Evaluation oF Epicardial Fat and Carotid Intima-Media Thickness in Obese Children

Assessment of Epicardial Fat in Children: Its Role as a Cardiovascular Risk Factor and How It Is Influenced by Lifestyle Habits

Epicardial adipose tissue (EAT) stands out as a distinctive repository of visceral fat, positioned in close anatomical and functional proximity to the heart. EAT has emerged as a distinctive reservoir of visceral fat, intricately interlinked with cardiovascular health, particularly within the domain of cardiovascular diseases (CVDs). The aim of our overview is to highlight the role of EAT as a marker for cardiovascular risk in children. We also explore the influence of unhealthy lifestyle habits as predisposing factors for the deposition of EAT. The literature data accentuate the consequential impact of lifestyle choices on EAT dynamics, with sedentary behavior and unwholesome dietary practices being contributory to a heightened cardiovascular risk. Lifestyle interventions with a multidisciplinary approach are therefore pivotal, involving a nutritionally balanced diet rich in polyunsaturated and monounsaturated fatty acids, regular engagement in aerobic exercise, and psychosocial support to effectively mitigate cardiovascular risks in children. Specific interventions, such as high-intensity intermittent training and circuit training, reveal favorable outcomes in diminishing the EAT volume and enhancing cardiometabolic health. Future clinical studies focusing on EAT in children are crucial for advancing our understanding and developing targeted strategies for cardiovascular risk management in this population.

C-Reactive Protein as a Marker of Inflammation in Children and Adolescents with Metabolic Syndrome: A Systematic Review and Meta-Analysis

Metabolic syndrome (MetS) in the pediatric population has been reported in many studies to be associated with an inflammatory response. However, to our knowledge, there is no definitive conclusion in the form of a meta-analysis. The issue we aimed to address is whether C-reactive protein (CRP) is a trustworthy marker in detecting inflammation in children and adolescents with MetS. We systematically searched PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, the ISI Web of Science, and SCOPUS until 31 June 2023 for studies involving children and adolescents with MetS where hsCRP or CRP were measured. After the screening process, we identified 24 full-text articles that compared 930 patients with MetS with either healthy (n = 3782) or obese (n = 1658) controls. The risk of bias in the included studies was assessed using the Begg's rank correlation test and Egger's regression test. Statistical analysis was carried out based on pooled mean differences (MDs) and an associated 95% CI. Data analysis showed that MetS is associated with higher levels of CRP than those in healthy controls (MD = 1.28, 95% CI: (0.49-2.08), p = 0.002) in obese patients (MD = 0.88, 95% CI: (0.38-1.39), p = 0.0006). However, conventional methods of CRP analysis were found to be more accurate in differentiating between children and adolescents with obesity and those with MetS, compared with hsCRP (MD = 0.60, 95% CI: (-0.08-1.28), p = 0.08). No risk of bias was assessed. In conclusion, CRP is a reliable inflammatory marker for differentiating pediatric patients with MetS from healthy ones. On the other hand, it did not prove to be very accurate in distinguishing between patients who had MetS and those who were obese. There should be more research performed in this field.

Epicardial Adipose Tissue: A Piece of The Puzzle in Pediatric Hypertension

Background and purpose: Epicardial adipose tissue (EAT) is a metabolically active tissue located on the surface of the myocardium, which might have a potential impact on cardiac function and morphology. The aim of this study was to evaluate whether EAT is associated with essential arterial hypertension (AH) in children and adolescents. Methods: Prospective cardiovascular magnetic resonance (CMR) study and clinical evaluation were performed on 72 children, 36 of whom were diagnosed with essential AH, and the other 36 were healthy controls. The two groups were compared in volume and thickness of EAT, end-diastolic volume, end-systolic volume, stroke volume, left ventricular (LV) ejection fraction, average heart mass, average LV myocardial thickness, peak filling rate, peak filling time and clinical parameters. Results: Hypertensive patients have a higher volume (16.5 ± 1.9 cm3 and 10.9 ± 1.5 cm3 (t = −13.815, p < 0.001)) and thickness (0.8 ± 0.3 cm and 0.4 ± 0.1 cm, (U = 65.5, p < 0.001)) of EAT compared to their healthy peers. The volume of EAT might be a potential predictor of AH in children. Conclusions: Our study indicates that the volume of EAT is closely associated with hypertension in children and adolescents.

Comparison of early atherosclerosis markers in children with Celiac disease and their healthy peers

Purpose: We aimed to evaluate carotid intima-media thickness (cIMT) and epicardial adipose tissue thickness (EATT) concurrently as early atherosclerotic markers in pediatric patients with Celiac disease. Materials and Methods: Patients with Celiac disease (n=54) and healthy peers (n=54) aged 5-18 years were enrolled in this cross-sectional study. Patients who followed gluten free diet at least the past 12 months were included. Anthropometric and biochemical measurements were performed. cIMT and EATT were measured by echocardiography and compared between the patient and control groups. Results: Body mass index (17.4±3.0 vs. 18.4±3.1 kg/m2), blood pressure (systolic: 100 (85-120) vs. 100 (80-100) mmHg; diastolic: 60 (40-90) vs. 70 (40-90) mmHg), and lipid profile (total cholesterol: 144.6±30.2 vs. 150.8±22.6 mg/dL; triglycerides: 71.5 (27-178) vs. 92.5 (34-203) mg/dL) were not different between the patient and control groups, while there were significant differences in cIMT and EATT. The patient group had higher cIMT (0.50±0.07 vs. 0.45±0.04 mm) and EATT (5.68±0.90 vs. 4.22±0.76 mm) than the control group. The risk of vitamin D insufficiency was 2.68 times higher in the patient group (95% CI=1.19-6.03). Conclusions: Children with Celiac disease had higher cIMT and EATT than healthy peers. cIMT and/or EATT measurements by echocardiography may present as a reliable and easy method to investigate subclinical atherosclerosis in children with Celiac disease.

Waist circumference a clinical criterion for prediction of cardio-vascular complications in children and adolescences with overweight and obesity

Overweight and obesity in childhood are associated with early cardiovascular dysfunction and promote heightened risk of cardiovascular morbidity and mortality in adulthood. Waist circumference (WC) correlates with visceral obesity, which is why obese children with elevated WC need to be carefully monitored to prevent long-term cardio-metabolic complications. The purpose of our study was to establish if WC could be a predictor of cardiovascular complications in children.The authors conducted a retrospective study that included 160 overweight and obese children and adolescents, aged 6 to 18 years. Patients were evaluated completely anthropometrically, biologically, and imagistic. The anthropometric data tracked were height, weight, WC, and body mass index. Echocardiography evaluated the following parameters: the interventricular septum, left ventricular mass, the relative thickness of the ventricular wall, the pathological epicardial fat.Our results confirm that the presence of visceral obesity was significantly associated (χ = 11.72, P = .0006) with pathological epicardial fat. In children, visceral obesity is not a risk factor for vascular or cardiac impairment, but in adolescents, the results showed that visceral obesity is an important predictive factor for the occurrence of vascular (AUC = 0.669, P = .021) and cardiac (AUC = 0.697, P = .037) impairment. Concentric left ventricular (LV) hypertrophy is significantly influenced by the presence of visceral obesity (AUC = 0.664, P = .013 children; AUC = 0.716, P = .026 adolescents).WC above the 90th percentile is a predictive factor for increased LVM index and concentric hypertrophy in both children and adolescents.

Perirenal and epicardial fat and their association with carotid intima-media thickness in children

Recent data suggest that subclinical atherosclerosis is more related to visceral adipose tissue distribution than to overall fat mass. Both perirenal fat and epicardial fat are visceral fat depots surrounding the kidneys and the myocardium, respectively, which can be easily assessed by ultrasound. Their clinical relevance in children is largely unknown. This review describes studies relating perirenal and epicardial fat to cardiovascular disease or carotid intima-media thickness (cIMT), a well-established surrogate for subclinical atherosclerosis, and discusses this in context with our own data from children. In adults, both perirenal and epicardial fat are useful biological markers of visceral obesity. The former has been related to hypertension in overweight subjects and with atherosclerosis in patients with human immunodeficiency virus. The latter was associated with several metabolic syndrome components and with calcification of the carotid artery. In healthy prepubertal children, both epicardial and perirenal fat thickness, rather than total body fat mass, were related to cIMT. Ultrasonography measures of perirenal and epicardial fat are related to atherosclerosis in adults and may be convenient tools for the assessment of cardiometabolic risk in children.

The Relationship between the Waist Circumference and Increased Carotid Intima Thickness in Obese Children

Background: This study aimed to evaluate the cardiometabolic risk factors in normotensive obese and hypertensive obese (HT-obese) children by comparison of anthropomorphic measurements, fat distribution, carotid artery intima-media thickness (CIMT), and inflammatory markers. Methods: Fifty-three obese patients 10-18 years of age with a BMI-for-age/gender >95th percentile and 20 age- and gender-matched healthy volunteers enrolled in the study. Obese patients were divided into two groups according to the presence of hypertension (HT), as follows: HT-obese subgroup (n = 30) and nonhypertensive obese (non-HT-obese) subgroup (n = 23). Results: Weight standard deviation score (SDS), BMI-SDS, waist circumference (WC) SDS, and the fat tissue z-score were significantly higher (p < 0.001 for all) in the obese patients than the control groups. Obese patients had higher 24-hour systolic blood pressure (SBP) SDS and leptin, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, and interleukin-6 levels. Furthermore, CIMT and CIMT-SDS were significantly higher in them. HT-obese patients (n = 30) had significantly higher WC-SDS and lower serum leptin and adiponectin levels than those of non-HT-obese group (n = 23). Finally, an association between increased CIMT-SDS and WC-SDS (β = 0.399, p = 0.002) and 24-hour SBP-SDS (β = 0.272, p = 0.009) was shown. Conclusions: Association between increased WC and HT implies the importance of central obesity in atherosclerosis. We concluded that WC measurement could be used to define risk groups since it is related to cardiometabolic complications.

Carotid Intima-Media Thickness and Metabolic Syndrome Components in Obese Children and Adolescents

Obesity in children and adolescents contributes to increased prevalence of metabolic and hemodynamic complications, which may impair endothelial function and structure. A high resolution B-mode ultrasound measurement of intima-media thickness (IMT) is a useful tool to assess early, preclinical stage of atherosclerosis. The objective of this study was to evaluate the carotid artery IMT in obese children and its association with insulin resistance and other traditional metabolic syndrome components. The study entailed 80 obese children, aged 5.3-17.9 year and a control group of 31 children. Obesity was defined using the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria of 2007. Each patient's anthropometric measurements, blood parameters, and the carotid IMT were evaluated. Insulin resistance indices were calculated. We found that children with metabolic syndrome had a significantly increased IMT compared to children who did not meet the syndrome criteria (0.62 ± 0.09 mm vs. 0.55 ± 0.18 mm, p = 0.03) and compared to control group (0.62 ± 0.09 vs. 0.52 ± 0.14, p = 0.02). In a multivariable linear regression analysis, IMT correlated with systolic blood pressure (p = 0.005). The results did not show an association between IMT and insulin resistance. We conclude that abdominal obesity and the accompanying components of metabolic syndrome lead to increased carotid IMT. The enhanced systolic blood pressure plays a major role in changing the carotid IMT.

Left and right ventricular function by echocardiography, tissue Doppler imaging, carotid intima-media thickness, and asymmetric dimethyl arginine levels in obese adolescents with metabolic syndrome

PurposeThe aim of our study was to assess left ventricle and right ventricle systolic and diastolic functions in obese adolescents with metabolic syndrome using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotis intima-media thickness, and asymmetric dimethyl arginine levels.

METHODS

A total of 198 obese adolescents were enrolled in the study. The obese patients were divided into metabolic syndrome group and non-metabolic syndrome group. All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulsed, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness.

RESULTS

Obese adolescents were characterised by enlarged left end-diastolic, end-systolic and left atrial diameters, thicker left and right ventricular walls compared with non-obese adolescents. The metabolic syndrome group had normal left ventricle systolic function, impaired diastolic function, and altered global systolic and diastolic myocardial performance. In the metabolic syndrome obese group patients, left ventricle mass was found positively correlated with body mass index, waist and hip circumferences, diastolic blood pressure, age, and waist-to-hip circumference ratio. The carotid intima-media thickness was found positively correlated with waist and hip circumferences and total cholesterol levels. Asymmetric dimethyl arginine levels were found positively correlated with systolic blood pressure, waist-to-hip circumference ratio, and diastolic blood pressure.

CONCLUSIONS

The results of this study demonstrate that metabolic syndrome in adolescence is associated with significant changes in myocardial geometry and function. In addition, it has been associated with a high level of asymmetric dimethyl arginine concentration and thicker carotid intima-media thickness reflecting endothelial dysfunction.

Insulin metabolism markers are predictors of subclinical atherosclerosis among overweight and obese children and adolescents

BACKGROUND

To investigate the association between markers of insulin metabolism and carotid intima-media thickness(cIMT) among overweight and obese children and adolescents.

METHODS

A total of 378 children and adolescents aged from 6 to 13 years, with WHO body mass index Z-Scores ≥2 were enrolled in this study. We measured fasting serum insulin and glucose, conducted a homeostatic model assessment of insulin resistance(HOMA-IR), and calculated the quantitative insulin sensitivity check index(QUICKI). Carotid intima-media thickness was measured in the common carotid artery with high-resolution ultrasonography.

RESULTS

The study participants consisted of 198 boys and 180 girls with a mean(±SD) age of 9.3 ± 1.7 years, 18.3% being pre-pubertal. In boys, after controlling for confounders, a one-SD increase in fasting insulin and HOMA-IR were associated with 0.351 mm(P < 0.001) and 0.350 mm(P < 0.001) increases in cIMT, respectively. However, a one-SD increase in QUICKI was associated with a - 0.305 mm(P = 0.001) decrease in cIMT. When categorizing into tertiles, a one-SD increase in fasting insulin and HOMA-IR were associated with 87 and 81% increases in the odds of higher categories of cIMT(both P < 0.05). However, a one-SD increase in QUICKI was associated with 37% lower odds of higher categories of cIMT(P = 0.022). No significant associations were found among girls.

CONCLUSION

This study demonstrated that insulin resistance and sensitivity markers were independent predictors of cIMT in overweight and obese boys, but not in girls, highlighting the importance of chronically elevated insulin levels for predisposing these boys to alterations in their vascular structure.

Relation Between Wrist Circumference and Left Ventricular Structure in Overweight Children

The aim of this study was to assess the relation of wrist circumference with changes in left ventricular (LV) structure in a population of overweight/obese children and adolescents. One hundred and six children and adolescents were consecutively enrolled. In all subjects body weight, height, wrist circumference, waist circumference, body mass index-standard deviation score, fasting glucose, insulin, lipid profile, and blood pressure were evaluated. All subjects underwent echocardiographic assessment, and the following parameters were evaluated: LV dimension at end diastole and LV dimension at end systole, LV posterior wall thickness at end diastole and LV posterior wall thickness at end systole, interventricular septal thickness at end diastole and interventricular septal thickness at end systole, LV mass, and epicardial adipose tissue (EAT). LV hypertrophy was defined as LVM Index ≥95th percentile. Wrist circumference correlated with all parameters of LV dimensions and LV mass (p <0.0001) and EAT (p = 0.04). The strongest correlations were reported between wrist circumference with LV dimension at end diastole and LV dimension at end systole (r = 0.73 and r = 0.68 respectively, p <0.0001, for both). Results of the multivariate regression analysis showed that wrist circumference was significantly associated with all parameters of LV dimensions, LV mass, and EAT (p ≤0.002). The logistic regression showed that wrist circumference was significantly associated with LV hypertrophy (odds ratio 1.39, p = 0.046). In conclusion, wrist circumference could be a useful measure of cardiovascular risk in obese children and adolescents, opening new perspectives in the prediction of cardiovascular diseases.