Cardiovascular Risk Factors in Children and Adolescents With Obesity: Sex-Related Differences and Effect of Puberty

Guzzetti, Chiara; Ibba, Anastasia; Casula, Letizia; Pilia, Sabrina; Casano, Simona; Loche, Sandro

doi:10.3389/fendo.2019.00591

Cited by 23 publications

(33 citation statements)

References 48 publications

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“…A fourth significant finding relates to the fact that SPISE had greater diagnostic accuracy in males compared to females. This is in line with evidence describing a sexual dimorphism in incidence, age of onset, and progression of most cardiometabolic diseases, with males generally showing less beneficial profiles 28 – 31 . In our sample, males had a more adverse cardiometabolic profile than females that may put them at higher risk of IR and MetS.…”

Section: Discussionsupporting

confidence: 90%

Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents

Correa‐Burrows

Blanco

Gahagan

et al. 2020

Sci Rep

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insulin measurements are not advised for cardiometabolic risk screening in large groups. Here we assessed the accuracy of the single-point insulin sensitivity estimator (SpiSe) to diagnose cardiometabolic risk in Chilean adolescents. In 678 post-pubertal adolescents (52% males, M(SD) age = 16.8 (0.2) years), height, weight, waist circumference, blood lipids, glucose, insulin, and blood pressure were measured. BMI, HOMA-IR, and SPISE were estimated; HOMA-IR values ≥ 2.6 were considered insulin resistance (IR). Metabolic syndrome (MetS) was defined with the joint IDF/AHA/ nHBLi standard. Using receiver operating characteristic curves, we obtained optimal SpiSe cutpoints for IR and MetS diagnosis. The prevalence of MetS and IR was 8.2% and 17.1%, respectively. In males, the optimal cutoff for MetS diagnosis was 5.0 (sensitivity: 97%; specificity: 82%), and the optimal cutoff for IR diagnosis was 5.9 (sensitivity: 71%; specificity: 83%). In females, a SPISE of 6.0 had the highest sensitivity (90%) and specificity (74%) for MetS diagnosis. A SPISE of 6.4 was the optimal cutoff for IR diagnosis; however, sensitivity and specificity were 61% and 75%. In males and female post-pubertal adolescents, SpiSe had a very good and good diagnostic performance, respectively, in predicting MetS. It was an accurate diagnostic tool for IR prediction in males, but not necessarily in females. Insulin resistance (IR), reduced responsiveness of a target cell or a whole organism to the insulin concentration to which it is exposed, is the prelude of major cardiometabolic disorders, such as coronary heart disease, stroke, Metabolic Syndrome (MetS), non-alcoholic fatty liver disease (NAFLD) and type-2 diabetes (T2D) 1,2. IR may be due to several causes, including the excess of adipose tissue, especially visceral adiposity. In children and adolescents, IR has grown dramatically, closely linked to the obesity epidemic, and the spread of Western-type dietary habits and sedentary behaviors 2,3. In Chile, one in four adolescents between 15 and 19 years of age have obesity, and 14% have MetS 4 , which suggests a rising number of individuals exposed to an early onset of serious and economically burdensome chronic illnesses. Early recognition of insulin-resistant youths may be beneficial for both clinical practice and population-based health promotion efforts. The reference standard to evaluate IR is the hyperinsulinemic-euglycemic clamp; however, it is invasive, costly, and difficult to perform in clinical and epidemiological settings 1. Several surrogate biomarkers have been proposed based on fasting measurements of glucose and/or insulin: HOMA-IR, QUICKI, 1/HOMA, log(HOMA), and 1/insulin 1-3. Pulsatility of insulin release, a relatively short half-life (~ 4-6 min), the fact that insulin assays are poorly standardized and may provide different results on the same sample, and difficulties in handling and storage can all cause problems in insulin determination and interpretation of results 5-7. Thus, insulin measurements are

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Section: Discussionsupporting

confidence: 90%

Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents

Correa‐Burrows

Blanco

Gahagan

et al. 2020

Sci Rep

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“…A study conducted by Guzzetti el al. demonstrated a significant decline in the prevalence of MHO among obese children occurring with age—from 59.8% at the prepubertal stage to 30.8% at the pubertal stages 4–5 [ 84 ]. It was associated with increase in the prevalence of PH, from 5.9% at the prepubertal stage to 23.9% at the pubertal stages 4–5, and the increased prevalence of MUHO.…”

Section: Concept Of Metabolically Healthy and Metabolically Unhealthymentioning

confidence: 99%

“…In a prospective study, it was demonstrated that after 6 years of observation, at the age of 16, the risk of developing PH was significantly greater in children with MHO than in those who were NWMH (relative risk 5.42). Thus, the diagnosis of MHO means only that the CVD risk is lower than in the case of patients suffering from MUHO, but blood pressure and the risk of developing PH and metabolic abnormalities are still higher than in children with normal weight and normal body composition [ 84 ]. The distribution of adipose tissue plays a role in the development of metabolic and haemodynamic complications of obesity.…”

Section: Concept Of Metabolically Healthy and Metabolically Unhealthymentioning

confidence: 99%

Obesity, metabolic syndrome, and primary hypertension

Litwin

Kułaga

2020

Pediatr Nephrol

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Primary hypertension is the dominant form of arterial hypertension in adolescents. Disturbed body composition with, among other things, increased visceral fat deposition, accelerated biological maturation, metabolic abnormalities typical for metabolic syndrome, and increased adrenergic drive constitutes the intermediary phenotype of primary hypertension. Metabolic syndrome is observed in 15–20% of adolescents with primary hypertension. These features are also typical of obesity-related hypertension. Metabolic abnormalities and metabolic syndrome are closely associated with both the severity of hypertension and the risk of target organ damage. However, even though increased body mass index is the main determinant of blood pressure in the general population, not every hypertensive adolescent is obese and not every obese patient suffers from hypertension or metabolic abnormalities typical for metabolic syndrome. Thus, the concepts of metabolically healthy obesity, normal weight metabolically unhealthy, and metabolically unhealthy obese phenotypes have been developed. The risk of hypertension and hypertensive target organ damage increases with exposure to metabolic risk factors which are determined by disturbed body composition and visceral obesity. Due to the fact that both primary hypertension and obesity-related hypertension present similar pathogenesis, the principles of treatment are the same and are focused not only on lowering blood pressure, but also on normalizing body composition and metabolic abnormalities.

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“…6 In another sample of youths, waist circumference and systolic blood pressure were more frequently abnormal in boys than girls, but there were no significant differences in dysglycemia. 7 Moreover, insulin resistance, HDL-C, and triglycerides were more frequently abnormal in girls than boys. 7 However, these effects varied across pubertal stages.…”

Section: Sex Differences In Metabolic Syndrome Components In Adolescent Military Dependents At High-risk For Adult Obesitymentioning

confidence: 99%

Sex differences in metabolic syndrome components in adolescent military dependents at high‐risk for adult obesity

et al. 2020

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Cardiovascular Risk Factors in Children and Adolescents With Obesity: Sex-Related Differences and Effect of Puberty

Cited by 23 publications

References 48 publications

Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents

Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents

Obesity, metabolic syndrome, and primary hypertension

Sex differences in metabolic syndrome components in adolescent military dependents at high‐risk for adult obesity

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