (Basel) 2024; 14:143. [PMID: 38248020 PMCID: PMC10814133 DOI: 10.3390/diagnostics14020143] [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: 11/13/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Childhood dyslipidemia is a common condition that can lead to atherosclerotic cardiovascular disease in adulthood. It is usually multifactorial. Screening for cholesterol disorders in children varies based on risk factors, with some guidelines recommending cascade screening for children with a clear family history of familial hypercholesterolemia, targeted screening for those with specific risk factors, and universal screening. Point-of-care testing (POCT) cholesterol tests offer potential advantages, including ease of use, portability, increased patient access, low cost, fewer medical or laboratory visits, and instant results. This study aimed to evaluate the effect of POCT cholesterol screening on the diagnosis of hypercholesterolemia in children in a family practice setting. METHODS We used a POCT cholesterol analyzer to perform two different (universal and targeted) screening approaches for dyslipidemia in children. We used the NCEP guidelines for the classification of the results. RESULTS We screened 183 children, 105 in the universal screening group and 78 in the targeted screening group. Eight patients in the targeted screening group had elevated cholesterol levels (p = 0.02). CONCLUSIONS All participants received instant feedback and recommendations. Using a targeted screening approach, POCT could be a practical and effective tool for identifying at-risk children with hypercholesterolemia.
Collapse
Affiliation(s)
- Héctor Eliud Arriaga-Cázares
- Instituto Mexicano del Seguro Social, Hospital de Traumatología y Ortopedia N.º 21, Monterrey 64000, Mexico
- Escuela de Medicina, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey 64849, Mexico
| | - David Vega-Morales
- Instituto Mexicano del Seguro Social, Hospital General de Zona 17, Monterrey 64420, Mexico;
| | - Carlos Alberto Moreno-Treviño
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar 26, Monterrey 64117, Mexico; (C.A.M.-T.); (C.A.P.-A.)
| | - Juana Lorena Juarez-Juarez
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar 26, Monterrey 64117, Mexico; (C.A.M.-T.); (C.A.P.-A.)
| | - Carlos Azael Pérez-Arizmendi
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar 26, Monterrey 64117, Mexico; (C.A.M.-T.); (C.A.P.-A.)
| | - Alexandro J. Martagón-Rosado
- Escuela de Medicina, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey 64849, Mexico
- Institute for Obesity Research, Instituto Tecnologico y de Estudios Superiores de Monterrey, Monterrey 64849, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| |
Collapse
|
7
|
Salama M, Balagopal B, Fennoy I, Kumar S. Childhood Obesity, Diabetes. and Cardiovascular Disease Risk. J Clin Endocrinol Metab 2023; 108:3051-3066. [PMID: 37319430 DOI: 10.1210/clinem/dgad361] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
This mini-review aims to briefly summarize the pathophysiology of childhood obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) risk in children and adolescents. Recent data on efficacy of lifestyle interventions, medications, and metabolic surgery for obesity, T2DM, and CVD risk factors are also reviewed. We conducted a PubMed search of English-language original and review articles relevant to childhood obesity, T2DM, and CVD risk factors, and biomarkers in children with an emphasis on recent publications. Childhood obesity arises from an intricate interaction between genetic, physiologic, environmental, and socioeconomic factors. The rise in the prevalence of childhood obesity is associated with the development of comorbidities including T2DM and CVD at an early age. A multipronged approach is central to the detection, monitoring, and management of childhood obesity and associated adverse metabolic consequences.
Collapse
Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
| | - Babu Balagopal
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biomedical Research, Nemours Children's Health System, Jacksonville, FL 32207, USA
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University, New York, NY 10032, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
8
|
Bagatini NC, Feil Pinho CD, Leites GT, da Cunha Voser R, Gaya AR, Santos Cunha GD. Effects of cardiorespiratory fitness and body mass index on cardiometabolic risk factors in schoolchildren. BMC Pediatr 2023; 23:454. [PMID: 37689621 PMCID: PMC10492303 DOI: 10.1186/s12887-023-04266-w] [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: 11/22/2022] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION High levels of physical fitness established during childhood and adolescence have been associated with positive effects on cardiometabolic risk factors (CMRF), which persist into adulthood. Conversely, a sedentary lifestyle, overweight, and obesity during this period are considered public health problems. These conditions tend to worsen in adulthood, increasing the incidence of chronic diseases, deteriorating CMRF, and consequently leading to higher comorbidity and mortality rates. OBJECTIVE To investigate the effect of cardiorespiratory fitness (CRF) and body mass index (BMI) on CMRF in children and adolescents. METHODS The sample consisted of 49 schoolchildren of both sexes aged 10-17 years. Anthropometric assessments, CRF test, muscle strength test, and blood pressure (BP) measurement were conducted. Participants were allocated into groups based on BMI (eutrophic, overweight, obese), and CRF levels (low-fit, normal-fit, and high-fit). RESULTS Obese individuals had lower CRF values compared to the eutrophic and overweight groups. The cardiometabolic risk profile (CMRP) was significantly higher in the obese group compared to the eutrophic group but showed no significant difference compared to the overweight group. The hight-fit group had lower CMRP values compared to the low-fit group. CONCLUSIONS Higher BMI and CRF values had negative and positive effects on CMRF and CMRP in schoolchildren, respectively. Overweight or obese schoolchildren with low levels of CRF constitute an unfavourable cardiometabolic risk profile.
Collapse
Affiliation(s)
- Natália Carvalho Bagatini
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Carolina Dertzbocher Feil Pinho
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rogério da Cunha Voser
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anelise Reis Gaya
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovani Dos Santos Cunha
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
9
|
Constantin AT, Delia C, Tudor LM, Rosca I, Irimie AD, Năstase L, Gherghina I. Dyslipidemia in Pediatric Patients: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1434. [PMID: 37629724 PMCID: PMC10456487 DOI: 10.3390/medicina59081434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
There is an increasing interest in dyslipidemia in adult patients since it is known to contribute to early cardiovascular disease. Often, dyslipidemia starts in childhood, and it is associated with aggravating lifestyle choices concerning eating habits, such as the tendency to consume processed food and fast food, as well as the tendency to be more and more sedentary. We conducted a retrospective cross-sectional study describing the prevalence of dyslipidemia in a single medical center in Romania and the associated pathology. We evaluated all lipid profiles that were ordered in our clinic over nine years. We included 2413 patients that were evaluated in our clinic in the timeframe 2011-2020. Out of them, 18.23% had high values for LDL-cholesterol. More than a quarter (25.91%) were diagnosed with obesity. 11.37% of the patients with high LDL-cholesterol levels had various metabolic disorders including primary dyslipidemia. A small number of patients with hypercholesterolemia had thyroid disorders (4.10%). Patients with high LDL-cholesterol had various diagnoses ranging from metabolic to neurologic disorders, keeping in mind that there are multiple pathologies that can lead to dyslipidemia. Evaluating children for dyslipidemia is at hand for medical professionals. Screening for dyslipidemia in children would provide the opportunity to prevent rather than treat cardiovascular events.
Collapse
Affiliation(s)
- Andreea Teodora Constantin
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania; (A.T.C.)
- Pediatrics Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania; (C.D.)
| | - Corina Delia
- Pediatrics Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania; (C.D.)
- Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania
| | - Lucia Maria Tudor
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania; (A.T.C.)
- Pediatrics Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania; (C.D.)
| | - Ioana Rosca
- Faculty of Midwifery and Nursery, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
- Neonatology Department, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. P.Sârbu”, 060251 Bucharest, Romania
| | - Ana Daniela Irimie
- Pediatrics Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania; (C.D.)
| | - Leonard Năstase
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania; (A.T.C.)
- Neonatology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania
| | - Ioan Gherghina
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania; (A.T.C.)
| |
Collapse
|
10
|
Zachariah JP, Pena S, Lupo PJ, Putluri N, Penny DJ, Richard MA. Effect of exogenous l-carnitine on aortic stiffness in dyslipidemic adolescents: Design of a quadruple-blind, randomized, controlled interventional trial. Contemp Clin Trials Commun 2023; 34:101174. [PMID: 37448910 PMCID: PMC10338141 DOI: 10.1016/j.conctc.2023.101174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) risk factors including vascular remodeling leading to hypertension and dyslipidemia are prevalent among children and adolescents. Conflicting observational and Mendelian randomization data suggest endogenous carnitine may affect arterial stiffness and lipid traits. Because of this, we developed a study to evaluate the causal role for carnitine in arterial stiffness at a point when the lifecourse trajectory to hypertension can be modified. Methods This study is a mechanistic, double-blinded, randomized control trial (RCT) in 166 adolescents with dyslipidemia for the effect of 6 months of maximum dose 3 g daily oral l-carnitine supplementation (CS+) versus placebo (CS-) on aortic stiffness measured as carotid-femoral pulse wave velocity (CFPWV) and pulse pressure (PP); lipid concentrations (total cholesterol, HDL-C, triglycerides, and LDL-C) and serum fatty acid oxidation biomarkers by metabolomic analysis. Conclusions The simultaneous evaluation of endogenous carnitine genetic effects and exogenous l-carnitine supplementation may facilitate future therapies for youth with cardiometabolic derangement to arrest atherosclerotic changes.
Collapse
Affiliation(s)
- Justin P. Zachariah
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sandra Pena
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Philip J. Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nagireddy Putluri
- Department of Molecular and Cellular Biology, Dan L. Duncan Comprehensive Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Daniel J. Penny
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Melissa A. Richard
- Section of Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
11
|
van der Heijden LB, Groothoff JW, Feskens EJ, Janse AJ. Office blood pressure versus ambulatory blood pressure measurement in childhood obesity. BMC Pediatr 2023; 23:205. [PMID: 37120521 PMCID: PMC10148489 DOI: 10.1186/s12887-023-04010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/13/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND The prevalence of obesity-related co-morbidities is rising parallel to the childhood obesity epidemic. High blood pressure (BP), as one of these co-morbidities, is detected nowadays at increasingly younger ages. The diagnosis of elevated BP and hypertension, especially in the childhood population, presents a challenge to clinicians. The added value of ambulatory blood pressure measurement (ABPM) in relation to office blood pressure (OBP) measurements in obese children is unclear. Furthermore, it is unknown how many overweight and obese children have an abnormal ABPM pattern. In this study we evaluated ABPM patterns in a population of overweight and obese children and adolescents, and compared these patterns with regular OBP measurements. METHODS In this cross-sectional study in overweight or obese children and adolescents aged 4-17 years who were referred to secondary pediatric obesity care in a large general hospital in The Netherlands, OBP was measured during a regular outpatient clinic visit. Additionally, all participants underwent a 24-hour ABPM on a regular week-day. Outcome measures were OBP, mean ambulatory SBP and DBP, BP load (percentage of readings above the ambulatory 95th blood pressure percentiles), ambulatory BP pattern (normal BP, white-coat hypertension, elevated BP, masked hypertension, ambulatory hypertension), and BP dipping. RESULTS We included 82 children aged 4-17 years. They had a mean BMI Z-score of 3.3 (standard deviation 0.6). Using ABPM, 54.9% of the children were normotensive (95% confidence interval 44.1-65.2), 26.8% had elevated BP, 9.8% ambulatory hypertension, 3.7% masked hypertension, and 4.9% white-coat hypertension. An isolated night-time BP load > 25% was detected in almost a quarter of the children. 40% of the participants lacked physiologic nocturnal systolic BP dipping. In the group of children with normal OBP, 22.2% turned out to have either elevated BP or masked hypertension on ABPM. CONCLUSIONS In this study a high prevalence of abnormal ABPM patterns in overweight or obese children and adolescents was detected. Additionally, OBP poorly correlated with the child's actual ABPM pattern. Herewith, we emphasized the usefulness of ABPM as an important diagnostic tool in this population.
Collapse
Affiliation(s)
- Laila B van der Heijden
- Department of Pediatrics, Hospital Gelderse Vallei, P.O. Box 9025, Ede, 6710 HN, The Netherlands.
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Edith Jm Feskens
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, Wageningen, 6700 AA, The Netherlands
| | - Arieke J Janse
- Department of Pediatrics, Hospital Gelderse Vallei, P.O. Box 9025, Ede, 6710 HN, The Netherlands
| |
Collapse
|
12
|
De La Barrera B, Manousaki D. Serum 25-Hydroxyvitamin D Levels and Youth-Onset Type 2 Diabetes: A Two-Sample Mendelian Randomization Study. Nutrients 2023; 15:nu15041016. [PMID: 36839376 PMCID: PMC9963923 DOI: 10.3390/nu15041016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Observational studies have linked vitamin D insufficiency to pediatric type 2 diabetes (T2D), but evidence from vitamin D supplementation trials is sparse. Given the rising prevalence of pediatric T2D in all ethnicities, determining the protective role of vitamin D has significant public health importance. We tested whether serum 25-hydroxyvitamin D (25OHD) levels are causally linked to youth-onset T2D risk using Mendelian randomization (MR). We selected 54 single-nucleotide polymorphisms (SNPs) associated with 25OHD in a European genome-wide association study (GWAS) on 443,734 individuals and obtained their effects on pediatric T2D from the multi-ethnic PRODIGY GWAS (3006 cases/6061 controls). We applied inverse variance weighted (IVW) MR and a series of MR methods to control for pleiotropy. We undertook sensitivity analyses in ethnic sub-cohorts of PRODIGY, using SNPs in core vitamin D genes or ancestry-informed 25OHD SNPs. Multivariable MR accounted for the mediating effects of body mass index. We found that a standard deviation increase in 25OHD in the logarithmic scale did not affect youth-onset T2D risk (IVW MR odds ratio (OR) = 1.04, 95% CI = 0.96-1.13, p = 0.35) in the multi-ethnic analysis, and sensitivity, ancestry-specific and multivariable MR analyses showed consistent results. Our study had limited power to detect small/moderate effects of 25OHD (OR of pediatric T2D < 1.39 to 2.1). In conclusion, 25OHD levels are unlikely to have significant effects on the risk of youth-onset T2D across different ethnicities.
Collapse
Affiliation(s)
- Benjamin De La Barrera
- Research Center of the Sainte-Justine University Hospital, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Despoina Manousaki
- Research Center of the Sainte-Justine University Hospital, University of Montreal, Montreal, QC H3T 1C5, Canada
- Departments of Pediatrics, Biochemistry and Molecular Medicine, University of Montreal, Montreal, QC H3T 1C5, Canada
- Correspondence: ; Tel.: +1-514-345-4931 (ext. 4735)
| |
Collapse
|
13
|
Nagpal N, Messito MJ, Katzow M, Gross RS. Obesity in Children. Pediatr Rev 2022; 43:601-617. [PMID: 36316265 DOI: 10.1542/pir.2021-005095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.
Collapse
Affiliation(s)
- Nikita Nagpal
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Mary Jo Messito
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Michelle Katzow
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Rachel S Gross
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| |
Collapse
|
14
|
Adhikary D, Barman S, Ranjan R, Stone H. A Systematic Review of Major Cardiovascular Risk Factors: A Growing Global Health Concern. Cureus 2022; 14:e30119. [PMID: 36381818 PMCID: PMC9644238 DOI: 10.7759/cureus.30119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 04/08/2023] Open
Abstract
Cardiovascular disease has become a growing global and public health concern among non-communicable diseases (NCDs). The purpose of the study was to focus on the increasing prevalence of the risk factors of cardiovascular diseases (CVD), irrespective of age and gender, and its effect on public health worldwide. A literature search was done in the electronic database: Medline, PubMed, Web of Science, Google Scholar, and the World Health Organization (WHO) website, based on recent research and the prevalence of the risk factors of cardiovascular diseases. Moreover, a manual search for published work has also been done. The coronary heart disease studies were not restricted during the search by sample size because of the limited number of studies in selected countries. The study reviews the potential risk factors responsible for coronary heart disease globally. Smoking was highly prevalent among the United States and Pakistani populations, but hypertension and diabetes were more common in Tanzania and the United Kingdom. However, dyslipidaemia and obesity were common in almost all the selected countries. CVD risk factors are highly prevalent in some countries, varying socioeconomic, gender, and educational levels. Furthermore, there has always been a need for awareness in the public and educational programs for a healthy lifestyle, intake of nutritional food, and increased physical activity to improve health conditions and reduce the risk of cardiovascular diseases.
Collapse
Affiliation(s)
- Dipannita Adhikary
- Faculty of Life Sciences and Medicine, King's College London, London, GBR
- Cardiovascular Science, Impulse Hospital, Dhaka, BGD
| | - Shanto Barman
- College of Medicine, Mugda Medical College and Hospital, Dhaka, BGD
| | - Redoy Ranjan
- Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
- Institute of Cardiovascular Research, Royal Holloway University of London, London, GBR
- Surgical Science Programme, The University of Edinburgh, Edinburgh, GBR
| | - Hana Stone
- Faculty of Life Sciences and Medicine, King's College London, London, GBR
| |
Collapse
|
15
|
The Combined Effect of Birth Weight and Lifestyle on Clustered Cardio-Metabolic Risk Factors in Children and Adolescents: A National School-Based Cross-Sectional Survey. Nutrients 2022; 14:nu14153131. [PMID: 35956308 PMCID: PMC9370142 DOI: 10.3390/nu14153131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Due to the adverse effects of cardio-metabolic risk factors (CMRFs) in children and adolescents on their current and later life health, and the growing evidence that birth weight and lifestyle have on CMRFs, we aimed to estimate the combined effect of birth weight and lifestyle on clustered CMRFs in children and adolescents. Methods: We enrolled 11,509 participants aged 7–18 years old in a national school-based cross-sectional study in seven provinces in China in 2013. Information on CMRFs was collected through anthropometric measurements and blood sample testing. Information on birth weight, lifestyle and other basic information were investigated through children and adolescents’ as well as parents’ questionnaires. The generalized linear mixed model was applied to estimate the odd ratio (OR) and 95% confidence interval (95% CI) for the associations between CMRFs, clustered CMRFs and birth weight, lifestyle, and the combinations of birth weight and lifestyle. Results: Overall, the prevalence of clustered CMRFs was 3.6% in children and adolescents aged 7–18 years, higher in boys (4.4%) than girls (2.9%). The combination of LBW/ideal lifestyle (OR = 2.00, 95% CI: 1.07–3.72) was associated with higher risk of clustered CMRFs, as well as in adolescents aged 13–18 years and in boys. The combination of HBW/poor lifestyle (OR = 1.74, 95% CI: 1.13–2.68) was related to elevated risk of clustered CMRFs, especially in children aged 7–12 years. Conclusions: CMRFs in Chinese children and adolescents is concerning, ideal lifestyle could weaken the association of birth weight with clustered CMRFs, especially in younger age, indicating that programs to prevent abnormal birth weight or poor lifestyle or both among children and adolescents may reduce CMRFs in China.
Collapse
|
16
|
Abbs E, Daniels R, Schillinger D. Type 2 Diabetes as a Socioecological Disease: Can Youth Poets of Color Become Messengers of Truth and Catalysts for Change? Health Promot Pract 2022; 23:583-593. [PMID: 33989074 PMCID: PMC8590708 DOI: 10.1177/15248399211007818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Efforts to confront the type 2 diabetes (T2D) epidemic have been stymied by an absence of effective communication on policy fronts. Whether art can be harnessed to reframe the T2D discourse from an individual, biomedical problem to a multilevel, communal and social problem is not known. METHOD We explored whether spoken word workshops enable young artists of color to convey a critical consciousness about T2D. The Bigger Picture fosters creation and dissemination of art to shift from the narrow biomedical model toward a comprehensive socioecological model (SEM). Workshops offer (1) public health content, (2) writing exercises, and (3) feedback on drafts. Based on Freire and Boal's participatory pedagogy, workshops encourage youth to tap into their lived experiences when creating poetry. We analyzed changes in public health literary and activation among participants and mapped poems onto the SEM to assess whether their poetry conveyed the multilevel perspective critical to public health literacy. RESULTS Participants reported significant increases in personal relevance of T2D prevention, T2D discussions with peers, concern about corporations' targeted marketing, and interest in community organizing to confront the epidemic. Across stanzas, nearly all poems (95%) featured >three of five SEM levels (systemic forces, sectors of influence, societal norms, behavioral settings, individual factors); three-quarters (78%) featured >four levels. CONCLUSIONS Engaging youth poets of color to develop artistic content to combat T2D can increase their public health literary and social activation and foster compelling art that communicates how complex, multilevel forces interact to generate disease and disease disparities.
Collapse
Affiliation(s)
- Elizabeth Abbs
- University of California San Francisco, San Francisco, CA, USA
| | - Ryane Daniels
- University of California San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
17
|
Tskhvedadze N, Janjgava S, Tananashvili D, Giorgadze E. The Impact of Obesity Assessed by Different Criteria on the Metabolic Parameters in Children and Adolescents in Georgia. Glob Pediatr Health 2022; 9:2333794X221097569. [PMID: 35592792 PMCID: PMC9112292 DOI: 10.1177/2333794x221097569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of our study was comparative analysis of anthropometric characteristics
in children and adolescents significantly correlated with the parameters of
metabolic syndrome. The study group is consisted of 113 children and adolescents
(study group) with excessive body weight and obesity (group 1—BMI percentile;
group 2—waist circumference; group 3—waist to height ratio). The control group
consisted of 113 children and adolescents without. Comparative analysis of
obtained data have been carried out by multiple regression analysis. BMI
percentile is more an indicator of a generalized obesity; WC and WHR percentiles
better describe visceral obesity and metabolic disorders—insulin resistance,
hypertension and dyslipidemia. However, the WHR Percentile may be a more useful
tool. To assess obesity in children and adolescents, it is necessary to evaluate
together BMI, WC, and WHR percentiles. It can be also concluded that these
findings indicate the need to continue research in this direction.
Collapse
Affiliation(s)
- Nino Tskhvedadze
- Tbilisi State University, Tbilisi, Georgia.,National Institute of Endocrinology, Tbilisi, Georgia
| | | | | | - Elene Giorgadze
- Tbilisi State University, Tbilisi, Georgia.,National Institute of Endocrinology, Tbilisi, Georgia
| |
Collapse
|
18
|
Pfeifer CE, Sacko RS, Ortaglia A, Monsma EV, Beattie PF, Goins J, Stodden DF. Fit to Play? Health-Related Fitness Levels of Youth Athletes: A Pilot Study. J Strength Cond Res 2022; 36:245-251. [PMID: 31809462 DOI: 10.1519/jsc.0000000000003430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Pfeifer, CE, Sacko, RS, Ortaglia, A, Monsma, EV, Beattie, PF, Goins, J, and Stodden, DF. Fit to play? Health-related fitness levels of youth athletes: A pilot study. J Strength Cond Res 36(1): 245-251, 2022-A recent National Strength and Conditioning Association position statement suggests that many youth are not prepared for the physical demands of sport. The purpose of this study was to compare health-related fitness (HRF) of youth athletes with normative findings from the general population. We recruited 136 athletes (63 male and 73 female athletes) aged 11-19 (16.01 ± 1.35) years and collected HRF (body composition, cardiorespiratory endurance, musculoskeletal strength and endurance). Results were categorized based on FITNESSGRAM® standards and compared with Canadian youth general population normative data. Most male athletes were classified as "needs improvement" for cardiorespiratory and muscular endurance, and body mass index (BMI). Conversely, most female athletes were at or above the "healthy fitness zone" for all measures. Male athletes at both age groups (11-14, 15-19; p < 0.001) and female athletes aged 11-14 (p < 0.05) demonstrated lower cardiorespiratory endurance compared with Canadian general population. Female athletes (both age groups) demonstrated greater muscular strength, and male athletes (age, 15-19 years) demonstrated lower BMI than the Canadian general population. The results are concerning as male athletes demonstrated poorer HRF compared with the general population. Although most female athletes were within healthy ranges, a portion of them were still at risk. Considering the demands sport places on the body, evaluating HRF is paramount for performance and injury prevention but more importantly for overall health. Youth sport and strength coaches should evaluate and aim to enhance HRF, as participation in sport does not guarantee adequate HRF. Promoting long-term athletic development and life-long health should be a priority in youth.
Collapse
Affiliation(s)
- Craig E Pfeifer
- Applied Sport and Exercise Sciences, University of Gloucestershire, Gloucester, United Kingdom
| | - Ryan S Sacko
- Department of Health and Human Performance, The Citadel, Charleston, South Carolina
| | | | - Eva V Monsma
- Department of Physical Education, University of South Carolina, Columbia, South Carolina
| | | | | | - David F Stodden
- Department of Physical Education, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
19
|
Novac CN, Boboc AA, Nastac C, Balgradean M, Radulian G. Ketoacidosis Onset of Diabetes on a Patient with Normal C-Peptide Value. MÆDICA 2021; 16:320-324. [PMID: 34621360 DOI: 10.26574/maedica.2020.16.2.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Diabetic ketoacidosis is an acute major life-threatening complication of diabetes, characterized by hyperglycemia, ketoacidosis and ketonuria, which can be life threatening if it is not promptly recognized and treated. This occurs mainly in patients with type 1 diabetes, but stressors like trauma and infection can increase the risk of ketoacidosis in other forms of diabetes such as type 2 diabetes. Type 2 diabetes mellitus is a complex metabolic disorder of heterogeneous etiology with behavioral, social, and environmental risk factors that unmask the effects of genetic susceptibility. Recent studies indicate an increasing prevalence of type 2 diabetes mellitus in children and adolescents around the world in all ethnicities. C-peptide is a useful and widely used method of assessing pancreatic beta cell function given his structure: part of proinsulin which is cleaved prior to co-secretion with insulin from pancreatic beta cells. This is used as a tool in the differentiation of type 1 diabetes from type 2 but also other types of diabetes. We present a 12-year-old previously healthy male who was hospitalized in our clinic for polydipsia, polyuria, weight loss and emesis, with symptom onset 10 days prior to admission. On the admission day, he presented to the emergency room for progressively increasing somnolence, apathy, decreased muscle tone and urinary incontinence. Physical examination was significant for grade I obesity [height 168 cm and weight 90 kg, yielding a body index mass (BMI) of 31.78 kg/m2, percentile >97%], lethargy, slurred speech, high blood pressure (145/90 mmHg), tachycardia (145 beats per minute) and acanthosis nigricans. Considering his physical examination, laboratory tests and clinical evolution, he was diagnosed with type 2 diabetes mellitus complicated with hyperosmolar hyperglycemic state and diabetic ketoacidosis. Diabetic ketoacidosis should be considered in the differential diagnosis of metabolic decompensation in all types of diabetes. Although type 2 diabetes mellitus seems to be still rare in childhood and adolescence, prevention and treatment of type 2 diabetes mellitus should become public awareness and public health intervention programs. The particularity of this case was the unusual onset of diabetes mellitus type 2 in a male child with metabolic syndrome.
Collapse
Affiliation(s)
| | | | - Cristiana Nastac
- "Grigore Alexandrescu" Emergency Clinical Hospital for Children, Bucharest, Romania
| | | | - Gabriela Radulian
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
20
|
Latif R, Rafique N. Prevalence and Risk Factors of Prediabetes in Young Saudi Females in a University Setting. Ethiop J Health Sci 2021; 30:929-940. [PMID: 33883838 PMCID: PMC8047230 DOI: 10.4314/ejhs.v30i6.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Studies reporting prediabetes prevalence in young Saudis are almost a decade old. The present study determined prediabetes prevalence and its associated risk factors (body composition, lipid profile, blood pressure and physical activity) in young Saudi females. Methods Three hundred Saudi females (18–20 years old), studying in year 2 and 3 at Imam Abdulrahman Bin Faisal University, were categorized as normoglycemic or prediabetic based on fasting plasma glucose criteria of World Health Organization (WHO) and American Diabetes Association (ADA). Anthropometric measurements, lipid profile, atherogenic indices, and physical activity data were compared. Association between fasting blood glucose and study variables was found by Bivariate analysis (Spearman Correlation for non-parametric variables and Pearson correlation for parametric) followed by Binary Logistic Regression analysis. Results Prevalence of prediabetes by WHO and ADA criteria were 11.3% and 18.7% respectively. Systolic, diastolic and mean arterial pressures, waist circumference, waist-hip and waist-stature-ratios were significantly raised in prediabetics compared to normoglycemic (WHO criteria p-values; 0.03, 0.003, 0.005, 0.01, 0.01, 0.04 respectively; ADA criteria 0.04, 0.001, 0.02, 0.02, 0.03, 0.01 respectively). For each unit increase in systolic, diastolic and mean arterial pressures, and waist circumference, the odds of becoming prediabetic increased by a factor of 1.02, 1.05, 1.04 and 1.03 respectively by WHO criteria: and 1.01, 1.03, 1.02, and 1.02 respectively by ADA criteria Conclusion Substantial numbers of young females in our university are suffering from prediabetes. An increase in systolic, diastolic, and mean arterial pressures and waist circumference are significant risk factors for prediabetes in young females.
Collapse
Affiliation(s)
- Rabia Latif
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University
| | - Nazish Rafique
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University
| |
Collapse
|
21
|
Yanes Cardozo LL, Romero DG. Novel biomarkers of childhood and adolescent obesity. Hypertens Res 2021; 44:1030-1033. [PMID: 33850307 PMCID: PMC8043837 DOI: 10.1038/s41440-021-00651-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/28/2021] [Indexed: 02/03/2023]
Abstract
Regulation of the Renin-Angiotensin System (RAS) and the kallikrein-kinin system (KKS) by obesity in adolescents.
Collapse
Affiliation(s)
- Licy L Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, USA.
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS, USA.
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Damian G Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, USA.
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, USA.
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS, USA.
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, USA.
| |
Collapse
|
22
|
Xargay-Torrent S, Puerto-Carranza E, Marcelo I, Mas-Parés B, Gómez-Vilarrubla A, Martínez-Calcerrada JM, de Zegher F, Ibáñez L, López-Bermejo A, Bassols J. Estimated glomerular filtration rate and cardiometabolic risk factors in a longitudinal cohort of children. Sci Rep 2021; 11:11702. [PMID: 34083639 PMCID: PMC8175594 DOI: 10.1038/s41598-021-91162-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023] Open
Abstract
Associations between glomerular filtration rate (GFR) and cardiometabolic risk factors have been reported in adult and pediatric patients with renal disease. We aimed to assess the relationship between the estimated GFR (eGFR) and cardiometabolic risk factors in apparently healthy children. A longitudinal study in 401 asymptomatic Caucasian children (mean age 8 years) followed up after 4 years (mean age 12 years). GFR was estimated using the pediatric form of the FAS-equation. Children were classified at baseline according to their obesity status (normal weight and overweight) and according to eGFR levels (lower, average, and higher). The association of eGFR with anthropometric data [body mass index (BMI) and waist], blood pressure [systolic (SBP) and diastolic (DBP)], metabolic parameters [glucose, insulin resistance (HOMA-IR) and serum lipids], and renal ultrasonography measurements were assessed at baseline and follow-up. Baseline eGFR associated with several cardiometabolic risk factors at follow-up including higher waist, SBP, HOMA-IR, and kidney size (all p < 0.0001) in both normal weight and overweight children. In multivariate analysis, baseline eGFR was independently associated with follow-up HOMA-IR and SBP in both normal weight and overweight subjects (model R2: 0.188–0.444), and with follow-up BMI and waist in overweight subjects (model R2: 0.367–0.477). Moreover, children with higher filtration rates at baseline showed higher waist, SBP, DBP, HOMA-IR and renal size both at baseline and follow-up. eGFR is related to insulin resistance, blood pressure and adiposity measures in school-age children. eGFR may help to profile the cardiometabolic risk of children.
Collapse
Affiliation(s)
- Sílvia Xargay-Torrent
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), 17190, Salt, Spain
| | - Elsa Puerto-Carranza
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), 17190, Salt, Spain.,Pediatrics, Dr. Trueta University Hospital, 17007, Girona, Spain
| | - Irene Marcelo
- Pediatrics, Dr. Trueta University Hospital, 17007, Girona, Spain
| | - Berta Mas-Parés
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí I Julià, Edifici M2, 17190, Salt, Spain
| | - Ariadna Gómez-Vilarrubla
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí I Julià, Edifici M2, 17190, Salt, Spain
| | - Jose-Maria Martínez-Calcerrada
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí I Julià, Edifici M2, 17190, Salt, Spain
| | - Francis de Zegher
- Department of Development and Regeneration, University of Leuven, 3000, Leuven, Belgium
| | - Lourdes Ibáñez
- Endocrinology, Pediatric Research Institute, Sant Joan de Déu Children's Hospital, 08950, Esplugues, Barcelona, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, CIBERDEM, ISCIII, 28029, Madrid, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), 17190, Salt, Spain. .,Pediatrics, Dr. Trueta University Hospital, 17007, Girona, Spain. .,Department of Medical Sciences, Faculty of Medicine, University of Girona, 17003, Girona, Spain.
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí I Julià, Edifici M2, 17190, Salt, Spain.
| |
Collapse
|
23
|
Vangeepuram N, Liu B, Chiu PH, Wang L, Pandey G. Predicting youth diabetes risk using NHANES data and machine learning. Sci Rep 2021; 11:11212. [PMID: 34045491 PMCID: PMC8160335 DOI: 10.1038/s41598-021-90406-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/30/2021] [Indexed: 01/21/2023] Open
Abstract
Prediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06-0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10-5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.
Collapse
Affiliation(s)
- Nita Vangeepuram
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Po-Hsiang Chiu
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Linhua Wang
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| |
Collapse
|
24
|
Leak TM, Gangrade N, Tester J. Facilitators and barriers to preparing and offering whole grains to children diagnosed with prediabetes: qualitative interviews with low-income caregivers. BMC Public Health 2021; 21:931. [PMID: 34001074 PMCID: PMC8127312 DOI: 10.1186/s12889-021-10915-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of U.S. youth with prediabetes and type 2 diabetes (T2D) is increasing, with those from racial/ethnic minority and low socioeconomic status (SES) backgrounds at greater risk. Dietary fiber (e.g., whole grains and vegetables) is shown to be inversely associated with T2D risk, yet dietary recommendations are not being met. Caregivers play an important role in home food availability, but low SES neighborhoods are shown to have limited access to fiber-rich foods such as whole grains. The overall aim of this qualitative study was to assess caregiver perceptions about facilitators and barriers to preparing and offering whole grains that they received as part of the 16-week Food Overcoming Our Diabetes Risk (FoodRx) pilot study. Methods A convenience sample of 60 youth (8–17 years) with obesity and prediabetes were recruited from an urban pediatric weight management clinic to participate in the FoodRx pilot study. Caregivers accompanied youth to a baseline clinic visit and completed a survey that asked about individual and household characteristics. Exit interviews were conducted at the follow-up clinic visit with caregivers of all youth who completed the study (n = 48) in order to assess facilitators and barriers experienced when preparing and offering whole grains. Interview transcripts were coded using the constant comparative method and grounded theory approaches. Results Caregivers (n = 48) had a mean age of 43 years and were primarily female (n = 46) and Hispanic (71%). Main facilitators to preparing and offering whole grains in the home were caregivers’ improved knowledge of whole grain health benefits and the development of strategies to encourage their children to consume whole grains (i.e., pairing whole grains with another liked food). A main barrier for caregivers was the lack of resources available to identify and prepare the novel whole grains that they received. Conclusion Findings suggest that caregivers are receptive to incorporating more whole grains into home-prepared meals, but they may need additional nutrition and cooking education to improve their self-efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10915-5.
Collapse
Affiliation(s)
- Tashara M Leak
- Cornell University, Division of Nutritional Sciences, 416 Savage Hall, Ithaca, NY, 14853, USA.
| | - Navika Gangrade
- Cornell University, Division of Nutritional Sciences, 416 Savage Hall, Ithaca, NY, 14853, USA
| | - June Tester
- UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| |
Collapse
|
25
|
Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents. CHILDREN-BASEL 2021; 8:children8050372. [PMID: 34065140 PMCID: PMC8151410 DOI: 10.3390/children8050372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.
Collapse
|
26
|
Hecht EM, Williams AYP, Abrams GA, Passman RS. Cardiovascular Risk Factors in Young Adolescents: Results from the National Health and Nutrition Examination Survey 1988-2016. South Med J 2021; 114:261-265. [PMID: 33942107 DOI: 10.14423/smj.0000000000001244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Lifestyle behaviors relevant to cardiovascular health are learned during childhood and continued into adulthood. Children and adolescents who participate in unhealthy behaviors have a higher lifetime risk of cardiovascular disease in adulthood. Public health institutions publish behavior and clinical recommendations designed for adolescents to reduce their lifetime cardiovascular risk. We assessed the prevalence and trends of cardiovascular-relevant behaviors and clinical tests among early adolescents using a nationally representative database. METHODS In 2020, we compared the prevalence of cardiovascular risk factors among 1408 adolescents surveyed from 1988 to 1994 with that of 1812 adolescents surveyed from 2011 to 2016 by obtaining and comparing measures on physical activity, diet, body mass index, smoking status, cholesterol levels, hemoglobin A1c, sodium intake, and blood pressure. RESULTS The prevalence of adherence to the current recommendations regarding physical activity, diet, and body weight declined over time. Conversely, the prevalence of adhering to recommendations to avoid smoking increased. Clinical indicators, including blood pressure control and normal measures of hemoglobin A1c and total serum cholesterol, showed mixed results, with more individuals showing signs of hyperglycemia, fewer showing signs of hypercholesterolemia, and the percentage of individuals with abnormal blood pressure remaining the same. The use of cardiometabolic medications also increased during the study period. Finally, the number of adolescents with all seven cardiovascular protective factors declined significantly during the study period, from 27.6% to 9.6%. CONCLUSIONS Modern American teenagers aged 12 to 16 years have more cardiovascular risk factors relating mostly to diet, exercise, and obesity than those of a prior generation; however, smoking rates have also declined precipitously.
Collapse
Affiliation(s)
- Eric M Hecht
- From the Institute of Etiological Research, Boca Raton, University of South Carolina-School of Medicine, Greenville, South Carolina and the Division of Cardiac Electrophysiology, Northwestern University School of Medicine, Chicago, Illinois
| | - Ana-Ysabel P Williams
- From the Institute of Etiological Research, Boca Raton, University of South Carolina-School of Medicine, Greenville, South Carolina and the Division of Cardiac Electrophysiology, Northwestern University School of Medicine, Chicago, Illinois
| | - Gary A Abrams
- From the Institute of Etiological Research, Boca Raton, University of South Carolina-School of Medicine, Greenville, South Carolina and the Division of Cardiac Electrophysiology, Northwestern University School of Medicine, Chicago, Illinois
| | - Rod S Passman
- From the Institute of Etiological Research, Boca Raton, University of South Carolina-School of Medicine, Greenville, South Carolina and the Division of Cardiac Electrophysiology, Northwestern University School of Medicine, Chicago, Illinois
| |
Collapse
|
27
|
Gande N, Pechlaner R, Bernar B, Staudt A, Stock K, Hochmayr C, Geiger R, Kiechl-Kohlendorfer U, Knoflach M. Cardiovascular health behaviors and associations of sex, age, and education in adolescents - Results from the EVA Tyrol study. Nutr Metab Cardiovasc Dis 2021; 31:1286-1292. [PMID: 33558093 DOI: 10.1016/j.numecd.2020.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Ideal cardiovascular health (CVH) behaviors in adolescents are defined by body mass index (BMI), diet, physical activity and smoking, and are directly associated with better health in later life. To further improve health prevention programs we investigated the prevalence of these behaviors in a cohort of healthy adolescents and focused on the associations with sex, age, and education. METHODS AND RESULTS The Early Vascular Aging Tyrol study is a cross-sectional study assessing 14- to 19-year-old pupils and apprentices in Western Austria and South Tyrol. Between May 2015 and July 2018 2047 adolescents (43.6% males, mean age 16.4 years) with complete data for all 4 health behaviors were included. The prevalence of ideal body mass index (BMI) was 78.3%, of ideal physical activity 42.5%, of non-smoking 70.4% and of ideal diet 8.1%. Females showed a higher smoking prevalence and a lower physical activity, but better dietary habits than males. Older adolescents of both sexes had lower prevalence of ideal smoking and diet. Apprentices and pupils of vocational schools had a higher BMI and a less favorable diet compared to secondary academic school students. Smoking prevalence was highest in apprentices. Non-ideal BMI was independently associated with smoking. CONCLUSION In our cohort, only a minority showed ideal CVH behaviors which were best in adolescents younger than 16 years. We observed significant differences between males and females and a clear impact of school education with apprentices being at risk for non-ideal CVH behaviors. CLINICAL TRIAL REGISTRATION NUMBER NCT03929692, clinicaltrials.gov.
Collapse
Affiliation(s)
- Nina Gande
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benoît Bernar
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Staudt
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Stock
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria; Department of Pediatrics III (Cardiology), Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Hochmayr
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics, Bruneck Hospital, Bruneck, Italy; Department of Pediatrics III (Cardiology), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
28
|
Zachariah JP, Wang Y, Newburger JW, deFerranti SD, Mitchell GF, Vasan RS. Biological Pathways in Adolescent Aortic Stiffness. J Am Heart Assoc 2021; 10:e018419. [PMID: 33641350 PMCID: PMC8174212 DOI: 10.1161/jaha.120.018419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Aortic stiffening begins in youth and antedates future hypertension. In adults, excess weight, systemic inflammation, dyslipidemia, insulin resistance, neurohormonal activation, and altered adipokines are implicated in the pathogenesis of increased aortic stiffness. In adolescents, we assessed the relations of comprehensive measures of aortic stiffness with body mass index (BMI) and related but distinct circulating biomarkers. Methods and Results A convenience sample of 246 adolescents (mean age, 16±2 years; 45% female, 24% Black, and 43% Hispanic) attending primary care or preventive cardiology clinics at 2 tertiary hospitals was grouped as normal weight (N=98) or excess weight (N=148, defined as BMI ≥age‐ and sex‐referenced 85th percentile). After an overnight fast, participants underwent anthropometry, noninvasive arterial tonometry, and assays for serum lipids, CRP (C‐reactive protein), glucose, insulin, renin, aldosterone, and leptin. We used multivariable linear regression to relate arterial stiffness markers (including carotid‐femoral pulse wave velocity) to BMI z score and a biomarker panel. Carotid‐femoral pulse wave velocity was higher in excess weight compared with normal weight group (5.0±0.7 versus 4.6±0.6 m/s; P<0.01). After multivariable adjustment, carotid‐femoral pulse wave velocity was associated with BMI z score (0.09 [95% CI, 0.01–0.18]; P=0.04) and with low‐density lipoprotein cholesterol (0.26 [95% CI, 0.03–0.50]; P=0.03). Conclusions Higher BMI and low‐density lipoprotein cholesterol were associated with greater aortic stiffness in adolescents. Maintaining optimal BMI and lipid levels may mitigate aortic stiffness.
Collapse
Affiliation(s)
- Justin P Zachariah
- Section of Pediatric Cardiology Department of Pediatrics Texas Children's HospitalBaylor College of Medicine Houston TX
| | - Yunfei Wang
- Section of Pediatric Cardiology Department of Pediatrics Texas Children's HospitalBaylor College of Medicine Houston TX
| | - Jane W Newburger
- Department of Cardiology Boston Children's HospitalHarvard Medical School Boston MA
| | - Sarah D deFerranti
- Department of Cardiology Boston Children's HospitalHarvard Medical School Boston MA
| | | | - Ramachandran S Vasan
- Section of Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Department of Epidemiology Boston University School of Public Health and Boston University Center for Computing and Data Sciences Boston MA
| |
Collapse
|
29
|
Effect of individual- versus collective-based nutritional-lifestyle intervention on the atherogenic index of plasma in children with obesity: a randomized trial. Nutr Metab (Lond) 2021; 18:11. [PMID: 33436021 PMCID: PMC7805105 DOI: 10.1186/s12986-020-00537-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background The Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity. Methods One-hundred sixty-four children aged 6–12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis. Results The participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (− 0.12 vs. − 0.05), as well as change in triglyceride-glucose index (− 0.22 vs. − 0.08) and Body Mass Index z-score (− 0.59 vs. − 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37). Conclusion In children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified. Trial Registration Clinical Trials NCT03728621
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW The goal of the current paper is to review the literature on the neural and behavioral factors involved in food decision-making in youth. RECENT FINDINGS Recent neuroimaging studies that employ passive viewing paradigms have found that exposure to food-related cues activate reward, motor planning, and attentional salience signals in children. Greater activations of reward signals and/or lower activations of control signals are associated with overeating and weight gain. Neuroimaging studies with decision-making paradigms have found the reward network in the brain activates during food choices, while control network activates less strongly. Findings suggest that exposure to food cues activates reward/valuation network, but activation of control network tends to be relatively weaker in children. Hedonic aspects of foods are predominantly considered in children's food choices, and their dietary self-control is not matured yet. The increased activation in reward network and the decreased activation in control network are associated with risk of developing obesity.
Collapse
Affiliation(s)
- Oh-Ryeong Ha
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St, Kansas City, MO, 64110, USA
| | - Seung-Lark Lim
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St, Kansas City, MO, 64110, USA
| | - Amanda S Bruce
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
- Center for Children's Healthy Lifestyles and Nutrition; Children's Mercy Hospital, Kansas City, MO, USA.
| |
Collapse
|
31
|
Abstract
To encourage students to walk and cycle to school and ensure their health and safety, it is essential to provide safe and operationally efficient infrastructure around schools. This study used an audit tool to assess the infrastructure and environment around schools in the city of Doha, Qatar, with a particular emphasis on active transport (walking and cycling). The aim was to identify strengths, weaknesses, and areas for improvement. Twenty-two schools with varied education levels were assessed. Among all assessed categories, active transport items scored the lowest, requiring the most improvements. A detailed analysis was conducted based on school type (elementary, primary, high, and mixed-schools) and revealed similar results except for elementary schools (scored acceptable for active transport). The study revealed that adding bike lanes, installing bicycle parking, and providing good separation of travel modes are the most needed improvements at school sites. In summary, improving active transport could significantly improve the overall quality of the infrastructure around schools in Qatar. Such improvements could greatly encourage more school children to walk and cycle to school instead of being primarily dropped-off and picked up by their parents’ vehicles or school buses.
Collapse
|
32
|
Choi YS, Beltran TA, Klaric JS. Prevalence of Optimal Metabolic Health in U.S. Adolescents, NHANES 2007-2016. Metab Syndr Relat Disord 2020; 19:56-63. [PMID: 33170075 DOI: 10.1089/met.2020.0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: While the overweight and obesity epidemic in the adolescent population is well described, a comprehensive evaluation of cardiometabolic health markers has not been reported. Our purpose was therefore to determine the prevalence of cardiometabolic risk factors among non-diabetic individuals 12 to19 years of age in the United States. Methods: We analyzed data from nationally representative samples of U.S. adolescents (NHANES, 2007-2016). Optimal cardiometabolic health was defined as an absence of risk factors, that is, at least normal values on each of the following 11 measures: body mass index (BMI) percentile, waist circumference percentile, blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, non-HDL cholesterol, triglycerides, fasting plasma glucose, alanine aminotransferase, and insulin resistance. Domain analyses were conducted with Rao-Scott chi-square tests of independence. Multivariable linear/logistic regressions examined sociodemographic associations with cardiometabolic health. Results: Less than a quarter of the population (22.0%; 95% CI; 19.4%-24.8%) was found to have no cardiometabolic risk factors. Among individuals with a normal BMI, 35.7% (95% CI; 31.6%-40.1%) had no cardiometabolic risk factors. Family poverty-to-income ratio was identified as an independent predictor of cardiometabolic health (P = 0.01). A consistent trend was present between increasing BMI percentile and number of cardiometabolic risk markers. Conclusions: The overall prevalence of U.S. adolescents with no cardiometabolic risk factors is less than 25%. Even among those without increased BMI, less than half meet all metabolic health criteria. In addition, socioeconomic disparities are predictors of metabolic health.
Collapse
|
33
|
Abstract
BACKGROUND Female participation in sport has grown substantially over the last 4 decades. OBJECTIVES We investigated the association between sports participation and (1) later-life health outcomes and (2) later-life quality-of-life (QoL) measures among female college alumni. METHODS We conducted a cross-sectional study of female alumni between the ages of 40 and 70 years. Participants completed a questionnaire that included QoL measures assessing general health, negative consequences of alcohol use, mental health, and other self-reported health outcomes. We divided alumni into athletes and nonathletes. Between-group comparisons of health outcomes were adjusted for age; QoL measures were adjusted for age, exercise habits, cigarette smoking, alcohol use, and comorbidities. RESULTS Questionnaires were sent to 47 836 alumni, 3702 (8%) responded. Forty-four percent of female respondents participated in collegiate sports. After adjusting for age, female respondents who participated in collegiate sports were more likely to exercise >3×/week (61.8% vs 50.2%; P ≤ 0.001), view themselves in good/great health (91% vs 85%; P < 0.001), and less likely to have ever smoked (13.6% vs 25.3%; P ≤ 0.001) or used recreational drugs (7.5% vs 9.5%; P = 0.018). A smaller proportion of female athletes reported hypertension (5.5% vs 13.5%; P ≤ 0.001), high cholesterol (9.9% vs 17.0%; P < 0.001), and obesity (3.1% vs 6.8%; P = 0.001) compared with nonathletes. Participation in sports was, however, associated with decreased mobility (R = 0.1826; P = 0.002) and increased anxiety (R = 0.039; P = 0.016) QoL scores. CONCLUSIONS Sports participation for female collegiate athletes was associated with mostly positive health outcomes, but also with lower mobility and increased anxiety QoL scores.
Collapse
|
34
|
Tester JM, Stiers KB, Garber A, Leung CW. Whole Grain Intake and Impaired Fasting Glucose in Adolescents, National Health and Nutrition Examination Survey, 2005-2014. Prev Chronic Dis 2020; 17:E130. [PMID: 33092687 PMCID: PMC7587298 DOI: 10.5888/pcd17.190439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Large prospective cohort studies show a lower risk of developing type 2 diabetes among adults with higher whole grain consumption. Less is known about the relationship between whole grain consumption and precursors for diabetes risk in adolescents. We examined whether intake of whole grains was associated with impaired fasting glucose (IFG) in adolescents. METHODS We analyzed data on dietary intake from an average of two 24-hour diet recalls from fasting, nondiabetic adolescents aged 12-18 years (N = 2,286) across 5 cycles of the National Health and Nutrition Examination Survey (NHANES 2005-2014). We used logistic regression to calculate the odds of having IFG (100-125 mg/dL) with respect to servings of whole and refined grains, as well as percentage of whole grains, adjusting for sex, age, race/ethnicity, annual household income, obesity, total energy, and diet quality. RESULTS IFG was present in 17% of participants. After adjusting for covariates, number of servings per day of whole grains was significantly associated with lower odds of IFG, but there was no relationship between IFG and servings of refined grains or percentage of whole grains. Consuming at least 1 ounce-equivalent serving (16 g) of whole grains daily, compared with consuming no whole grains, was associated with a 40% reduction in the adjusted odds of having IFG (adjusted odds ratio = 0.60; 95% CI, 0.38-0.93). CONCLUSION Analysis of 10 years of national cross-sectional data suggests that US adolescents whose daily diets consist of a minimum threshold amount of whole grains may be less likely to have IFG, a finding that has implications for diabetes prevention in adolescents.
Collapse
Affiliation(s)
- June M Tester
- UCSF Benioff Children's Hospital Oakland, 747 52nd St, Oakland, CA 94609.
| | - Katharine B Stiers
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrea Garber
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Cindy W Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
35
|
Dos Santos FD, Pinto EF, Moura ARLI, Carvalho Lima EVD, Souza MFD, Carvalho FO, Moraes JFVND. Blood pressure responses to the Cold Pressor Test according to body mass index and waist-to-height ratio in adolescents. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i3.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: to analyze the blood pressure (BP) values and responses to the Cold Pressor Test (CPT) according to the body mass index (BMI) and the waist-to-height ratio (WHtR). Methods: 166 adolescents of both sexes participated in the study. Participants underwent measurements of body mass, height and waist circumference. BMI and WHtR were calculated. BP was measured before (pre-test), during (test) and after CPT (recovery). The groups were compared using a mixed ANOVA with Bonferroni post hoc, and Odds Ratio calculation. The level of significance was p < 0.05. Results: prevalences of 16.9% of high BMI, 19.9% of increased WHR and 8.4% of pretest BP were found above the recommended. Participants with high BMI had increased systolic BP compared to their normal peers (113.0 ± 11.4 vs. 121.7 ± 11.6 mmHg; p = 0.003). Adolescents with elevated WHR had higher pre-test and recovery systolic BP (pre-test: 113.2 ± 11.4 vs. 119.6 ± 12.7 mmHg; p = 0.021; recovery: 111.9 ± 14.1 vs. 117.4 ± 14.0 mmHg; p = 0.044). Finally, individuals with BMI and WHtR above the recommended had 2.1 (95% CI 0.62 - 7.36) and 2.5 (95% CI 0.77 - 7.91) times, respectively, more likely to have high pre-test BP values. Conclusion: adolescents with increased BMI and WHtR have higher BP values compared to their normal peers.
Collapse
|
36
|
Fuemmeler BF, Sheng Y, Schechter JC, Do E, Zucker N, Majors A, Maguire R, Murphy SK, Hoyo C, Kollins SH. Associations between attention deficit hyperactivity disorder symptoms and eating behaviors in early childhood. Pediatr Obes 2020; 15:e12631. [PMID: 32119190 PMCID: PMC7391797 DOI: 10.1111/ijpo.12631] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/13/2020] [Accepted: 02/10/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) symptoms have been linked with eating behaviors and obesity adolescence and young adulthood. Yet, little is known about whether these associations occur during early childhood and few studies have examined these associations prospectively. OBJECTIVES To assess magnitude and direction of associations between childhood ADHD symptoms and eating behaviors. METHODS Participants were from the Newborn Epigenetics Study (N = 470, M age = 4 years). Multivariable linear regression models were used to examine cross-sectional associations between ADHD symptoms and eating behaviors. Latent Change Score (LCS) modeling was performed to examine prospective association among a subset of children with available follow-up data. (N = 100, M age = 7 years). RESULTS The cross-sectional results showed that attention problem (AP) and hyperactivity (HY) were positively associated with food responsiveness, emotional overeating, desire to drink, and slowness in eating. AP, but not HY, was inversely associated with enjoyment of food. Results of the LCS models revealed AP and HY were both positively associated with prospective changes in emotional overeating and satiety responsiveness. AP was further positively associated with prospective changes in food responsiveness. The reverse relationship predicting changes in ADHD symptoms from earlier assessments of eating behaviors was not significant. CONCLUSION Results suggest a link between ADHD symptoms and obesity-related eating behaviors in early childhood, highlighting the need to address self-regulation and healthy eating behaviors in the prevention of childhood obesity.
Collapse
Affiliation(s)
- Bernard F. Fuemmeler
- Virginia Commonwealth University, Department of Health Behavior and Policy, Richmond, VA
| | - Yaou Sheng
- Virginia Commonwealth University, Department of Health Behavior and Policy, Richmond, VA
| | - Julia C. Schechter
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Elizabeth Do
- Virginia Commonwealth University, Department of Health Behavior and Policy, Richmond, VA
| | - Nancy Zucker
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Alesha Majors
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Rachel Maguire
- North Carolina State University, Department of Biological Sciences, Raleigh, NC
| | - Susan K. Murphy
- Duke University Medical Center, Obstetrics and Gynecology, Durham, NC
| | - Cathrine Hoyo
- North Carolina State University, Department of Biological Sciences, Raleigh, NC
| | - Scott H. Kollins
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC
| |
Collapse
|
37
|
Srinivas S, Anand K, Chockalingam A. Longitudinal association between adolescent negative emotions and adulthood cardiovascular disease risk: an opportunity for healthcare quality improvement. BENCHMARKING-AN INTERNATIONAL JOURNAL 2020. [DOI: 10.1108/bij-01-2020-0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PurposeWhile cardiovascular disease (CVD) is the leading cause of death globally, over 80% of the cases could be prevented through early lifestyle changes. From the perspective of quality management in healthcare, this may offer an effective prevention window if modifiable CVD risk factors are identified and treated in adolescence. The purpose of this research is to examine the negative emotions in adolescents and determine if it independently increases CVD risk later in life.Design/methodology/approachLongitudinal data from 12,350 participants of the Add Health study, which conducted a multi-wave survey for 14 years from adolescence (Wave 1) through adulthood (Wave 4), were used to test the research hypothesis. Four items (perception of life, self-reported depression, perceived loneliness and fearfulness) reflective of adolescent negative emotion were identified from the Wave 1 questionnaire, and factor analysis was conducted to confirm the hypothesized structure. The outcome variable, 30-year adulthood CVD risk category (high or low risk), was estimated using biomarkers, biological data and other factors collected during the 14-year follow-up in Wave 4. A logistic regression analysis was employed to assess the impact of adolescent negative emotions on adulthood CVD risk after adjusting for common risk factors such as sociodemographic characteristics, socioeconomic status and medical conditions in adolescence.FindingsThe results indicated adolescent negative emotion to be significantly associated with CVD risk category (p-value < 0.0001), even after controlling for common risk factors. A unit increase in the level of adolescent negative emotion increased the chance of being in the high CVD risk group in adulthood by 8% (odds ratio = 1.08 ± 0.03).Practical implicationsHealthcare providers and organizations could capitalize on the research findings by screening for negative emotions early in life through individual and societal interventions. The findings also provide an opportunity for implementing quality improvement initiatives to deliver robust preventive care, which, in turn, could improve the overall population health, reduce healthcare costs and improve care quality.Originality/valueAlthough previous studies showed a strong link between adolescent physiological factors (e.g. obesity) and adulthood cardiovascular disease (CVD), the association between adolescent outlook/attitude (negative emotion) and CVD risk has not been examined.
Collapse
|
38
|
Smith JD, Mohanty N, Davis MM, Knapp AA, Tedla YG, Carroll AJ, Price HE, Villamar JA, Padilla R, Jordan N, Brown CH, Langman CB. Optimizing the implementation of a population panel management intervention in safety-net clinics for pediatric hypertension (The OpTIMISe-Pediatric Hypertension Study). Implement Sci Commun 2020; 1:57. [PMID: 32835224 PMCID: PMC7386167 DOI: 10.1186/s43058-020-00039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Though clinical practice guidelines are available, the diagnosis of pediatric hypertension (HTN) is often missed. Management may not follow guidelines due to the measurement challenges in children, complexity of interpreting youth blood pressure standards that are dependent on height, age, and sex, familiarity with diagnostic criteria, and variable comfort with management of pediatric HTN among providers. Evidence suggests that wide adoption and adherence to pediatric HTN guidelines would result in lower cardiovascular disease and kidney damage in adulthood. The proposed project will develop an implementation strategy package to increase adherence to clinical practice guidelines for pediatric HTN within safety-net community health centers (CHCs). The centerpiece of which is a provider-facing population panel management (PPM) tool and point-of-care clinical decision support (CDS). Prior research indicates that multiple discrete implementation strategies (e.g., stakeholder involvement, readiness planning, training, ongoing audit and feedback) are needed to institute practice- and provider-level adoption of such tools. METHODS Using participatory research methods involving stakeholders from a practice-based research network of CHCs, with input from scientific advisors, the project aims to (1) employ user-centered design methods to tailor an existing CDS tool for use at the point of care and optimize cohort management with a PPM tool to support adherence to the latest pediatric HTN guidelines, and (2) use a stakeholder-driven method for selecting implementation strategies that support tool adoption and increase guideline-adherent physician behaviors. Multilevel process evaluation using surveys and key informant interview data will assess the acceptability, adoption, appropriateness, cost, and feasibility of the PPM tool and its multicomponent implementation strategy package. Usability testing will be conducted with the PPM tool to iteratively refine features and ensure proper functionality. DISCUSSION The proposed research has the potential to improve identification, diagnosis, and management of HTN in primary care settings for high-risk youth by assisting healthcare providers in implementing the American Academy of Pediatrics' 2017 guidelines using an EHR-integrated PPM tool with CDS. Should the strategy package for PPM tool adoption be successful for pediatric HTN, findings will be translatable to other settings and PPM of other chronic cardiovascular conditions affecting overall population health.
Collapse
Affiliation(s)
- Justin D. Smith
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, Medical Social Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Nivedita Mohanty
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Matthew M. Davis
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, and Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Ashley A. Knapp
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Yacob G. Tedla
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Allison J. Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Heather E. Price
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Juan A. Villamar
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Roxane Padilla
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - C. Hendricks Brown
- Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Craig B. Langman
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| |
Collapse
|
39
|
Vizzuso S, Amatruda M, Del Torto A, D’Auria E, Ippolito G, Zuccotti GV, Verduci E. Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents? Nutrients 2020; 12:nu12061785. [PMID: 32560039 PMCID: PMC7353408 DOI: 10.3390/nu12061785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent β-cell function (HOMA-β), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents.
Collapse
Affiliation(s)
- Sara Vizzuso
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
| | - Matilde Amatruda
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
| | | | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital University of Milan, 20154 Milan, Italy; (E.D.); (G.V.Z.)
| | - Giulio Ippolito
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital University of Milan, 20154 Milan, Italy; (E.D.); (G.V.Z.)
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
- Department of Pediatrics, Vittore Buzzi Children’s Hospital University of Milan, 20154 Milan, Italy; (E.D.); (G.V.Z.)
- Correspondence:
| |
Collapse
|
40
|
Dionne JM. Evidence Gaps in the Identification and Treatment of Hypertension in Children. Can J Cardiol 2020; 36:1384-1393. [PMID: 32502426 DOI: 10.1016/j.cjca.2020.02.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/06/2020] [Indexed: 01/03/2023] Open
Abstract
The ultimate goal of recognizing and treating hypertension in childhood is to prevent target-organ damage during childhood and to reduce the risk of adulthood cardiovascular disease. The quality of evidence to guide blood pressure management in children is lower than in adult medicine, yet some common findings support clinical practice recommendations. Oscillometric devices are increasingly replacing manual blood pressure measurements, but evidence shows that readings are not equivalent between the 2 methods. In addition, multiple blood pressure readings are needed before diagnosing a child with hypertension, but the optimal number and timing are still being determined. The recent American Academy of Pediatrics blood pressure guideline has revised the normative data tables and included threshold blood pressure limits which seem to identify children with higher cardiovascular risks. Threshold limits vary between guidelines, and the most accurate threshold has yet to be determined. Lifestyle modifications are a cornerstone of hypertension management, but the optimal diet and physical activity changes for beneficial effect are not known. When pharmacotherapy is needed, physicians have used drugs from all antihypertensive classes in children, yet only a few classes have been systematically studied. The long-term cardiovascular consequences of elevated blood pressure during childhood are under investigation and it seems that the lower the childhood blood pressure the better and that the rate of change during childhood is predictive of adulthood disease. With much still to learn, this article summarizes the evidence and the evidence gaps for the diagnosis, investigation, management, and outcomes of pediatric hypertension.
Collapse
Affiliation(s)
- Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
41
|
Leopold S, Zachariah JP. Pediatric Obesity, Hypertension, Lipids. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:62-77. [PMID: 33457188 PMCID: PMC7810340 DOI: 10.1007/s40746-020-00188-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The rise of the pediatric obesity pandemic over the past 40 years has sharpened focus on the management of obesity, hypertension and lipid abnormalities in children. Multiple studies demonstrate that these risk factors track from childhood into adulthood predisposing individuals to premature atherosclerotic cardiovascular disease and putting them at risk for early morbidity and mortality. RECENT FINDINGS Importantly, obesity, hypertension and lipid problems are individual risk factors that can occur independently. Multiple studies have shown that each risk factor causes target organ damage in children. Intensive and focused lifestyle modifications can improve a child's subclinical disease and decrease the risk for future morbidity. SUMMARY Childhood offers a unique opportunity at primordial and primary prevention of atherosclerotic cardiovascular disease. Clinicians must focus on targeting these highly prevalent conditions and applying lifestyle modification and then pharmacologic or surgical therapies as needed.
Collapse
Affiliation(s)
- Scott Leopold
- Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
42
|
Börnhorst C, Russo P, Veidebaum T, Tornaritis M, Molnár D, Lissner L, Marild S, De Henauw S, Moreno LA, Intemann T, Wolters M, Ahrens W, Floegel A. Metabolic status in children and its transitions during childhood and adolescence-the IDEFICS/I.Family study. Int J Epidemiol 2020; 48:1673-1683. [PMID: 31098634 DOI: 10.1093/ije/dyz097] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate metabolic status in children and its transitions into adolescence. METHODS The analysis was based on 6768 children who participated in the European IDEFICS/I.Family cohort (T0 2007/2008, T1 2009/2010 and/or T3 2013/2014; mean ages: 6.6, 8.4 and 12.0 years, respectively) and provided at least two measurements of waist circumference, blood pressure, blood glucose and lipids over time. Latent transition analysis was used to identify groups with similar metabolic status and to estimate transition probabilities. RESULTS The best-fitting model identified five latent groups: (i) metabolically healthy (61.5%; probability for group membership at T0); (ii) abdominal obesity (15.9%); (iii) hypertension (7.0%); (iv) dyslipidaemia (9.0%); and (v) several metabolic syndrome (MetS) components (6.6%). The probability of metabolically healthy children at T0 remaining healthy at T1 was 86.6%; when transitioning from T1 to T3, it was 90.1%. Metabolically healthy children further had a 6.7% probability of developing abdominal obesity at T1. Children with abdominal obesity at T0 had an 18.5% probability of developing several metabolic syndrome (MetS) components at T1. The subgroup with dyslipidaemia at T0 had the highest chances of becoming metabolically healthy at T1 (32.4%) or at T3 (35.1%). Only a minor proportion of children showing several MetS components at T0 were classified as healthy at follow-up; 99.8% and 88.3% remained in the group with several disorders at T1 and T3, respectively. CONCLUSIONS Our study identified five distinct metabolic statuses in children and adolescents. Although lipid disturbances seem to be quite reversible, abdominal obesity is likely to be followed by further metabolic disturbances.
Collapse
Affiliation(s)
- Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Biometry and Data Management, Bremen, Germany
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Toomas Veidebaum
- National Institute for Health Development, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia
| | | | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Lauren Lissner
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Marild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | | | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Timm Intemann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Anna Floegel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany
| |
Collapse
|
43
|
Smith JD, Fu E, Kobayashi MA. Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annu Rev Clin Psychol 2020; 16:351-378. [PMID: 32097572 PMCID: PMC7259820 DOI: 10.1146/annurev-clinpsy-100219-060201] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.
Collapse
Affiliation(s)
- Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136, USA;
| |
Collapse
|
44
|
Davis CL, Litwin SE, Pollock NK, Waller JL, Zhu H, Dong Y, Kapuku G, Bhagatwala J, Harris RA, Looney J, Williams CF, Armento A, Schmidt MD, Bassali R. Exercise effects on arterial stiffness and heart health in children with excess weight: The SMART RCT. Int J Obes (Lond) 2020; 44:1152-1163. [PMID: 31754238 PMCID: PMC7192762 DOI: 10.1038/s41366-019-0482-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/14/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Childhood obesity and inactivity are associated with cardiovascular risk. Evidence is limited for exercise effects on arterial health in children. METHODS One hundred and seventy-five inactive children with overweight or obesity (8-11 years, ≥85th percentile BMI, 61% female, 87% Black, 73% with obesity) were randomized to an 8-month daily after-school aerobic exercise program (40 min/day, n = 90) or a sedentary control condition (n = 85). Carotid-femoral pulse wave velocity (PWV, primary outcome, arterial stiffness), fitness, adiposity, blood pressure (BP), glucose, insulin resistance, lipids, and C-reactive protein were measured at baseline and posttest (8 months). Adiposity, fitness, and BP were measured again at follow-up, 8-12 months later. Intent-to-treat analyses were conducted using mixed models. RESULTS The study had 89% retention, with attendance of 59% in exercise and 64% in the control condition, and vigorous exercise participation (average heart rate 161 ± 7 beats/min). Compared with controls, the exercise group had twice the improvement in fitness (VȮ2 peak, 2.7 (95% CI 1.8, 3.6) vs. 1.3 (0.4, 2.3) mL/kg/min) and adiposity (-1.8 (-2.4, -1.1) vs. -0.8 (-1.5, -0.1)%), each p = 0.04, and a large improvement in HDL-cholesterol (0.13 (0.075, 0.186) vs. -0.028 (-0.083, 0.023) mmol/L, p < 0.0001). There was no group × time effect on other outcomes at 8 months, or on any outcomes at follow-up. The change in PWV at 8 months correlated with changes in insulin and insulin resistance (both r = 0.32), diastolic BP (r = 0.24), BMI (r = 0.22), and adiposity (r = 0.18). CONCLUSIONS Eight months of aerobic exercise training improved fitness, adiposity, and HDL-cholesterol levels, but did not reduce arterial stiffness in children with excess weight. PWV improved as a function of insulin resistance, BP, BMI, and adiposity. Weight loss may be required to improve arterial stiffness. Exercise benefits waned after discontinuing the program.
Collapse
Affiliation(s)
- Catherine L Davis
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA.
- Medicine, MCG, Augusta University, Augusta, GA, USA.
| | - Sheldon E Litwin
- Cardiology, Medicine, MCG, Augusta University, Augusta, GA, USA
- Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Norman K Pollock
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Jennifer L Waller
- Population Health Sciences, MCG, Augusta University, Augusta, GA, USA
| | - Haidong Zhu
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Gaston Kapuku
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Jigar Bhagatwala
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Ryan A Harris
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
- Medicine, MCG, Augusta University, Augusta, GA, USA
| | - Jacob Looney
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Celestine F Williams
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Aubrey Armento
- Georgia Prevention Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | | | - Reda Bassali
- Pediatrics, MCG, Augusta University, Augusta, GA, USA
| |
Collapse
|
45
|
Azar KMJ, Halley M, Lv N, Wulfovich S, Gillespie K, Liang L, Goldman Rosas L. Differing views regarding diet and physical activity: adolescents versus parents' perspectives. BMC Pediatr 2020; 20:137. [PMID: 32220230 PMCID: PMC7099828 DOI: 10.1186/s12887-020-02038-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/17/2020] [Indexed: 01/02/2023] Open
Abstract
Background Today, approximately one in five United States adolescents age 12 to 19 years is obese and just over a third are either overweight or obese. This study examines how parents and peers influence diet and physical activity behaviors of older adolescents (14–18 years) with overweight or obesity to inform weight management interventions. Methods Adolescent participants included 14 to 18-year-olds with a Body Mass Index (BMI) greater than the 85th percentile for their age and sex who were receiving care in a large healthcare system in Northern California. Adolescents and their parents participated in separate focus groups and interviews (if not able to attend focus groups) that were held at the same time in the same location. We used qualitative thematic analysis to identify common themes discussed in the adolescent and parent focus groups as well as paired analysis of adolescent-parent dyads. Results Participants included 26 adolescents and 27 parents. Adolescent participants were 14 to 18 years old. Half were female and the participants were almost evenly distributed across year in school. The majority self-identified as White (56%) and Asian (36%).Three themes were identified which included 1) parents overestimated how supportive they were compared to adolescents’ perception 2) parents and adolescents had different views regarding parental influence on adolescent diet and physical activity behaviors 3) parents and adolescents held similar views on peers’ influential role on lifestyle behaviors. Conclusion Parents’ and adolescents’ differing views suggest that alignment of parent and adolescent expectations and behaviors for supporting effective weight management could be incorporated into interventions.
Collapse
Affiliation(s)
- Kristen M J Azar
- Sutter Health Center for Health Systems Research, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA.
| | | | - Nan Lv
- University of Illinois, Chicago, USA
| | | | - Katie Gillespie
- Sutter Health Center for Health Systems Research, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Lily Liang
- Sutter Health Center for Health Systems Research, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | | |
Collapse
|
46
|
Park E, Volding DC, Taylor WC, Chan W, Meininger JC. Cardiorespiratory fitness, adiposity, and ambulatory blood pressure in adolescents. J Sports Med Phys Fitness 2020; 60:926-933. [PMID: 32141274 DOI: 10.23736/s0022-4707.20.10279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study examined the association of cardiorespiratory fitness (fitness) and adiposity (Body Mass Index [BMI] and waist circumference [WC]) with ambulatory blood pressure (ABP) and tested the moderating effect of adiposity on the association between fitness and ABP. METHODS A cross-sectional study was conducted with 370 adolescents aged 11-16 years. Fitness was assessed by a height-adjusted step test and estimated by heart rate recovery, defined as the difference between peak heart rate during exercise and heart rate two minutes postexercise. Adiposity was measured using dichotomized values for percentiles of BMI (≥85th) and WC (≥50th). ABP was measured every 30-60 minutes over 24 hours on a school day. Mixed-effects regression analysis was used. RESULTS Each unit increase in fitness was associated with a decrease of systolic blood pressure (SBP) [-0.058 mmHg, P=0.001] and diastolic blood pressure (DBP) [-0.043 mmHg, P<0.001] after adjustment for WC and covariates. Each unit increase in fitness was associated with a decrease in SBP [-0.058 mmHg, P=0.001] and DBP [-0.045 mmHg, P<0.001] after adjustment for BMI and covariates. Fitness and BMI≥85th percentile (or WC ≥ 50th percentile) interactions were not associated with ABP after adjustment for covariates. CONCLUSIONS Our findings indicate a small but statistically significant inverse effect of fitness on ABP in adolescents. No evidence of a modifying effect of adiposity on this association suggesting that fitness and weight management have essential roles for maintaining lower ABP in adolescents.
Collapse
Affiliation(s)
- Eunduck Park
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, USA -
| | - Devin C Volding
- Houston Methodist Hospital, Houston, TX, USA.,Stephen F. Austin State University, Nacogdoches, TX, USA
| | - Wendell C Taylor
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Janet C Meininger
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
47
|
Hasan RA, Koh AY, Zia A. The gut microbiome and thromboembolism. Thromb Res 2020; 189:77-87. [PMID: 32192995 DOI: 10.1016/j.thromres.2020.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/09/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
The gut microbiome plays a critical role in various inflammatory conditions, and its modulation is a potential treatment option for these conditions. The role of the gut microbiome in the pathogenesis of thromboembolism has not been fully elucidated. In this review, we summarize the evidence linking the gut microbiome to the pathogenesis of arterial and venous thrombosis. In a human host, potentially pathogenic bacteria are normal residents of the human gut microbiome, but significantly outnumbered by commensal anaerobic bacteria. Several disease states with an increased risk of venous thromboembolism (VTE) are associated with an imbalance in the gut microbiome characterized by a decrease in commensal anaerobic bacteria and an increase in the abundance of pathogenic bacteria of which the most common is the gram-negative Enterobacteriaceae (ENTERO) family. Bacterial lipopolysaccharides (LPS), the glycolipids found on the outer membrane of gram-negative bacteria, is one of the links between the microbiome and hypercoagulability. LPS binds to toll-like receptors to activate endothelial cells and platelets, leading to activation of the coagulation cascade. Bacteria in the microbiome can also metabolite compounds in the diet to produce important metabolites like trimethylamine-N-oxide (TMAO). TMAO causes platelet hyperreactivity, promotes thrombus formation and is associated with cardiovascular disease. Modulating the gut microbiome to target LPS and TMAO levels may be an innovative approach for decreasing the risk of thrombosis.
Collapse
Affiliation(s)
- Rida Abid Hasan
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Andrew Y Koh
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ayesha Zia
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
| |
Collapse
|
48
|
Hua L, Yuan JX, He S, Zhao CH, Jia QW, Zhang J, An FH, Chen ZH, Li LH, Wang LS, Ma WZ, Xu GX, Jia EZ. Analysis on the polymorphisms of site RS4977574, and RS1333045 in region 9p21 and the susceptibility of coronary heart disease in Chinese population. BMC MEDICAL GENETICS 2020; 21:36. [PMID: 32066403 PMCID: PMC7026955 DOI: 10.1186/s12881-020-0965-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
Background Rs4977574 (A > G) and Rs1333045 (C > T) are both single nucleotide polymorphisms (SNPs) related with coronary artery disease, locating on chromosome 9p21.3. The study aimed to identify the correlation between rs4977574 and rs1333045 polymorphism genotypes and coronary heart disease (CHD) in a Chinese population. Methods Blood samples were collected from 855 subjects. A case-control study was used in this experiment, and 598 cases in the CHD group and 257 subjects in the control group were enrolled. Genotyping was identified by the Agena MassARRAY system. Statistical analysis was conducted by SPSS (Ver 16.0) and plink (Ver. 1.07, Shaun Purcell). Haplotype analysis was performed using Haploview software. Results Association analysis by plink indicated a significant difference in the allele distribution for single nucleotide polymorphisms between cases and controls (rs4977574 P = 0.003, rs1333045 P = 0.035). Fisher’s exact test by plink proved that allele G may be associated with a higher risk of CHD (P = 0.003, odds ratio (OR) = 1.371) and the T allele was likely to reduce the risk of coronary events (P = 0.035, OR = 0.798). The serum levels of apolipoprotein A (ApoA) were higher in subjects with the AG + AA genotype of rs4977574 compared to those with the GG genotype (P = 0.028). In the dominant model of rs1333045, the levels of ApoA were higher and LDL levels were lower in the TC + TT genotype than in the CC genotype. Conclusions The present study examined the association between the 9p21 chromosome rs4977574 and rs1333045 polymorphism genotypes and CHD in a population of Chinese patients. The G allele of rs4977574 and the C allele of rs1333045 are the susceptibility sites of CHD.
Collapse
Affiliation(s)
- Lei Hua
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Jin-Xia Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Shu He
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Chen-Hui Zhao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Qiao-Wei Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Feng-Hui An
- Department of Cardiovascular Medicine, The Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Zhao-Hong Chen
- Department of Cardiovascular Medicine, The Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Li-Hua Li
- Department of Cardiovascular Medicine, The Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Lian-Sheng Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Wen-Zhu Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China
| | - Guang-Xu Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - En-Zhi Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, China.
| |
Collapse
|
49
|
Parsanathan R, Jain SK. Novel Invasive and Noninvasive Cardiac-Specific Biomarkers in Obesity and Cardiovascular Diseases. Metab Syndr Relat Disord 2020; 18:10-30. [PMID: 31618136 PMCID: PMC7041332 DOI: 10.1089/met.2019.0073] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of fatality and disability worldwide regardless of gender. Obesity has reached epidemic proportions in population across different regions. According to epidemiological studies, CVD risk markers in childhood obesity are one of the significant risk factors for adulthood CVD, but have received disproportionally little attention. This review has examined the evidence for the presence of traditional cardiac biomarkers (nonspecific; lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, myoglobulin, glycogen phosphorylase isoenzyme BB, myosin light chains, ST2, and ischemia-modified albumin) and novel emerging cardiac-specific biomarkers (cardiac troponins, natriuretic peptides, heart-type fatty acid-binding protein, and miRNAs). Besides, noninvasive anatomical and electrophysiological markers (carotid intima-media thickness, coronary artery calcification, and heart rate variability) in CVDs and obesity are also discussed. Modifiable and nonmodifiable risk factors associated with metabolic syndrome in the progression of CVD, such as obesity, diabetes, hypertension, dyslipidemia, oxidative stress, inflammation, and adipocytokines are also outlined. These underlying prognostic risk factors predict the onset of future microvascular and macrovascular complications. The understanding of invasive and noninvasive cardiac-specific biomarkers and the risk factors may yield valuable insights into the pathophysiology and prevention of CVD in a high-risk obese population at an early stage.
Collapse
Affiliation(s)
- Rajesh Parsanathan
- Department of Pediatrics and Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Sushil K. Jain
- Department of Pediatrics and Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| |
Collapse
|
50
|
Association between urine lead levels and cardiovascular disease risk factors, carotid intima-media thickness and metabolic syndrome in adolescents and young adults. Int J Hyg Environ Health 2020; 223:248-255. [DOI: 10.1016/j.ijheh.2019.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 01/23/2023]
|