Abstract
BackgroundAdiposity in childhood is associated with later cardiovascular disease (CVD), but it is unclear whether this relationship is independent of other risk factors experienced in later life, such as smoking and hypertension. Carotid-intima media thickness (cIMT) is a measure of subclinical atherosclerosis that may be used to assess CVD risk in young people. The aim of this study was to examine the relationship between adiposity and cIMT in children and adolescents.MethodsWe searched Medline, Embase, Global Health, and CINAHL Plus electronic databases (1980–2014). Population-based observational studies that reported a measure of association between objectively-measured adiposity and cIMT in childhood were included in this review.ResultsTwenty-two cross-sectional studies were included (n = 7,366 children and adolescents). Thirteen of nineteen studies conducted in adolescent populations (mean age ≥12 years, n = 5,986) reported positive associations between cIMT and adiposity measures (correlation coefficients 0.13 to 0.59). Three studies of pre-adolescent populations (n = 1,380) reported mixed evidence, two studies finding no evidence of a correlation, and one an inverse relationship between skinfolds and cIMT. Included studies did not report an adiposity threshold for subclinical atherosclerosis.ConclusionsBased on studies conducted mostly in Western Europe and the US, adiposity does not appear to be associated with cIMT in pre-adolescents, but may be associated in adolescents. If further studies confirm these findings, a focus on cardiovascular disease prevention efforts in pre-adolescence, before arterial changes have emerged, may be justified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0478-5) contains supplementary material, which is available to authorized users.
Highlights
Adiposity in childhood is associated with later cardiovascular disease (CVD), but it is unclear whether this relationship is independent of other risk factors experienced in later life, such as smoking and hypertension
None of the studies included in this review reported the relationship between adiposity and Carotid-intima media thickness (cIMT) by ethnicity or age
The studies we included did not identify a threshold level of adiposity that led to increased cIMT, and there was little information available on whether the association between adiposity and cIMT varied by characteristics such as ethnicity, age or lifestyle behaviors
Summary
Adiposity in childhood is associated with later cardiovascular disease (CVD), but it is unclear whether this relationship is independent of other risk factors experienced in later life, such as smoking and hypertension. A number of studies have reported positive associations between body mass index (BMI) in childhood and cardiovascular disease (CVD) risk factors, morbidity and mortality in adulthood [1–4]. Childhood obesity tracks into adulthood [5], and where studies have been able to account for obesity in adulthood, the associations between childhood obesity and adult cardiovascular disease have been less convincing [6]. The standard method of accounting for potential alternative explanations in epidemiological studies (i.e. confounding) is to adjust for them in multiple variable regression models. This technique is strongly reliant on the accuracy with which these variables can be assessed.
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