Cardiovascular Risk In Obese Children Research Articles

Obstructive sleep related breathing disorders and cardiometabolic risk factors – A Portuguese birth cohort

BackgroundPediatric obstructive sleep related breathing disorders (SRBD) are an important under-diagnosed health problem with associated cardiometabolic comorbidities, demonstrated with polysomnographic studies in selected samples. Our main goal was to assess the prevalence of SRBD in a population-based cohort and to analyze its association with cardiometabolic risk factors, in general and by sex. MethodsPediatric Sleep Questionnaire (PSQ) was applied to parents of 7-years-old children evaluated in the birth cohort, Generation XXI. Sex, anthropometrics, blood pressure (BP), lipid profile, glucose, insulin, HOMA-IR, and high-sensitivity C-reactive protein were compared among children with/without SRBD, using Chi-square, Mann-Whitney tests and logistic regression models. ResultsA total of 1931 children (51.2 % boys) were included; 17.5 % were overweight and 15.7 % obese. The prevalence of SRBD was 13.4 %, more frequent among boys (15.7 % vs.10.9 %, p = 0.002) and in overweight/obese children (22.0 % vs.13.6 % vs.11.3 % in obese, overweight and normal weight group, respectively, p < 0.001). Children with SRBD had higher systolic BP (107 ± 8 vs.105±9 mmHg; p = 0.001) and lower HDL-cholesterol levels (54 ± 11 vs.56 ± 11 mg/dL; p = 0.04) than children without SRBD. After adjustment for sex, age, birthweight-for-gestational age and maternal age, children with SRBD had higher BMI-z-score, systolic BP, insulin and HOMA-IR levels, and lower HDL-cholesterol, when compared to those without SRBD, but these associations were lost when adjusting to BMI z-score. Analyzing obese children with the same regression model, those with SRBD presented lower HDL-cholesterol than those without SRBD. ConclusionsOur results identified a male predominance of SRBD in pre-pubertal children and highlighted the potential contribution of SRBD to cardiovascular risk in obese children.

Evaluación del riesgo cardiovascular en niños y adolescentes obesos atendidos en un hospital de Nivel III de Posadas- Misiones

Argentina suffers from an epidemic of non-communicable chronic diseases and a population with cardiovascular risk factors, particularly obesity. In this work, the cardiovascular risk in obese children and adolescents who attended a level III hospital in the city of Posadas, between September 2018 and January 2020, was studied. Eightyone patients were included, age 10 (2-15) years; 51% female. Body mass index was calculated, blood pressure was measured and serum HDLc, LDLc, triglycerides and glucose were determined. A questionnaire was completed on family history of cardiovascular disease, physical activity, tobacco and alcohol consumption. The presence of metabolic syndrome (SAP) according to Argentine Pediatric Society criteria and cardiovascular risk (Alustiza´s score) were identified and the relationship between them was established. Results: severe obesity: 43 (53%) patients; biochemical or clinical family history 27 individuals (33%); insufficient physical activity: 57 (70%) patients; tobacco and/or alcohol consumption: absent; blood pressure &amp;gt;p95: 11 individuals (14%). Fifty one patients (63%) had some dyslipidemia, 4 (5%) had hyperglycemia; metabolic syndrome was observed in 26 (32%) and 25 (31%) at medium/high cardiovascular (CV) risk. No association was found between CV risk by Alustiza score and metabolic syndrome. Since the pediatric population has cardiovascular risk factors and components of metabolic syndrome, it is important to search for and validate scores to measure this risk.

A CROSS SECTIONAL STUDY ON C-REACTIVE PROTEIN LEVELAMONG OVERWEIGHT AND OBESE CHILDREN ATTENDING A TERTIARY CARE HOSPITAL OF DISTRICT KANPUR

Introduction- The global prevalence of overweight and obesity in children and adolescents has increased substantially over the past several decades. Accumulating evidence suggests that Hs-CRP, which is also found within macrophages of atheromatous plaques. However, there is no much data available that guarantee its utility as a marker of cardiovascular risk in obese children and adolescents. Hence, the present study was taken up to assess the metabolic abnormalities and its association with hsCRP in obese children and adolescents. Methodology-Present cross sectional study was conducted on 100participants attending the tertiary care hospital of District Kanpur and 5ml fasting sample had been collected after overnight fasting and data was entered in Microsoft excel and analysed in SPSS 15.0 using ANOVAand unpaired student t test.Result- among cases group there were 4 participants among the age group of 4-8yrs,10 in the age group of 9-13yrs,23 in the age group of &gt;13yrs while in control group there were 3 participants ampong 4-8yrs of age and 28 in 9-13 yrs ,32 participants among the age of &gt;13yrs. On applying independent sample T-test, we could not established correlation between age and Hs-CRP (p value &gt;0.05).Conclusion- obese children and adolescents have signicantly increased hsCRP compared with a normal weight group. Early intervention and prevention of obesity in children and adolescents decreases cardiovascular disease in later life

Adiponectin and Cardiovascular Risk. From Pathophysiology to Clinic: Focus on Children and Adolescents.

Adiponectin (Ad) is a cytokine produced by adipocytes that acts on specific receptors of several tissues through autocrine, paracrine, and endocrine signaling mechanisms. Ad is involved in the regulation of cell survival, cell growth, and apoptosis. Furthermore, Ad plays an important pathophysiological role in metabolic activities by acting on peripheral tissues involved in glucose and lipid metabolism such as skeletal muscle, and the liver. Adiponectin has anti-inflammatory, anti-atherogenic, and insulin-sensitizing effects. For this reason, low levels of Ad are associated with the development of cardiovascular complications of obesity in adulthood. Numerous studies have shown that, even in children and adolescents, Ad is associated with risk factors for cardiovascular diseases. In obese children, reduced levels of Ad have been reported and Ad plasma levels are inversely related with abdominal obesity. Moreover, lower Ad concentrations are associated with the development of metabolic syndrome, insulin resistance and hypertension in pediatric subjects. In addition to a higher prevalence of cardiovascular risk factors, plasma values of Ad are also inversely associated with early organ damage, such as an increase in carotid intima-media thickness. It has been suggested that low Ad levels in childhood might predict the development of atherosclerosis in adulthood, suggesting the possibility of using Ad to stratify cardiovascular risk in obese children. Some evidence suggests that lifestyle modification may increase Ad plasma levels. The aim of this review is to summarize the evidence on the relationship between Ad, obesity, metabolic alterations and hypertension in children and adolescents, and to address the possibility that Ad represents an early marker of cardiovascular risk in pediatric subjects. Furthermore, the effects of non-pharmacological treatment (weight loss and physical activity) on Ad levels are considered.

Estimation of gamma-glutamyl transferase as a suitable simple biomarker of the cardiovascular risk in children with non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome and a risk factor for cardiovascular disease (CVD). Research conducted in adults has proven that GGT can also be an independent risk factor for CVD. The aim of this study was to ascertain if GGT can be regarded as a simple biomarker of cardiovascular risk in obese children with NAFLD. One hundred obese children, aged 7-17 years, with suspected liver pathology were admitted to our Department. Viral hepatitis and autoimmune, toxic and selected metabolic liver diseases were excluded. Anthropometry, laboratory tests, 1HMR spectroscopy and evaluation of the common carotid artery intima-media thickness (IMT) were performed in all subjects. NAFLD was confirmed in 38 obese patients. There was a significantly higher activity of GGT and ALT, the concentration of total and LDL cholesterol, waist circumference, left coronary artery IMT, mean IMT value and total lipids in 1HMRS in children with NAFLD in comparison to non-hepatopathic obese children. Logistic regression analysis indicated that GGT, total cholesterol, LDL-cholesterol, left IMT and waist circumference significantly affected the development of NAFLD in obese children. In ROC analysis only GGT, waist circumference and left IMT allowed to differentiate children with NAFLD from those without steatosis with GGT having the highest result (AUC=0.94). GGT activity in patients revealed weak or at the upper limit of statistical significance correlation with traditional cardiovascular risk factors: glucose level, waist circumference, BMI, total cholesterol, LDL-cholesterol and insulin level. This allows to suggest, that GGT might be a potential reliable, simple and non-invasive biochemical marker for estimation of cardiovascular risk in obese children with NAFLD. However, further studies on larger population are necessary to confirm that observation.

Cardiovascular Risk in Obese Children and Hypercholesterolemic Children; a Wake-Up Call for Paediatricians?

Exercise is considered to be the best approach to improve quality of life, and together with a healthy and adequate dietary pattern, exercise represents the best strategy to reduce the risk of chronic metabolic and inflammatory diseases, such as those related to obesity. The regularity and intensity of exercise is modulated at the molecular level in the skeletal muscle by two protein kinases, the mechanistic target of rapamycin (mTOR) and AMP-activated protein kinase (AMPK), which act as sensors of external stimuli, showing the energy status of muscular fibers. The mTOR pathway is activated by insulin and amino acid availability, and its metabolic actions culminate in increased protein synthesis and reduced autophagy, leading to an increase in muscle mass. In contrast, AMPK activation induces a transcriptional program aimed to increase the mitochondrial content in skeletal muscle, transforming fast-twitch glycolytic fibers to slow-twitch oxidative fibers and increasing resistance to fatigue. In addition, inadequate exercise training induces imbalance in the immune response, generating excessive inflammation and/or immunosuppression. The purpose of this review is to summarize recent studies that provide insight into dietary protein interventions and/or amino acid supplementation that may improve outcomes after exercise by modulating 1) mTOR and AMPK activation during early exercise recovery, leading to increased muscle protein synthesis or increased oxidative capacity; 2) undesirable inflammatory responses; and 3) fibroblast growth factor 21 (FGF21) levels that may have relevant implications in skeletal muscle metabolism, particularly during the exercise recovery and performance of obese subjects.

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.

Subtle inflammation: a possible mechanism of future cardiovascular risk in obese children.

PurposeThe risk of cardiovascular disease (CVD) has been shown to be associated with systemic inflammation in obese adults with metabolic syndrome (MetS). The aims of this study were to evaluate the prevalence of MetS and its relation to inflammatory markers in obese Thai children.MethodsA cross-sectional study was conducted. Children with history of endogenous obesity, chronic diseases, drug ingestion, and any acute illness within 2 weeks prior to enrollment were excluded. Their fasting blood glucose (FBG) levels, oral glucose tolerance tests, insulin, lipid profiles, and selected inflammatory markers, including interleukin-6, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein (hs-CRP) levels, were tested.ResultsIn this study, 58 obese Thai children (female, 20; male, 38) with a mean body mass index z score of 5.1±2.2 were enrolled. The prevalence of MetS and prediabetes was 31% and 17.2%, respectively. None of the children had diabetes. FBG levels, 2-hour glucose levels, and lipid profiles were not statistically different between those with and without MetS. However, obese children with MetS had higher insulin levels and homeostasis model assessment of insulin resistance values. Elevated hs-CRP levels were found in 69% of the cases, although it was not statistically different between the 2 groups.ConclusionWe described a substantial prevalence of MetS in Thai obese children. Regardless of MetS status, two-thirds of the obese children had elevated hs-CRP level, indicating subtle ongoing inflammatory process. This chronic inflammation feasibly predisposes them to CVD in the future, even in children without MetS.

Experience of vitamin D supplementation — is it possible to influence the metabolic and cardiovascular risk in obese children?

Background. Obese adolescents are at a greater risk of vitamin D deficiency, which is related to bone and metabolic changes. Vitamin D deficiency is associated with a higher prevalence of metabolic syndrome, type 2 diabetes mellitus in children and adolescents. Objective. To evaluate efficacy and safety of 3‑and 6‑month therapy with 1500 IU and 2000 vitamin D months in obese children and adolescents, and to assess whether increased circulating 25‑hydroxyvitamin D (25 (OH)D) level is associated with improved markers ofinsulin sensitivity and resistance, serum leptin and adiponectin levels and reduction of body mass index (BMI). Design and methods. Altogether 66 obese children and adolescents (mean age — 12,6 ± 2,2 years; BMI — 32 ± 6,22 kg/m2 , 25 (OH)D: 16,7 ± 5,58 ng/ml) were recruited from the Pediatric Endocrinology Unit from Almazov North-West Medical Research Centre and were assigned to receive either vitamin D3 (1500 IU/day and then 2000 IU/day) as a part of their standard care. Anthropometric parameters, adipokines (leptin, adiponectin), fasting glucose, insulin, triglyceride levels and HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) were measured at baseline and at 2 follow-up visits at 3 and 6 months. Results. Vitamin D deficiency has a high prevalence in both obese and non-obese children from St Petersburg. Vitamin D 1500 IU per day was prescribed to obese children for 3 months followed by 2000 IU per day during subsequent 3 months. At 3 and 6 months vitamin D supplementation was associated with an increase in the serum levels of 25 (OH)D, adiponectin and insulin sensitivity. However, BMI and serum leptin level remained unchanged in the majority of children. The unfavourable changes in some of the indices in 6 month might be due to the decreased adherence to treatment. Conclusions. Diet vitamin D supplement (1500 and 2000 IU/day) is effective to normalize plasma level of 25 (ОН)D in 40% of children. It leads to an increase in adiponectin level and a decrease in HOMA-IR and triglyceride level, but it does not affect BMI. Diet vitamin D supplement may be an effective additional approach to obesity management associated with the favourable metabolic and cardiovascular effects.

Plant-Based, No-Added-Fat or American Heart Association Diets: Impact on Cardiovascular Risk in Obese Children with Hypercholesterolemia and Their Parents

ObjectiveTo perform a randomized trial to determine if there is cardiovascular disease (CVD) risk reduction from a plant-based no added fat diet (PB) and the American Heart Association Diet (AHA) in children.Study designFour-week (4/20/2013-5/18/2013) prospective randomized trial in a large Midwestern hospital system’s predominantly middle class outpatient pediatric practices. Thirty children (9–18 years old) parent pairs with a last recorded child BMI >95th percentile and child cholesterol >169 mg/dL were randomized to PB or AHA with weekly 2-hour classes of nutrition education.ResultsChildren on PB had nine and children on AHA had four statistically significant (P<0.05) beneficial changes from baseline (mean decreases): BMI Z-scorePB (−0.14), systolic blood pressurePB (−6.43 mm Hg), total cholesterolPB (−22.5 mg/dL), low density lipoproteinPB (−13.14 mg/dL), hsCRPPB (−2.09 mg/L), insulinPB (−5.42uU/ml), myeloperoxidasePB/AHA (−75.34/69.23 pmol/L), mid-arm circumferencePB/AHA (−2.02/−1.55 cm), weightPB/AHA (−3.05/ −1.14kg) and waist circumferenceAHA (−2.96 cm). Adults on PB and AHA had seven and two respectively statistically significant (P<0.05) beneficial changes. The significant change favoring AHA was a 1% difference in children’s waist circumference. Difficulty shopping for food for the PB was the only statistically significant acceptability barrier.ConclusionsPB and the AHA in both children and adults demonstrated potentially beneficial changes from baseline in risk factors for CVD. Future larger, long-term randomized trials with easily accessible PB foods will further define the role of the PB in preventing CVD.

Could the triglyceride:HDL cholesterol ratio be considered a new marker of cardiovascular risk in obese children?

Could the triglyceride:HDL cholesterol ratio be considered a new marker of cardiovascular risk in obese children?

Evaluation of Echocardiography as a Marker of Cardiovascular Risk in Obese Children and Adolescents

Background: Childhood obesity is a global epidemic and its prevalence has increased from the early 1970s to the 1990s. The objective of the study was to compare the echocardiographic parameters of left ventricular (LV) geometry between obese and non-obese children. Methods: A prospective cross-sectional study with 71 individuals aged 7 - 11 years, from Ribeirao Preto metropolitan region, was conducted. Personal data (sex and date of birth) were obtained for each subject, as well as anthropometric measurements (weight, height and abdominal circumference), arterial pressure and an echocardiogram. The individuals were classified according to their nutritional status in “obese” and “non-obese” groups. Results: There was no difference in gender (P = 0.81), with 48.6% boys in obese group and 52.9% in non-obese group. Similarly, there was no difference in age (P = 0.72), with a mean of 106.97 ± 19.59 months in obese group and a mean of 105.50 ± 13.61 months in non-obese group. Systolic and diastolic pressure values were higher in obese group. The study showed LV mass, LV 3 index, systolic arterial pressure and diastolic arterial pressure when the two groups were compared. LV 1 index, LV 2 index and relative LV wall thickness did not differ between groups. Conclusion: The study contributes to demonstrate the importance of transthoracic echocardiography as a marker of cardiovascular risk in obese children and adolescents. Int J Clin Pediatr. 2014;3(3):72-78 doi: http://dx.doi.org/10.14740/ijcp164w

Association between vitamin D level and cardiovascular risk in obese children and adolescents.

The aim of our study was to evaluate the associations between vitamin D deficiency, the atherosclerosis and metabolic syndrome. Two hundred and forty-seven obese children and adolescents, 8-16 years of age (body mass index>95 p) were included in the study. Anthropometric measurements, blood pressure measurements, lipid profile, vitamin D level and carotid intima media thickness (c-IMT) were measured. MS was diagnosed according to IDF criteria. The prevalance of vitamin D deficieny in obese children and adolescent was 46.6%. Low levels of vitamin D were associated with increased carotis intima media thickness and metabolic syndrome (p=0.03, p=0.04, respectively). For clinical cardiovascular risk factors, mutivariable regression analyses showed that low vitamin D level was best predictor of c-IMT. In this study we showed an association between low vitamin D status and atherosclerosis independent of traditional risk factors in obese children and adolescents.

Plasma resistin levels are associated with homocysteine, endothelial activation, and nitrosative stress in obese youths

ObjectiveTo evaluate whether serum resistin levels are related to cardiovascular risk in obese children. Design and methodsCross-sectional study of 110 children (40 normal weight and 70 severely obese). Clinical and biochemical parameters, including lipid profile, fasting glucose and insulin, and homocysteine, were determined. The levels of adipokines (adiponectin, leptin, and resistin), markers of inflammation (high-sensitivity C-reactive protein (hs-CRP)), endothelial activation (serum concentrations of soluble intercellular and vascular cellular adhesion molecule-1 (sICAM-1, sVCAM-1)), and oxidative/nitrosative stress (malondialdehyde and urinary nitrate/nitrite) were measured. ResultsA partial correlation adjusted by gender, Tanner stage, and body mass index in obese children showed that resistin was significantly related to central obesity (p<0.002), insulin resistance (p<0.005), and homocysteine (p<0.001). No association was found with other metabolic risk factors or hs-CRP levels. Malondialdehyde (p<0.043) and sVCAM-1 (p<0.002) were positively correlated whereas urinary nitrate/nitrite was negatively correlated (p<0.007). In multiple regression analysis homocysteine, sVCAM-1, and urinary nitrate/nitrite remained independent determinants of resistin levels (R2 adjusted=0.347, p=0.000). ConclusionsResistin could be considered as a promising marker for future cardiovascular disease in obese children.

Plasma leptin and adiponectin concentrations correlate with cardiometabolic risk and systemic inflammation in healthy, non-obese children

Plasma adipocytokines are associated with metabolic profile and cardiovascular risk in obese children. To investigate the association of plasma leptin and adiponectin concentrations with cardiometabolic risk profile and systemic inflammation in non-obese children. We studied 170 healthy, non-obese children (86 males, mean age 10±2 years). Children's current body mass index (BMI), plasma leptin and adiponectin concentrations, lipid profile, fasting plasma glucose and high sensitivity C reactive protein (hsCRP) were measured. After adjustment for age, gender and BMI, plasma leptin concentrations were positively associated with hsCRP (t=2.72, p=0.009) and fasting plasma glucose (t=4.27, p<0.0001); plasma adiponectin concentrations were negatively associated with hsCRP (t=-3.31, p=0.0016); and positively with high density lipoprotein cholesterol (t=2.32, p=0.02). Children in the highest quartile of leptin/adiponectin (L/A) ratio demonstrated significantly higher BMI, systolic blood pressure, hsCRP, triglycerides and fasting glucose and the lowest high density lipoprotein (HDL) compared to lower L/A ratio quartiles. Alterations in plasma leptin and adiponectin may help to reclassify non-obese children, detecting those with more unfavorable risk profiles independent of BMI status.

Association Between Nonalcoholic Fatty Liver Disease and Cardiovascular Risk in Obese Children and Adolescents

BackgroundThe recent rise in the prevalence of obesity likely explains nonalcoholic fatty liver disease (NAFLD) epidemic worldwide. We evaluated cardiac functions, cardiovascular risk, and associated parameters with grades of NAFLD in obese children. MethodsFour hundred obese children were enrolled in the study. Obese children with NAFLD were classified in 2 subgroups according to ultrasonographic visualizing. Ninety-three obese children with NAFLD (mean age 11.73 ± 2.72 years in group 2 and 12.69 ± 2.61 years in group 3) were compared with 307 age- and sex-matched non-NAFLD obese children and 150 control subjects. Laboratory parameters were measured during the fasting state. Pulsed and tissue Doppler echocardiography were performed. Intima-media (IMT) and epicardial adipose tissue (EAT) thicknesses were measured. ResultsNAFLD groups had a significantly higher body mass index (29.15 ± 3.42 and 30.46 ± 4.60; P < 0.001), total adipose tissue mass (37.95 ± 4.46% and 46.57 ± 6.45%; P < 0.001), higher insulin, alanine aminotransferase, and aspartate aminotransferase levels. Increased end-systolic thickness of the interventricular septum (P < 0.001), larger left ventricular mass (P < 0.003) and index (P < 0.003) were found in NAFLD groups. Children with NAFLD had higher Tei index values. Also, carotid artery IMT and EAT thickness were significantly higher in obese children. Waist and hip circumference, total cholesterol level, total adipose tissue mass, and interventricular septum were statistically different in NAFLD groups. ConclusionsChildren with NAFLD had mildly altered left and right ventricular functions and all obese children had increased IMT and EAT thickness. Also, grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness.

Could Receptors for Advanced Glycation End Products Be Considered Cardiovascular Risk Markers in Obese Children?

Early development of increased cardiovascular risk in obese children and the possible related cardiovascular diseases into adulthood have been shown; however, the underling pathogenetic mechanisms implicated are not yet completely defined. Receptors for advanced glycation end products (RAGE) pathway play a pivotal role in the genesis of abnormality of arterial wall. However, whether obese prepubertal children present impaired levels of endogenous and soluble secretory receptor for advanced glycation end products (esRAGE/sRAGE) and whether an association exists between RAGE levels and carotid intima media thickness (cIMT) are not yet evaluated in this age group. We note that esRAGE and sRAGE were significantly lower in obese children than controls and were independently related to cIMT. Our findings lead to the hypothesis that RAGE system seems to be related to the development of atherosclerosis even in obese prepubertal children.

Utility of ApoB/ApoA1 Ratio for the Prediction of Cardiovascular Risk in Children with Metabolic Syndrome

To assess whether apoB/apoA1 ratio is associated or not with metabolic syndrome in obese children. A 198 obese children and 41 healthy control subjects were enrolled in a cross-sectional study. The apoB/apoA1 ratio and other metabolic syndrome components in obese children with/without metabolic syndrome were compared to healthy controls. The apoA1 level did not show significant difference (p = 0.664) but apoB level (p = 0.000) and apoB/apoA1 ratio (p = 0.001) were significantly higher in obese group than in control group. Also, the apoB/apoA1 ratio was significantly higher in obese children with metabolic syndrome when compared to obese children without metabolic syndrome (p = 0.007) and showed positive correlation with triglyceride (r = 0.404, p = 0.000) and negative correlation with high-density lipoprotein cholesterol (r = -0.593, p = 0.000). The apoB/apoA1 ratio is associated with metabolic syndrome in obese children. An elevated apoB/apoA1 ratio may constitute an important feature of the metabolic syndrome. There is a need for long term follow-up studies concerning cardiovascular risk in obese children with metabolic syndrome and high apoB/apoA1 ratio.

[Ultrasound measurements of intra-abdominal adiposity and factors associated with cardiovascular risk in obese children].

Cardiovascular risk factors are commonly present in obese children. To evaluate the association among radiological measurements of intra-abdominal adipose tissue, and cardiovascular risk factors, in prepuberal obese children. We evaluated 30 obese (body mass index > p95) children aged 6 to 12 years (15 males). Anthropometry and blood pressure were measured. Subcutaneous and intra-abdominal fat thickness and fat area were measured by ultrasound (US) and computed tomography. Serum insulin, glucose and lipid profile were measured in a fasting blood sample. Homeostasis model assessment (HOMA) was calculated as an index of insulin resistance. There was a significant correlation between US intra-abdominal fat thickness and HOMA (r = 0.47, p < 0.01), serum triglycerides (r = 0.46, p < 0.05) and with positive criteria for metabolic syndrome (r = 0.66, p < 0.01). A receiver operating curve (ROC) analysis showed that, above a cut-off of 45 mm for intra-abdominal fat thickness, US was able to identify insulin resistance with a sensibility and specificity of 79 and 69% respectively and metabolic syndrome with sensibility and specificity of 100 and 67% respectively. US and computed tomography measurements for intra-abdominal fat thickness were significantly correlated (r= 0.62, p < 0.01). US measurements of intra-abdominal fat thickness identify obesity-associated damage in childhood. Age-specific measurements of intra-abdominal adipose tissue may improve the detection power of this approach.

High-sensitivity C-reactive protein as a marker of cardiovascular risk in obese children and adolescents

Background and aim of the work: High-sensiti- vity C-reactive protein (hsCRP) is a marker of low grade inflammatory state, which characterises an atherosclerotic process. The metabolic syndrome is associated with insulin resistance and a systemic low-grade inflammatory state. These disorders may arise at a very early age in obese children. We aimed to assess the utility of (hsCRP) as a marker of cardiovascular risk in obese children and adolescents. Patients and methods: This study was conducted on 100 obese child and adolescents (6-16 years). 50 apparently healthy children of matched age and sex served as control. All patients and controls were subjected to: 1-complete history taking. 2-anthropometric measurements and clinical examination including body height, weight, waist circumference, body mass index and blood pressure. 3-laboratory investigations in- cluding fasting glucose, lipid profile, apolipoprotiens and (hsCRP) were assessed. Metabolic syndrome patients had to meet three out of five criteria: concentration of triglycerides (TG) ≥ 110 mg/dL, high density lipoprotein cholesterol (HDL- C) ≤ 40 mg/dL, waist circumference ≥ 90th percentile, glucose concentration ≥ 110 mg/dL, and systolic or diastolic blood pressure ≥ 90th percentile. Results, height, weight BMI and blood pressure were significantly higher in the obese than the control. Obese group had significantly higher (hsCRP) levels than control group, (p 3.0 mg/L, a concentration considered to place adults at high risk for cardiovascular disease. In multiple logistic regression analysis only abdominal obesity was significantly associated with (hsCRP). Conclusion: me- tabolic syndrome and abdominal obesity among our patients predispose to cardiovascular disease later in life through early low grade inflammation. (hsCRP) is one of the inflammatory markers that can be easily estimated in these patients.