Is There an Association of Vascular Disease and Atherosclerosis in Children and Adolescents With Obesity and Non-alcoholic Fatty Liver Disease?

Non-alcoholic fatty liver and fibrosis is associated with cardiovascular structure and function in young adults

BACKGROUND

Non-alcoholic fatty liver disease shares many risk factors with other metabolic disorders. We sought to establish whether non-alcoholic fatty liver disease may be associated with cardiovascular health independently of other known risk factors.

METHODS

In this prospective, population-based cohort of young adults, controlled attenuation parameter-defined liver steatosis, transient elastography-defined liver fibrosis, echocardiography, carotid ultrasonography, and pulse wave analysis were assessed at age 24 years. We examined associations between liver and cardiovascular measures, with and without accounting for demographics, body mass index, alcohol, smoking, blood pressure, lipidemia, glycemia, and inflammation.

RESULTS

We included 2047 participants (mean age 24.4 y; 36.2% female): 212 (10.4%) had steatosis, whereas 38 (1.9%) had fibrosis. Steatosis was associated with cardiovascular measures after adjusting for demographics, but with more comprehensive adjustment, steatosis only remained associated with stroke index [β (95% CI) of -1.85 (-3.29, -0.41) mL/m2] and heart rate [2.17 (0.58, 3.75) beats/min]. Fibrosis was associated with several measures of cardiovascular structure and function after full adjustment for risk factors, including left ventricular mass index [2.46 (0.56, 4.37) g/m2.7], E/A ratio [0.32 (0.13, 0.50)], tricuspid annular plane systolic excursion [0.14 (0.01, 0.26) cm], carotid intima-media thickness [0.024 (0.008, 0.040) mm], pulse wave velocity [0.40 (0.06, 0.75) m/s], cardiac index [-0.23 (-0.41, -0.06) L/min⋅m2], and heart rate [-7.23 (-10.16, -4.29) beats/min].

CONCLUSIONS

Steatosis was not associated with measures of cardiovascular structure and function nor with subclinical atherosclerosis after adjusting for known cardiovascular risk factors. Fibrosis, however, was associated with several cardiovascular measures, including indicators of subclinical atherosclerosis, even after full adjustment. Further follow-up will help determine whether cardiovascular health worsens later with steatosis alone.

Current applications for measuring pediatric intima-media thickness

Intima-media thickness is a known subclinical radiologic marker of the early manifestations of atherosclerotic disease. It is the thickness of the vessel wall, most often the carotid artery. Intima-media thickness is measured on conventional US manually or automatically. Other measurement techniques include radiofrequency US. Because there is variation in its measurement, especially in children, several recommendations have been set to increase the measurement's validity and comparability among studies. Despite these recommendations, several pitfalls should be avoided, and quality control should be performed to avoid erroneous interpretation. This article summarizes current literature in relation to the clinical applications for intima-media thickness measurement in children with known risk factors such as obesity, liver steatosis, hypercholesterolemia, diabetes, hypertension, systemic inflammatory diseases, cancer survival, kidney and liver transplant, and sickle cell disease or beta thalassemia major. Most potential indications for intima-media thickness measurement remain in the research domain and should be interpreted combined with other markers. The objective of diagnosing an increased intima-media thickness is to start a multidisciplinary treatment approach to prevent disease progression and its sequelae in adulthood.

Liver Enzymes Correlate With Metabolic Syndrome, Inflammation, and Endothelial Dysfunction in Prepubertal Children With Obesity

Background: Metabolic syndrome (MetS) can start in children with obesity at very young ages. Non-alcoholic fatty liver disease (NAFLD) is considered to be the hepatic component of metabolic syndrome. If left untreated, the clinical course of NAFLD can be progressive and can become chronic if not detected at an early stage. Objective: We aimed to quantify the differences in liver enzymes between prepubertal children with obesity and children with normal weight to determine any associations between them and parameters related to MetS, adipokines, or markers of endothelial dysfunction and inflammation. Methods: This cross-sectional study included 54 prepuberal children with obesity (aged 6-9 years) and 54 children with normal weight, matched by age and sex. Liver enzymes, C-reactive protein (CRP), interleukin-6, soluble intercellular adhesion molecule-1 (sICAM-1), adipokines, and parameters related to metabolic syndrome (MetS) were all measured. Results: Alanine aminotransferase (ALT) levels, serum butyryl cholinesterase (BChE), leptin, CRP, sICAM-1, triglycerides, blood pressure, and homeostasis model assessment for insulin resistance were significantly higher in children with obesity, while Apolipoprotein A-1, HDL-cholesterol, and adiponectin were significantly lower. In the children with obesity group, ALT and BChE levels correlated with anthropometric measurements, insulin resistance, and lipid parameters, leptin, interleukin-6, CRP, and sICAM-1 while BChE levels negatively correlated with adiponectin. Conclusions: Compared to children with normal weight, prepubertal children with obesity had elevated values for liver enzymes, leptin, markers of insulin resistance, inflammation, and endothelial dysfunction, and variables associated with MetS. There was also a correlation between these disorders and liver enzyme levels.

Kinetics of Muscle Damage Biomarkers at Moments Subsequent to a Fight in Brazilian Jiu-Jitsu Practice by Disabled Athletes

Purpose: Evidence indicates that muscle injury caused by exercise can lead to functional, biochemical, and clinical damage. These outcomes encompass an intrinsic potential to understand the real magnitude of interpretation of classic signs in sport environments and to monitor athletes, contributing to specific actions. However, little or no research has explored the general behavior of the variables presented in response to paradesportivo Brazilian jiu-jitsu. The objective of this study was to investigate the physiological behavior through clinical, functional, and metabolic outcomes in the moments following a simulated fight. Methods: Six disabled athletes, male Brazilian jiu-jitsu practitioners (34-44 years old), were included. The participants had their outcomes analyzed individually and the variables studied were correlated. It is noteworthy that participants I and II are professional athletes with world titles. The ethics committee involving human beings of the Federal University of Mato Grosso (register no. 2.997.241) accepted the study. The participants attended the collection site four times, with a 24-h interval between sessions, characterizing the following moments: pre-exertion, and post-exertion, 24, 48, and 72 h after the simulated fight. Data collected were muscle pain, perception of recovery, muscle strength, and blood samples for creatine kinase (CK) and lactate dehydrogenase (LDH) analysis. The variables described were measured at all collection moments. The data were presented in individual raw values of each participant, with Spearman correlation analysis to verify the relationship between variables and moments. Results: The outcomes demonstrated that the CK and LDH activity was higher of high-performance parathletes (I and II) and the reported muscle pain was lower. The fight did not influence maximal isometric strength levels in either participant. In addition, regarding delayed effects, the participants reported peak pain, CK, LDH, and decreased perception of recovery within 24 h. However, it was found that, at 72 h, all values had recovered, close to baseline levels. Conclusion: The presented outcomes provide parameters and suggest a safe scenario based on the intensity and volume commonly adopted in this sports parade modality where the level of effort recommended during combat does not seem to cause deleterious damage.