Epicardial Fat Thickness in Non-Obese Neurologically Impaired Children: Association with Unfavorable Cardiometabolic Risk Profile

Abstract

Background: Cardiovascular risk is reported in disabled children and epicardial fat (EF) is considered an independent predictor of cardiovascular disease (CVD). No data on the EF thickness (EFT) evaluation in disabled children have been published. Objective: We investigated EFT in neurologically impaired (NI) children; its relationship with their metabolic profile was also considered. Methods: Clinical data, body composition estimation, biochemical profile, and ultrasound-measured EFT were performed in 32 disabled patients (12.4 ± 6.3 years). Pathological parameters were defined using the following criteria: waist circumference >95th percentile, waist to height ratio (WHtR) >0.5, total cholesterol and triglycerides (TG) values >95th percentile, high density lipoprotein cholesterol <5th percentile, fasting blood glucose >100 mg/dL, homeostasis model assessment for insulin resistance (HOMA) >97.5th percentile, and EFT >3.6 mm. Results: EFT values in NI children were higher compared with control group values (p = 0.02). EFT correlated with gender (p < 0.001), age (p = 0.02), pubertal stage (p = 0.04), as well as WHtR (p = 0.03). A correlation between EFT and leptin was also noted (p = 0.04). EFT levels significantly correlated with pathological TG (p = 0.01) and HOMA-IR (p = 0.04). Conclusions: Higher EFT was observed in NI children compared with controls. EFT values correlated with clinical, metabolic, and endocrinological parameters. Ultrasound-measured EFT could be used to promptly detect subclinical CVD and to prevent adverse outcomes in disabled children.

Diabetes Type 2 in Neurologically Impaired Children and Adolescents Without Obesity: A New Emerging Entity?

“…Individuals with neurological impairment are at increased risk for frailty and chronic disease due to factors experienced throughout lifespan, such as excessive sedentary behaviors and malnutrition (19). Unfavorable cardio-metabolic profile and high allostatic load have been previously reported in early childhood (9–11). However, little is known about diabetes in disabled population.…”

“…As previously reported, IR in these disabled patients was not correlated to BMI nor to energy intake (11). Negative regulation of insulin signaling could be viewed as a physiologic “adaptive mechanism for human survival” that is activated whenever the organism needs to switch from an anabolic to a catabolic or “insulin resistance” state, such as undernutrition, and to mobilize energy to support vital metabolic processes (9–11, 24–26). The restricted physical activity (27) may also play a crucial role on insulin resistance; it causes a rapid loss of lean mass, which is associated with a decline in basal metabolic rate and increased whole body and regional adiposity leading to insulin signaling interference (10).…”

“…Additionally, chronic stress also tends to alter the anabolic/catabolic hormonal balance and may be involved in increased cortisol levels and insulin resistance (28). Finally, long-term therapy, such as anticonvulsive drugs and hormonal therapy may be associated with several metabolic abnormalities and their effects on insulin resistance and diabetes should be considered (9–11).…”

“…Insulin resistance (IR) plays a key role in the pathogenesis of T2D (1). Previously, we described that neurologically impaired (NI) children showed an unfavorable cardio-metabolic risk profile with a high prevalence of IR which was not related to BMI (9–11).…”

Malnutrition and Associated Risk Factors Among Disabled Children. Special Considerations in the Pediatric Surgical “Fragile” Patients

“…Some conditions associated with intellectual or developmental disabilities in children remain highly correlated with cardiovascular risk factors in adulthood (19, 20). In disabled children, predictive cardiovascular signs are reported: hypertension was present in more than 15% of NI children and a epicardial fat measurement, considered an independent predictor of coronary atherosclerotic burden, was thicker than age-matched-controls (21).…”