Obesity and Arterial Stiffness in Children

Abstract

Objective-Childhood obesity is associated with risk factors for cardiovascular disease. Arterial stiffness is considered one of the earliest detectable measures of vascular damage. There is controversy in the literature regarding the effects of childhood obesity on arterial stiffness. The objective of this study is to systematically review the literature and to conduct a meta-analysis comparing measures of central arterial stiffness in children and adolescents with obesity to healthy body mass index controls. Approach and Results-Literature searches were conducted using databases (eg, MEDLINE, EMBASE) and citations cross-referenced. Studies assessing central pulse wave velocity or β-stiffness index were included. A random effects meta-analysis of the standardized mean difference and 95% confidence intervals in arterial stiffness between children with obesity and control children was performed for each arterial stiffness measure. A total of 523 studies were identified. Fifteen case-control studies were included, with 2237 children/adolescents (1281 with obesity, 956 healthy body mass index controls) between 5 and 24 years of age. All studies measuring carotid and aortic β-stiffness index and 10/12 studies measuring central pulse wave velocity reported greater arterial stiffness in children/adolescents with obesity compared with controls. A random effects meta-analysis was performed revealing a significant effect of obesity on pulse wave velocity (standardized mean difference=0.718; 95% confidence interval=0.291-1.415), carotid β-stiffness index (0.862; 0.323-1.402), and aortic β stiffness index (1.017; 0.419-1.615). Conclusion-These findings indicate that child/adolescent obesity is associated with greater arterial stiffness. However, further research is needed to address confounders, such as pubertal status, that may affect this relationship in children. In the future, these techniques may be useful in risk stratification and guiding clinical management of obese children to optimize cardiovascular outcomes.

Cardiometabolic Determinants of Carotid and Aortic Distensibility From Childhood to Early Adulthood

“…4,19,20 Our data are also in line with earlier studies in 13-to 15-year-old mostly normal weight children showing an independent association between BMI and brachial artery distensibility. 21,22 Interestingly, childhood obesity is also shown to relate with carotid artery stiffening later in adulthood.…”

Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

“…There is increasing evidence that the matching of tissue perfusion with local metabolic demand during exercise is impaired in obesity even before frank atherosclerotic vascular disease develops (1). Recent studies have shown that even at rest, subclinical abnormalities in vascular and cardiac function are detectable using sophisticated imaging techniques in obese youth (10,36). Moreover, Sunagawa and coworkers (39) suggested in 1984 that an abnormal VO 2 -HR slope could indicate cardiac impairment during exercise in children.…”

New guidelines, and a new hypertensive population How to select women for menopausal hormone therapy

“…Emerging research suggests the importance of arterial stiffness already in pediatric populations (23) . This arterial stiffness is reportedly greater in children/adolescents with obesity compared with controls (24) . Epicardial fat thickness is linked to obesity, carotid subclinical atherosclerosis, and cardiac geometry parameters, and may be a useful tool for cardiovascular risk stratification in children and adolescents (25) .…”