Characteristics of the retinal microvasculature in association with cardiovascular risk markers in children with overweight, obesity and morbid obesity

Abstract

To aim of this study was to evaluate characteristics of the retinal microvasculature, but particularly potential associations with classic and novel (endothelial function and low-grade inflammation)markers for cardiovascular risk, in a cohort of children with overweight and (morbid) obesity. Central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE) were assessed. CRAE was significantly lower and AVR significantly higher in children with morbid obesity than in children with overweight and normal weight(p < 0.01). CRVE did not differ significantly between the four weight categories. A multiple linear regression model with CRAE as dependent variable showed that only DBP z-score(β = −2.848,p = 0.029) and plasma glucose concentrations(β = 6.029,p = 0.019) contributed significantly to the variation in CRAE. Remarkably, despite a correlation between CRAE and circulating concentrations of the adhesion molecules VCAM-1 or ICAM-1, markers for inflammation and endothelial function did not contribute to the variation in CRAE. This is the first study showing in population of children with overweight and obesity that the retinal arteriolar microvasculature, but not venular diameter is aberrant, with increasing BMI z-score. CRAE was significantly associated with several cardiovascular risk markers, and multiple linear regression showed that a higher diastolic blood pressure z-score and lower fasting plasma glucose concentrations significantly contributed to the variance in CRAE.

Effect of weight loss on the retinochoroidal structural alterations among patients with exogenous obesity

“…The AVR is calculated using the mean vessel calibre of the largest six arteries (central retinal arteriolar equivalent-CRAE) and largest six venules (central retinal venular equivalent-CRVE). In children with obesity, CRAE has been strongly linked to severe cardiovascular risk factors [9]. Similarly, CRAE has been negatively correlated to fat mass indices in children with obesity, reflecting presence of narrow arterioles in these patients affecting the retinal microcirculation [10].…”

Systematic review on retinal microvasculature, physical activity, sedentary behaviour and adiposity in children and adolescents

“…Ages ranged from 30 weeks of gestation to 18 years. We found 23 studies reporting on measures of weight status (88%) as exposure, while measures of PA were present in six studies (23%) and SB was assessed in three studies (12%); four studies (15%) reported measures of weight status and PA/SB …”

“…Included studies were published between 2007 and 2018. Most studies were conducted in Australia, Singapore, Netherlands, Germany and Switzerland . Sample size ranged between 24 and 4145 children and adolescents.…”

“…from 30 weeks of gestation to 18 years. We found 23 studies reporting on measures of weight status (88%) as exposure, 23,28,38,39,[55][56][57][58][59][60][61][62][63][64][65][68][69][70][71][72][73][74][75] while measures of PA were present in six studies (23%) 41,64-67, 73 and SB was assessed in three studies (12%) 28,41,73 ; four studies (15%) reported measures of weight status and PA/SB. 28,64,65,73 Adiposity assessments included birthweight (n = 5), BMI (n = 11), OCT device, non-mydriatic vessel analyzer and a spectralis OCT device (4% each).…”

“…We found 20 cross-sectional studies. The exposures varied between birthweight, 56,59,70,73 BMI, 23,28,38,39,55,[57][58][59]61,62,65,69,72 WC, 28,38,55,57 other measures of adiposity, 28,39,58,61,68,71 SB 28,41,73 and PA. 41,65,67,73 One study stated that children born with low-birth-weight were 4% more likely to have abnormal vascularisation than normal birthweight children. 70 Also, Kandasamy et al, 56 found that low birthweight was related to larger arterioles and venules.…”