Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of ‘tracking’ of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.

Abstract-The objective was to analyze pulse wave velocity (PWV) in normotensive, high-normal, and hypertensive youths by using aortic-derived parameters from peripheral recordings. The impact of obesity on vascular phenotypes was also analyzed. A total of 501 whites from 8 to 18 years of age were included. The subjects were divided according to BP criteria: 424 (85%) were normotensive, 56 (11%) high-normal, and 21 (4%) hypertensive. Obesity was present in 284 (56%) and overweight in 138 (28%). Pulse wave analysis using a SphygmoCor device was performed to determine central blood pressure (BP), augmentation index, and measurement of PWV. Among the BP groups, differences appeared in age, sex, and height but not in body mass index. Significant differences in peripheral and central systolic and diastolic BPs and pulse pressures were observed within groups. A graded increase in PWV was present across the BP strata without differences in augmentation index. Using a multiple regression analysis, age, BP groups, and obesity status were independently associated with PWV. Older and hypertensive subjects had the highest PWV, whereas, from normal weight status to obesity, PWV decreased. Likewise, PWV was positively related to peripheral or central systolic BP and negatively related to body mass index z score. For 1 SD of peripheral systolic BP, PWV increased 0.329 m/s, and for 1 SD of body mass index z score PWV decreased 0.129 m/s. In conclusion, PWV is increased in hypertensive and even in high-normal children and adolescents. Furthermore, obesity, the factor most frequently related to essential hypertension in adolescents, blunted the expected increment in PWV of hypertensive and high-normal subjects. (Hypertension. 2012;60:550-555.)Key Words: hypertension Ⅲ obesity Ⅲ children Ⅲ adolescents Ⅲ augmentation index Ⅲ pulse wave velocity C ardiovascular damage occurring in adults finds its roots in risk factors operating early in life. Among the factors influencing cardiovascular risk, blood pressure (BP) values represent an important measurable marker of the level of potential cardiovascular risk in children and adolescents. The need to identify cardiovascular risk factors, including high BP, in youth, is acknowledged more and more frequently. Consequently, measurement of BP has become a routine part of pediatric care, and asymptomatic hypertension is now detected in pediatric care practice.BP phenotype is determined not only by conventional risk factors but also by weight gain in childhood. The adverse effects of excessive weight gain on BP and the association of weight gain with higher incidence of BP elevation represent major issues in health care.1-5 Elevation of systolic and/or diastolic BP indicates high BP in the child. In addition, children and adolescents with mild BP elevation, in the high-normal range, are much more common than was thought in the past, ranging from 3.4% to 15.7%. 6,7 Rather than having a goal of classifying children as high-normal, we should be identifying those who may be at risk for the developm...

Abstract-The aim of the present study was to analyze the relationship between insulin resistance and the ambulatory blood pressure components in obese children and adolescents. Eighty-seven overweight and obese white children and adolescents of both sexes, of European origin from 6 to 18 years of age (mean age: 10.9Ϯ2.7 years), were selected. Obesity was defined on the basis of a threshold body mass index z score Ͼ2 (Cole's least mean square method) and overweight with a body mass index from the 85th to 97th percentile. A validated oscillometric method was used to measure ambulatory BP (Spacelabs 90207) during 24 hours. Fasting glucose and insulin were measured, and the homeostasis model assessment index was calculated. Subjects were grouped into tertiles of homeostasis model assessment index. No significant differences in terms of age, sex, and body mass index z score distribution were observed among groups. When adjusted by age, sex, and height, nocturnal systolic blood pressure and heart rate were significantly higher in subjects in the highest homeostasis model assessment index tertile (Ͼ4.7) as compared with those of the other groups, whereas no differences were observed for awake systolic blood pressure or heart rate. Whereas body mass index z score was more closely related with blood pressure and heart rate values, waist circumference was strongly related with insulin resistance. Moreover, both waist circumference and insulin resistance were mainly associated with higher nocturnal but not with awake blood pressure. The early increment of nocturnal blood pressure and heart rate associated with hyperinsulinemia may be a harbinger of hypertension-related insulin resistance and may contribute to heightened cardiovascular risk associated with this condition. Key Words: obesity Ⅲ insulin resistance Ⅲ nocturnal blood pressure Ⅲ heart rate Ⅲ children Ⅲ adolescents T he prevalence of obesity is continuously increasing among children. 1,2 The adverse effects of weight gain on metabolic and cardiovascular function and the association of weight gain with a higher incidence of health problems later in life represent major issues in health care, which have generated great concern over the last few years. [3][4][5][6] Indeed, considering the increasing tendency for obesity to appear during childhood and to track, to some extent, into adult life, 7,8 as well as the firmly established relationships among obesity, type 2 diabetes, and hypertension in adults, obese children appear to be at particularly high risk of becoming diabetic and hypertensive as they age. 9 Blood pressure (BP) values in childhood represent the most important measurable marker of the potential level of cardiovascular risk later in life. 10 This strongly supports the importance of performing careful and repeated BP measurements during childhood and adolescence. Solid evidence collected over the last 20 years has demonstrated the high prognostic power of ambulatory BP monitoring (ABPM). Indeed, 24-hour BP values have been significantly better predictors...

Abstract-The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those subjects with low birth weight who became obese. The lowest BP values were present in nonobese subjects in the absence of low birth weight. In the middle, with similar BP values, were nonobese subjects with low birth weight and obese subjects in the absence of low birth weight. No interaction existed between obesity and low birth weight in the office (Pϭ0.165) or ambulatory (Pϭ0.603) systolic BP values. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in the nonobese low birth weight group when compared with the other groups after controlling for height, heart rate, and diastolic BP. A significant interaction between low birth weight and obesity (PϽ0.005) existed. In conclusion, although the low birth weight children who become obese have the highest systolic BP values, the presence of obesity blunts the increment of the reflecting wave observed in low birth weight subjects. T he need to identify cardiovascular risk factors, including high blood pressure (BP), in children and adolescents is acknowledged more frequently now. In this context, it is important to emphasize that BP values in children represent an important measurable marker of the level of potential cardiovascular risk later in life, despite the known variability of BP readings and the uncertainties related to their accuracy. This strongly supports the importance of performing careful and repeated BP measurements during childhood and adolescence. Therefore, use of ambulatory BP monitoring in this setting appears to be of particular value.BP phenotype is determined not only by conventional risk factors but also by early life programming based on intrauterine fetal growth retardation. 1-3 During childhood, there is a mismatch between the conditions for which the fetus is programmed in utero and the environment that the child meets. Consequently, BP is influenced both by size at birth 4 as well as by weight gain in childhood. 5 The adverse effects of excessive weight gain on BP, and the association of weight gain with a higher incidence of hypertension later in life, represent major issues in health care. 5-9 Indeed, because of the increasing tendency of obesity to appear during childhood and to track, to some extent, into adult life, 10,11 children with low birth weight (BW) who become obese could be at particularly high r...

This study analyzes the potential of virtual reality (VR) to enhance attentional distraction in overweight children as they experience bodily sensations during exercise. It has been suggested that one reason why obese children stop exercising is the perception of bodily sensations. In a counterbalanced design, a total of 109 children (33 overweight, 10-15 years old) were asked to walk twice for 6 minutes on a treadmill under one of two conditions: (a) traditional condition (TC)-focusing their attention on their physical feelings and sensations or (b) distraction condition (DC)-focusing their attention on a virtual environment. Attentional focus during exercise, bad-good feeling states (pre- and postexperimental), perceived exertion (3 minutes and post), heart rate, and enjoyment were assessed. Results indicated that overweight children focused on internal information under the TC, but they significantly shifted their attention to regard the external environment in the DC. This attentional distraction effect of VR was more intense in overweight than in normal-weight children. No differences between groups were found when examining changes in feeling states and perceived exertion. VR increased enjoyment during exercise, and children preferred exercise using virtual environments. VR is useful to promote distraction and may help overweight and obese children to enjoy exercise.

The study findings indicate that a simple home-based combined exercise and Mediterranean diet program may be effective among overweight and obese children and adolescents, because it improves body composition, is feasible and can be adopted on a large scale without substantial expenses.

The present study found a positive association between uric acid and blood pressure, insulin and triglycerides. As uric acid levels increase there is a relevant clustering of metabolic risk factors, whereas elevated blood pressure is the risk factor less frequently present. Further studies need to assess the mechanistic link between uric acid and the cardiometabolic risk factors.

BackgroundEarly life is a period of drastic epigenetic remodeling in which the epigenome is especially sensitive to extrinsic and intrinsic influence. However, the epigenome-wide dynamics of the DNA methylation changes that occur during this period have not been sufficiently characterized in longitudinal studies.MethodsTo this end, we studied the DNA methylation status of more than 750,000 CpG sites using Illumina MethylationEPIC arrays on 33 paired blood samples from 11 subjects at birth and at 5 and 10 years of age, then characterized the chromatin context associated with these loci by integrating our data with histone, chromatin-state and enhancer-element external datasets, and, finally, validated our results through bisulfite pyrosequencing in two independent longitudinal cohorts of 18 additional subjects.ResultsWe found abundant DNA methylation changes (110,726 CpG sites) during the first lustrum of life, while far fewer alterations were observed in the subsequent 5 years (460 CpG sites). However, our analysis revealed persistent DNA methylation changes at 240 CpG sites, indicating that there are genomic locations of considerable epigenetic change beyond immediate birth. The chromatin context of hypermethylation changes was associated with repressive genomic locations and genes with developmental and cell signaling functions, while hypomethylation changes were linked to enhancer regions and genes with immunological and mRNA and protein metabolism functions. Significantly, our results show that genes that suffer simultaneous hyper- and hypomethylation are functionally distinct from exclusively hyper- or hypomethylated genes, and that enhancer-associated methylation is different in hyper- and hypomethylation scenarios, with hypomethylation being more associated to epigenetic changes at blood tissue-specific enhancer elements.ConclusionsThese data show that epigenetic remodeling is dramatically reduced after the first 5 years of life. However, there are certain loci which continue to manifest DNA methylation changes, pointing towards a possible functionality beyond early development. Furthermore, our results deepen the understanding of the genomic context associated to hyper- or hypomethylation alterations during time, suggesting that hypomethylation of blood tissue-specific enhancer elements could be of importance in the establishment of functional states in blood tissue during early-life.Electronic supplementary materialThe online version of this article (10.1186/s12967-018-1751-9) contains supplementary material, which is available to authorized users.