Insulin resistance, dyslipidemia and cardiovascular changes in a group of obese children

Methods to evaluate vascular function: a crucial approach towards predictive, preventive, and personalised medicine

Endothelium, the gatekeeper of our blood vessels, is highly heterogeneous and a crucial physical barrier with the ability to produce vasoactive and protective mediators under physiological conditions. It regulates vascular tone, haemostasis, vascular inflammation, remodelling, and angiogenesis. Several cardio-, reno-, and cerebrovascular diseases begin with the dysfunction of endothelial cells, and more recently, COVID-19 was also associated with endothelial disease highlighting the need to monitor its function towards prevention and reduction of vascular dysfunction. Endothelial cells are an important therapeutic target in predictive, preventive, and personalised (3P) medicine with upmost importance in vascular diseases. The development of novel non-invasive techniques to access endothelial dysfunction for use in combination with existing clinical imaging modalities provides a feasible opportunity to reduce the burden of vascular disease.

This review summarises recent advances in the principles of endothelial function measurements. This article presents an overview of invasive and non-invasive techniques to determine vascular function and their major advantages and disadvantages. In addition, the article describes mechanisms underlying the regulation of vascular function and dysfunction and potential new biomarkers of endothelial damage. Recognising these biomarkers is fundamental towards a shift from reactive to 3P medicine in the vascular field. Identifying vascular dysfunction earlier with non-invasive or minimally invasive techniques adds value to predictive diagnostics and targeted prevention (primary, secondary, tertiary care). In addition, vascular dysfunction is a potential target for treatments tailored to the person.

Severe Quantitative Scale of Acanthosis Nigricans in Neck is Associated with Abdominal Obesity, HOMA-IR, and Hyperlipidemia in Obese Children from Mexico City: A Cross-Sectional Study

Background. Acanthosis nigricans (AN) is a clinical sign that commonly occurs in obesity; however, its specificity and sensitivity have been controversial. It is unknown if AN severity degree can be a useful marker for cardiometabolic disorders screening. We suggest that the stratified analysis of AN severity degree in neck by Burke’s scale could be a useful tool in the screening of cardiometabolic alterations in obese children. Objective. The aim of this study was the association of AN severity degree in neck by Burke’s scale with anthropometric, biochemical, and inflammatory parameters in obese school-age children from Mexico City. Methods. A cross-sectional study was conducted, including 95 obese school-age children stratified by AN severity degree in neck by Burke’s scale. Anthropometric and fasting biochemical measurements were determined. Variables were compared by x2 test for frequencies and one-way ANOVA with Bonferroni posttest for continuous variables. Linear regression analysis adjusted by gender, BMI, and age was performed to evaluate the association between AN severity degree and cardiometabolic alterations. Statistical significance was set at $p<0.05$ . Results. As AN severity degree in neck by Burke’s scale increased, diastolic blood pressure ( $p=0.001$ ) and triglycerides ( $p=0.02$ ) significantly increased and adiponectin significantly decreased ( $p=0.02$ ). Positive associations between grade 3 AN and waist circumference, HOMA-IR, triglycerides, total cholesterol, and LDL cholesterol were observed. Conclusion. Our findings could be used to identify an easier clinical tool to prevent obesity progression and its complications in pediatrics. There are no similar studies.

Reduction of small dense LDL and Il-6 after intervention with Plantago psyllium in adolescents with obesity: a parallel, double blind, randomized clinical trial

Obesity can lead children and adolescents to an increased cardiovascular disease (CVD) risk. A diet supplemented with Plantago psyllium has been shown to be effective in reducing LDL-C and IL-6 in adolescents. However, there are no studies that have explored small-dense LDL (sdLDL) or HDL subclasses. The aim of this study was to evaluate the impact of a fiber dietary intervention on LDL and HDL subclasses in adolescents with obesity. In this parallel, double blind, randomized clinical trial, the participants were assigned to Plantago psyllium or placebo (10g/day for 7 weeks). We randomized 113 participants, and evaluated and analyzed 100 adolescents (50 in each group), 15 to 19 years with a body mass index of 29-34. We measured biochemical markers LDL and HDL subclasses using the Lipoprint system (Quantimetrix) and IL-6 by ELISA. Post-treatment there was a decrease in sdLDL between the groups 2.0 (0-5.0) vs 1 (0-3.0) mg/dl (p = 0.004), IL-6 median 3.32 (1.24-5.96) vs 1.76 (0.54-3.28) pg/ml, p <0.0001. There were no differences in HDL subclasses and no adverse effects were reported in either group.Conclusions: Small dense LDL and IL-6 reduced in adolescents with obesity when consuming Plantago psyllium. This may be an early good strategy for the reduction of cardiovascular disease risk in this vulnerable population.Trial registration: ISRCTN # 14180431. Date assigned 24/08/2020 What is Known: • Supplementing the diet with Plantago psyllium lowers LDL-C levels. What is New: • First evidence that soluble fiber supplementation like Plantago psyllium decreases small dense LDL particles in association with lowered IL-6, reducing the risk of cardiovascular disease in obese adolescents.

Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology

OBJECTIVES

To investigate the optical coherence tomography angiography (OCTA) and specular microscopy (SM) findings in obese children and compare them with healthy ones.

METHODS

In this prospective study, 50 eyes of 25 obese children [body mass index (BMI) ≥95th percentile], 36 eyes of 18 control age- and sex- matched healthy subjects (BMI <85th percentile) were included. Demographic features and ophthalmological examination including OCTA measurements as well as SM findings were assessed. Cellular morphology was observed by noncontact SM and results for corneal endothelial cell density (cells/mm²), coefficient of variation of cell size and percentage of hexagonal cells were obtained. The OCTA was performed with 6 × 6 mm sections for macula and 4.5 × 4.5 mm sections for optic disc in all eyes. Foveal retinal thickness (FRT), retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of retina and optic nerve head were analyzed.

RESULTS

All SM parameters, RNFL thickness for average, and all quadrants and optic disc radial peripapillary capillary densities were similar between groups. However, FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities were significantly higher in obese group when compared to controls (242.4 ± 18.2 µm vs. 232.1 ± 16.5 µm, p=0.024, 2.2 ± 0.1 mm² vs, 2.2 ± 0.0 mm², p=0.042, 22.4 ± 6.9% vs. 15.6 ± 5.5%, p=0.001, and 38.9 ± 7.5% vs. 31.1 ± 8.6 %, p=0.001, respectively).

CONCLUSIONS

Obese children seem to have higher values of FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities. These results may have significant implications for understanding of how childhood obesity could affect retinal microvasculature.

Effects of Green Banana Biomass (Musa spp.) on Laboratory Parameters of Animal Models of Wistar Mice under Hyperlipidic Diet

AIM

Analyze the effects of green banana biomass (Musa spp.) on the biochemical parameters in Wistar male rats under standard and hyperlipidic diet.

METHODS

Ethical approval for this study was obtained from Ethics Committee on the Use of Animals CEUA - PUC-GO and consisted in the division of 32 rats in 4 differentiated groups according to their diet (standard - CT; standard with green banana biomass - CTBM; hyperlipidic - HL and hyperlipidic with green banana biomass - HLBM). Through 8 weeks animals were weighted and their glycemia were measured. After this period, they were euthanized and biological material was collected to evaluate the biochemical parameters, which analysis used the ANOVA test.

RESULTS

The weekly evaluation confirmed that the efficacy of the hyperlipidic model since the final weight was bigger in the HL group in comparison with the CT group, from the sixth to the eighth week. It was also possible to observe that the CTBM group had a smaller weight compared to the CT group. Besides, the measurement of glycemia, high-density lipoprotein, triglycerides, alanine aminotransferase, aspartate aminotransferase, serum total bilirubin, direct bilirubin, alkaline phosphatase, urea, serum creatine, uric acid, calcium, phosphor, magnesium and the hematological parameters from the 8 animal of each group were compared by the ANOVA test without any significative difference (p < 0.05) in the comparisons.

CONCLUSIONS

This study it did not demonstrate significative changes of the green banana biomass on the observed laboratory parameters during the 8 weeks in comparison to the standard group, indicating an absence of interference of the probiotics in the laboratory parameters on the hyperlipidic model during the analyzed period. Therefore, it is necessary an evaluation of its efficacy in obesity treatment in longer studies with molecular parameters.

What Change in Body Mass Index Is Required to Improve Cardiovascular Outcomes in Childhood and Adolescent Obesity through Lifestyle Interventions: A Meta-Regression

Background: Using meta-regression, this article aims at establishing the minimum change in BMI-standard deviation score (SDS) needed to improve lipid profiles and blood pressure in children and adolescents with obesity, to aid future trials and guidelines. Methods: Studies with participants involved in lifestyle interventions, aged 4-19 years, with a diagnosis of obesity according to defined BMI thresholds, were considered for inclusion in a large systematic review. Interventions had to report pre- and post-intervention (or mean change in) BMI-SDS, plus either systolic blood pressure (SBP), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and/or triglycerides (TGs). Random-effects meta-regression quantified the relationship between mean change in BMI-SDS and mean change in cardiovascular outcomes. Results: Seventy-one papers reported various cardiovascular measurements and mean change in BMI-SDS. Fifty-four, 59, 46, and 54 studies were analyzed, reporting a change in SBP, HDL, LDL, and TG, respectively. Reduction in mean BMI-SDS was significantly related to improvements in SBP, LDL, TG, and HDL (p < 0.05); BMI-SDS reductions of 1, 1.2, and 0.7 ensured a mean reduction of SBP, LDL, and TG, respectively, although an equivalent value for HDL improvement was indeterminate. Conclusion: Reductions in mean BMI-SDS of >1, >1.2, or >0.7 are likely to reduce SBP, LDL, and TG, respectively. Further studies are needed to clarify the optimal duration, intensity, and setting for interventions. Consistency is required regarding derived BMI values to facilitate future systematic reviews and meta-analyses.

Sex differences in circulating leptin as a marker of adiposity in obese or overweight adolescents with type 1 diabetes

INTRODUCTION

We aimed to test whether the serum adipokines leptin and adiponectin are more strongly associated with body fat percentage (BF%) than body mass index (BMI) in adolescents with type 1 diabetes (T1D) and overweight/obesity.

RESEARCH DESIGN AND METHODS

We studied all participants in the T1D Exchange Metformin Study (n=122, median age 12.9 years, range 12-19.5; 32% males; 77% non-Hispanic whites, 100% overweight or obesity; median diabetes duration 6.7 years, range 1.4-15) with a baseline serum sample where we measured leptin and adiponectin concentrations. Anthropometric, clinical, laboratory and dual-energy X-ray absorptiometry (DEXA) scan measurements were analyzed. We compared correlation coefficients between variables of interest.

RESULTS

BF% by DEXA was significantly correlated with BMI Z-score (r=0.38, p<0.0001), BMI per cent of the 95th percentile (BMI%95) (r=0.45, p<0.0001), waist circumference (r=0.46, p<0.0001), leptin (r=0.58, p<0.00001) and leptin/adiponectin ratio (r=0.36, p<0.0001), while it was not significantly correlated with absolute body weight, adiponectin or insulin dose (total or basal). BF% was significantly more strongly correlated with leptin than with BMI Z-score in the overall group (p=0.022). However, there were sex-based differences. Among the significant correlations in the overall group, BF% was most strongly associated with leptin (r=0.75) in boys (n=39) but with waist circumference (r=0.58) in girls (n=83) (all p<0.0001).

CONCLUSIONS

Serum leptin could be used as a surrogate convenient marker of adiposity in overweight/obese adolescent boys with T1D, equivalent to BMI Z-score or BMI%95. In girls, waist circumference was the best performing marker overall, and was also strongly correlated with %BF in boys.

Anthropometric and Biochemical Markers as Possible Indicators of Left Ventricular Abnormal Geometric Pattern and Function Impairment in Obese Normotensive Children

Εmerging data indicate that various effects of obesity on the cardiovascular system can be evident during childhood. The aim of this study was to detect early changes in left ventricular structure and function in obese normotensive children and explore possible associations of these changes with anthropometric and biochemical parameters. Normotensive 8–11-year-old obese and normal weight children were included in the study. They all underwent anthropometric measurements, laboratory tests, and echocardiography study by conventional and tissue Doppler to assess geometric pattern and function of left ventricle. Statistically significant differences in most anthropometric and metabolic parameters were noticed between groups. Obese children showed higher left ventricular mass index (LVMI) (40.05 ± 9.44 vs. 28.31 ± 6.22), lower E/A ratio (1.76 ± 0.33 vs. 2.08 ± 0.56), and higher E/e’ (6.04 ± 1.13 vs. 5.43 ± 0.96) compared to lean peers. Waist-to-height ratio and hs-CRP correlated significantly with E/A in the obese group. Left ventricular hypertrophy was present in 47.2% of obese children and eccentric was the prominent type. Waist-to-height ratio and serum cortisol levels in plasma increased the odds of having any type of abnormal ventricular geometric pattern. Echocardiographic evaluation of left ventricle and diastolic function could be considered for obese normotensive children based on waist-to-height ratio, hs-CRP, and serum cortisol.

Overfeeding During Lactation in Rats is Associated with Cardiovascular Insulin Resistance in the Short-Term

Childhood obesity is associated with metabolic and cardiovascular comorbidities. The development of these alterations may have its origin in early life stages such as the lactation period through metabolic programming. Insulin resistance is a common complication in obese patients and may be responsible for the cardiovascular alterations associated with this condition. This study analyzed the development of cardiovascular insulin resistance in a rat model of childhood overweight induced by overfeeding during the lactation period. On birth day, litters were divided into twelve (L12) or three pups per mother (L3). Overfed rats showed a lower increase in myocardial contractility in response to insulin perfusion and a reduced insulin-induced vasodilation, suggesting a state of cardiovascular insulin resistance. Vascular insulin resistance was due to decreased activation of phosphoinositide 3-kinase (PI3K)/Akt pathway, whereas cardiac insulin resistance was associated with mitogen-activated protein kinase (MAPK) hyperactivity. Early overfeeding was also associated with a proinflammatory and pro-oxidant state; endothelial dysfunction; decreased release of nitrites and nitrates; and decreased gene expression of insulin receptor (IR), glucose transporter-4 (GLUT-4), and endothelial nitric oxide synthase (eNOS) in response to insulin. In conclusion, overweight induced by lactational overnutrition in rat pups is associated with cardiovascular insulin resistance that could be related to the cardiovascular alterations associated with this condition.

Association between body fat mass and cardiometabolic risk in children and adolescents in Bucaramanga, Colombia

BACKGROUND

Obesity is common among children and teenagers and is associated with cardiometabolic risk factors in the adult age. The objective of this paper was to evaluate the association between the percentage of body fat and cardiometabolic risk factors in children and adolescents in the city of Bucaramanga, Colombia.

MATERIAL AND METHODS

About 494 children and adolescents aged 10-20 years were studied. Laboratory tests were made for analyzing cardiovascular risk factors and anthropometric measurements. Percentage body fat was determined with Slaughter equation. Lineal regression analyses were conducted to evaluate the association between cardiometabolic risk factors and the percentage body fat.

RESULTS

Prevalence of percentage body fat (>26%) was 46.1%. Variables associated with percentage body fat were HOMA-IR - insulin resistance, HDL, LDL, triglycerides, and total cholesterol levels, and high blood pressure.

CONCLUSIONS

Increase in percentage body fat is significantly associated with cardiometabolic risk factors in children and adolescents in Bucaramanga. Early identification and intervention of this population at risk is fundamental.

What change in body mass index is associated with improvement in percentage body fat in childhood obesity? A meta-regression

OBJECTIVE

Using meta-regression this paper sets out the minimum change in body mass index-SD score (BMI-SDS) required to improve adiposity as percentage body fat for children and adolescents with obesity.

DESIGN

Meta-regression.

SETTING

Studies were identified as part of a large-scale systematic review of the following electronic databases: AMED, Embase, MEDLINE via OVID, Web of Science and CENTRAL via Cochrane library.

PARTICIPANTS

Individuals aged 4-19 years with a diagnosis of obesity according to defined BMI thresholds.

INTERVENTIONS

Studies of lifestyle treatment interventions that included dietary, physical activity and/or behavioural components with the objective of reducing obesity were included. Interventions of <2 weeks duration and those that involved surgical and/or pharmacological components (eg, bariatric surgery, drug therapy) were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

To be included in the review, studies had to report baseline and post-intervention BMI-SDS or change measurements (primary outcome measures) plus one or more of the following markers of metabolic health (secondary outcome measures): adiposity measures other than BMI; blood pressure; glucose; inflammation; insulin sensitivity/resistance; lipid profile; liver function. This paper focuses on adiposity measures only. Further papers in this series will report on other outcome measures.

RESULTS

This paper explores the potential impact of BMI-SDS reduction in terms of change in percentage body fat. Thirty-nine studies reporting change in mean percentage body fat were analysed. Meta-regression demonstrated that reduction of at least 0.6 in mean BMI-SDS ensured a mean reduction of percentage body fat mass, in the sense that the associated 95% prediction interval for change in mean percentage body fat was wholly negative.

CONCLUSIONS

Interventions demonstrating reductions of 0.6 BMI-SDS might be termed successful in reducing adiposity, a key purpose of weight management interventions.

TRIAL REGISTRATION NUMBER

CRD42016025317.

Association of Acanthosis Nigricans and Insulin Resistance in Indian Children and Youth - A HOMA2-IR Based Cross-Sectional Study

Introduction:

The American Diabetes Association includes acanthosis nigricans (AN) as an indicator of diabetes mellitus risk in overweight youth entering puberty. Some argue that AN is not an independent predictor of insulin resistance (IR), when body mass index (BMI) is controlled for. There is a paucity of studies on the association of AN and IR among children and young adults from India. Homeostatic model assessment-IR (HOMA2-IR), a computerized updated model, which is supposed to be superior to HOMA1-IR, has rarely been used for quantification of IR.

Methods:

Sixty cases (irrespective of BMI), aged 2–24 years with AN, and 30 age- and sex-matched normal weight controls were included. A thorough clinical examination and grading of AN was done. BMI, fasting glucose levels, and fasting insulin levels were measured for all. HOMA-IR calculator V.2.2.3 was used to calculate IR. Those with HOMA 2-IR >1.8 were considered insulin-resistant. Lifestyle modifications were advised for patients with IR.

Results:

The mean HOMA2-IR value in cases and controls was 2.422 and 1.322, respectively, which was statistically significant. Overweight and obese cases had 2.5 and 11.25 times higher risk of having IR, respectively, by logistic regression. The association of AN with IR was found to be statistically significant in normal weight cases when compared with controls (P = 0.045). Grade 4 of neck severity (P = 0.007), Grade 3 of neck texture (P = 0.001), and Grade 4 of axillary severity (P = 0.001) of AN were found to be significantly associated with IR.

Limitations:

The relatively small sample size may not reflect the accuracy of AN as a marker of IR.

Conclusion:

Acanthosis nigricans is associated with IR in both normal and obese. We propose that all children, adolescents, and youth with AN be screened for IR irrespective of BMI. Early identification and prompt lifestyle interventions may prevent or delay the onset of diabetes later.

The Influence of Obesity on Puberty and Insulin Resistance in Mexican Children

Obesity is considered the main risk factor associated with the development of insulin resistance (IR). The aim of this study was to evaluate the influence of obesity on puberty onset and IR in Mexican children. A total of 378 children (189 boys and 189 girls) aged 8-14 years participated in the study. IR was estimated using the homeostasis model assessment for IR (HOMA-IR). The mean fasting glucose (FG) and basal insulin levels were 82 mg/dl and 11.0 μIU/ml in boys and 77.3 mg/dl and 12.3 μIU/ml in girls (P < 0.05). Subjects with obesity at Tanner stages II-V showed increased FG levels (P < 0.05). In boys with obesity, there was a decrease in HOMA-IR in Tanner stage IV and differences in age between boys with normal weight and those with obesity in Tanner V, being older the boys with obesity. Obesity in children and adolescents was associated with higher HOMA-IR values. In boys with obesity, IR increased at the end of pubertal maturation, with a delay in puberty. These findings should be considered on the establishment of IR cutoff values for pubertal population in Mexico and in the establishment of strategies to prevent the health problems related to obesity.

CARDIOVASCULAR RISK FACTORS IN ADOLESCENTS: ROLE OF INSULIN RESISTANCE AND OBESITY

Introduction

Childhood obesity is a public health problem characterized by early insulin resistance (IR), inflammation, and oxidative stress. The presence of an uninterrupted low-grade inflammatory state impairs metabolic and cardiovascular health. The population is particularly susceptible to develop metabolic disorders related to increased body fat.

Methods

Eighty-three adolescents were recruited and grouped according to HOMA-IR and BMI in either with or without IR and obese or normal-weight respectively. Anthropometric, biochemical, immunological and hormonal variables were determined. Transverse Analytical Study.

Results

Obesity, dyslipidemia, IL-6, and C-reactive protein were significantly higher in the IR group than in the non-IR group. Obese adolescents showed increased insulin levels, HOMA-IR, inflammatory markers, and triglycerides; while having lower HDL-C, and adiponectin when compared to normal-weight adolescents. As expected, obesity-related anthropometric markers positively correlated with IR and inflammatory markers while negatively correlated with adiponectin levels.

Conclusions

Early IR, subclinical inflammation, dyslipidemia, and hypoadiponectinemia characterize obesity in adolescents. These factors may increase the risk of future coronary heart disease (CHD) and diabetes mellitus development (DM) in early adulthood.

Insulin resistance in ischemic stroke

Insulin resistance often refers to a pathological condition in which cells fail to respond to the normal actions of insulin. Increasing literature has noted a critical role of insulin resistance in the pathogenesis of ischemic stroke. Insulin resistance plays an important role in the pathogenesis of ischemic stroke via enhancing advanced changes of atherosclerosis. A variety of literature indicates that insulin resistance enhances platelet adhesion, activation and aggregation which are conducive to the occurrence of ischemic stroke. Insulin resistance also induces hemodynamic disturbances and contributes to the onset of ischemic stroke. In addition, insulin resistance may augment the role of the modifiable risk factors in ischemic stroke and induce the occurrence of ischemic stroke. Preclinical and clinical studies have supported that improving insulin resistance may be an effective measure to prevent or delay ischemic stroke.

What change in body mass index is needed to improve metabolic health status in childhood obesity: protocol for a systematic review

BACKGROUND

Childhood obesity is one of the most serious, global, public health challenges and has adverse health consequences in both the short-and long-term. The purpose of this study is to establish the change in body mass index (BMI) needed to achieve improvements in metabolic health status in obese children and adolescents attending lifestyle treatment interventions.

METHODS

The following electronic databases will be searched from their inception: AMED, Embase, MEDLINE via OVID, Web of Science and CENTRAL via Cochrane library. Randomised controlled trials (RCTs) or cohort studies of lifestyle interventions (i.e. dietary, physical activity and/or behavioural therapy) for treating obesity in children and adolescents (4-18 years) will be included. Interventions that last less than 2 weeks and trials that include overweight participants or those with a secondary or syndromic cause of obesity will not be included. No language restrictions will be applied. Titles and abstracts will be assessed for eligibility by two reviewers, and data from full-text articles will be extracted using a standardised data extraction template. Reference lists of all included articles will be hand-searched for additional publications. A narrative synthesis of the findings will be presented, and meta-analysis will be conducted if considered appropriate.

DISCUSSION

This will be the first systematic review of studies to establish the change in BMI required to improve metabolic health status in obese children and adolescents.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016025317.

Prediabetes and Cardiovascular Parameters in Obese Children and Adolescents

OBJECTIVE

In this study, our aim was to determine cardiovascular risk and cardiac function in prediabetic obese children and adolescents.

METHODS

The study was conducted on 198 obese children and adolescents 6-18 years of age. Anthropometric measurements, blood pressure measurements, oral glucose tolerance test, lipid profile, and HbA1c levels of patients were assessed. Prediabetes was defined according to American Diabetes Association criteria. Left ventricular mass index (LVMi), carotid intima-media thickness (c-IMT), and tissue Doppler measurements records were used.

RESULTS

LVMi was found to be significantly higher in the prediabetes group (p=0.03). There were no statistically significant differences in right ventricular tissue Doppler measurements between the prediabetic and non-prediabetic groups. Left ventricular tissue Doppler measurements were significantly higher in the prediabetes group: LVEEM (left ventricular E/e ratio) (p=0.04); LVEM (left ventricular myocardial velocity cm/s) (p=0.035). LVMi was found to positively correlate with triglyceride level, diastolic blood pressure, waist circumference, body weight standard deviation score and to negatively correlate with high-density lipoprotein cholesterol (p=0.043, r=0.15; p=0.039, r=0.15; p=0.025, r=0.17; p=0.009, r=0.19; p=0.038, r=-0.15, respectively). LVEM was correlated with glucose (p=0.046, r=0.15) and LVEEM was correlated with systolic blood pressure (p=0.035, r=0.15). In linear regression analysis for clinical cardiovascular risk factors, fasting glucose level was the best predictor of LVEM.

CONCLUSION

In this study, deterioration of cardiac function in prediabetic obese children and adolescents was shown. We recommend determining cardiovascular risk and cardiac dysfunction at early stages in prediabetic obese children and adolescents.