Abstract 19801: Obesity, Insulin Resistance and Loss of Dipping are Associated With Pulse Wave Velocity in Prepubertal Children

Abstract

Introduction: Arterial stiffness is a dynamic property of the vessels which reflects changes in their structure and function and pulse wave velocity (PWV) is a noninvasive and high-resolution technique to indirectly evaluate it. Childhood obesity is known to be associated with the development of several cardiovascular comorbidities and to the progression of atherosclerosis. Hypothesis: We aimed to compare carotid-femoral PWV between normal weight and overweight/obese prepubertal children and to evaluate its association with other cardiovascular risk factors. Methods: We conducted a cross-sectional study of 315 children aged 8-9 years that have been followed in the population-based birth cohort Generation XXI (Portugal). Anthropometrics, 24-hour ambulatory blood pressure (BP) and PWV were measured. Classification of obesity was according to World Health Organization body mass index (BMI)-for-age reference values. Results: Compared to normal weight children, overweight and obese children presented significantly higher levels of PWV (4.95 (P25-P75: 4.61-5.23), 5.00 (4.71-5.33), 5.10 (4.82-5.50) m/sec, respectively; p for trend<0.001). Significant positive correlations were found between PWV and total cholesterol, LDL cholesterol, triglycerides, fasting insulin and insulin resistance levels (estimated by homeostasis model assessment of insulin resistance - HOMA-IR) and with high-sensitivity C-reactive protein. In a multivariate linear regression model adjusted for sex, age, height and 24-hour systolic BP z-score, the independent determinants of PWV were BMI, HOMA-IR and the absence of dipping pattern. Conclusions: The association between PWV and the loss of dipping and insulin resistance levels, independently of the BMI, reinforces the contribution of these comorbidities to vascular injury in early life. Longitudinal studies are needed to strengthen the role of PWV as a valid tool for risk stratification in children.