Endothelial Dysfunction and Increased Arterial Intima-Media Thickness in Children With Type 1 Diabetes

Järvisalo, Mikko J.; Raitakari, Maria; Toikka, Jyri; Putto-Laurila, Anne; Rontu, Riikka; Laine, Seppo; Lehtimäki, Terho; Rönnemaa, Tapani; Viikari, Jorma; Raitakari, Olli T.

doi:10.1161/01.cir.0000124725.46165.2c

Cited by 387 publications

(311 citation statements)

References 48 publications

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“…Measurement of FMD in brachial artery is an accepted method for measuring endothelial function in the peripheral circulation [29,30]. The technique has been used previously in children with diabetes and generated very similar data to our own in young adults [43]. Indeed in that study, ultrasound assessment was also made of CIMT in type 1 diabetic children, again with results remarkably similar to those of the current study.…”

Section: Discussionsupporting

confidence: 84%

Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

et al. 2009

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Aims/hypothesis Type 1 diabetes is associated with premature arterial disease. Bone-marrow derived, circulating endothelial progenitor cells (EPCs) are believed to contribute to endothelial repair. The hypothesis tested was that circulating EPCs are reduced in young people with type 1 diabetes without vascular injury and that this is associated with impaired endothelial function and increased carotid intima-media thickness (CIMT). Methods We compared 74 people with type 1 diabetes with 80 healthy controls. CD34, CD133, vascular endothelial (VE) growth factor receptor-2 (VEGFR-2) and VE-cadherin antibodies were used to quantify EPCs and progenitor cell subtypes using flow-cytometry. Ultrasound assessment of endothelial function by brachial artery flow-mediated dilatation (FMD) and CIMT was made. Circulating endothelial markers, inflammatory markers and plasma plasminogen activator inhibitor-1 (PAI-1) levels were measured. Results CD34+VE-cadherin+, CD133+VE-cadherin+ and CD133+VEGFR-2+ EPC counts were significantly lower in people with diabetes (46-69%; p=0.004-0.043). In people with type 1 diabetes, FMD was reduced by 45% (p<0.001) and CIMT increased by 25% (p<0.001), these being correlated (r=−0.25, p=0.033). There was a significant relationship between FMD and CD34+VE-cadherin+ (r = 0.39, p = 0.001), CD133+VEGFR-2+ (r =0.25, p = 0.037) and CD34+ (r=0.34, p=0.003) counts. Circulating high-sensitivity C-reactive protein, PAI-1, interleukin-6 and E-selectin were significantly higher in the diabetes group (p < 0.001 to p = 0.049), the last two of these correlating with FMD (r=−0.27, p=0.028 and r=−0.24, p=0.048, respectively). Conclusions/interpretation These findings suggest that abnormalities of endothelial function in addition to proinflammatory and pro-thrombotic states are already common in people with type 1 diabetes before development of clinically evident arterial damage. Low EPC counts confirm risk of macrovascular complications and may account for impaired endothelial function and predict future cardiovascular events.

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Section: Discussionsupporting

confidence: 84%

Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

et al. 2009

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“…The multi-centre study EURODIAB found that low intake of saturated fat and high intake of fibre reduced the risk of cardiovascular disease among type 1 diabetic subjects [3,4]. The development of atherosclerosis starts during childhood and adolescence [5][6][7][8]; moreover imaging techniques have shown that atherosclerosis develops earlier in diabetic children than in age-matched control subjects [1,9]. Thus compliance with nutrition recommendations is especially important for children and adolescents with type 1 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Children and adolescents with type 1 diabetes eat a more atherosclerosis-prone diet than healthy control subjects

et al. 2006

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Aims/hypothesis We evaluated how well the diet of Norwegian children and adolescents with type 1 diabetes fulfils the Nordic and European dietary recommendations, focusing on parameters affecting prevention of atherosclerosis. We also compared the diet of this patient group with that of healthy same-age control subjects. Materials and methods A total of 177 children and adolescents with type 1 diabetes (9-10-year-olds, 12-13-year-olds) and 1,809 healthy same-age control subjects recorded their food intake for 4 days in precoded food diaries.Results In children and adolescents with type 1 diabetes the percentage of energy (E%) from fat (33-35 E%) and saturated fat (14-15 E%) was higher than recommended for that group. Furthermore their intake of fibre was lower (16-19 g/day) than current recommendations. There were no differences in energy intake between diabetic subjects and healthy control subjects. Percentage of energy from fat (mean difference: 3.4 E%, p<0.001) and saturated fat (mean difference: 1.0 E%, p<0.001) was significantly higher among diabetic subjects than control subjects. Intake of fruits and vegetables was low (210 g/day) compared with recommendations, both in the diabetic and control subjects. Conclusions/interpretation Diabetic children and adolescents had a high intake of energy from saturated fat and low intake of fibre, fruits and vegetables, which could increase the risk of development of atherosclerosis. This study supports the idea that nutritional guidance in the treatment of children and adolescents with type 1 diabetes should be more focused, especially with regard to intake of fibre, fruits and vegetables and to quality and quantity of fat intake.

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“…14,15 There are no other studies on medical literature indexes that define standards for normal endothelial function in adolescents.…”

Section: Methodsmentioning

confidence: 99%

“…They defined the lower limit of normality as being the 10th percentile of the percentage difference between the diameters before and after reactive hyperemia in healthy children. 15 The 10th percentile was derived from the normal distribution of values from a population of 105 children and adolescents studied by Järvisalo et al 14 and was dilatation of 3.3%. In our study the 10th percentile was at a dilatation of 6.7%.…”

Section: Variablesmentioning

confidence: 99%

Função endotelial de adolescentes normotensos sem fatores de risco para hipertensão arterial

Andrade¹,

Carvalhaes²,

Taddei³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To define standards for normal endothelial function in adolescents by high-resolution ultrasound measurement of endothelium-dependent vascular dilatation.Methods: This was a cross-sectional, descriptive, observational study and part of the thematic project Clinical Study of Growth, Behavior, Arterial Hypertension, Obesity and Oral Health (ECCCHOS) that was developed by the Discipline of Nutrition at the Universidade Federal de São Paulo. Thirty-one adolescents, eight male and 23 female, with no risk factors for systemic arterial hypertension were selected from 1,420 high-school students. The students were daytime pupils at a school in the southeastern district of the city of São Paulo, the capital of São Paulo state, located in the Southeast region of Brazil. All results are presented in the form of means with standard deviations and percentiles.Results: For male students, endothelium-dependant dilation 90 seconds after the cuff was released was 20.9±6,7% [mean ±1 standard deviation] with a 10th percentile of 12.5 and for females these figures were 18.8±12.9% with a 10th percentile of 6.6%. Values for the whole group of subjects were 19.3±11.7% and 6.7%, respectively.Conclusion: Endothelium-dependant vascular dilation of 6.7%, after 90 seconds, which corresponds to the 10th percentile, can be considered the lower limit of normality for this age group. Knowledge of this limit is important for the diagnosis of endothelium dysfunction that appears before cardiovascular disease.J Pediatr (Rio J). 2005;81(5):395-9: Adolescents, endothelium, and ultrasound.

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Endothelial Dysfunction and Increased Arterial Intima-Media Thickness in Children With Type 1 Diabetes

Cited by 387 publications

References 48 publications

Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

Children and adolescents with type 1 diabetes eat a more atherosclerosis-prone diet than healthy control subjects

Função endotelial de adolescentes normotensos sem fatores de risco para hipertensão arterial

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