Pediatric Precursors of Adult Cardiovascular Disease: Noninvasive Assessment of Early Vascular Changes in Children and Adolescents

Groner, Judith A.; Joshi, Mandar; Bauer, John

doi:10.1542/peds.2005-2992

Cited by 97 publications

(57 citation statements)

References 73 publications

(92 reference statements)

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“…A similar clinical trial incorporating the plant stanol into low-fat yogurt likewise showed reductions in LDL cholesterol levels without improvement in endothelial function. 148,149 These studies give preliminary evidence for an impact on the actual atherosclerotic disease process with treatment of familial hypercholesterolemia in children. Similar studies are required for other types of high-risk lipid abnormalities.…”

Section: Mccrindle Et Al Drug Therapy Of Lipid Abnormalities In Youthmentioning

confidence: 90%

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

McCrindle¹,

Urbina

Dennison³

et al. 2007

Circulation

361

148

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Abstract-Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

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Section: Mccrindle Et Al Drug Therapy Of Lipid Abnormalities In Youthmentioning

confidence: 90%

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

McCrindle¹,

Urbina

Dennison³

et al. 2007

Circulation

361

148

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“…Acredita-se que crianças e adolescentes obesos tornam-se adultos obesos (15) , com relação direta entre a gravidade da obesidade na infância e o risco de se manter o sobrepeso ou a obesidade na vida adulta (16) . O IMC aumentado é indicativo de risco precoce para morbidade e mortalidade (13,17) . A elevada prevalência da obesidade infantil, concomitante à hipertensão arterial, hiperlipidemia e síndrome metabólica, está associada à doença cardiovascular na vida adulta (18) .…”

Section: Discussionunclassified

“…Acredita-se que houve aumento da incidência da hipertensão arterial paralelamente à epidemia de obesidade na infância (19,20) e que o aumento mundial da prevalência de crianças e adolescentes com hipertensão arterial primária está diretamente relacionado ao aumento da prevalência da obesidade (17) . Estudos indicam que há uma relação direta entre o grau da obesidade e o risco de hipertensão arterial sistêmica na infância (21,22) .…”

Section: Discussionunclassified

Estudo comparativo de fatores de risco em crianças e adolescentes com diagnóstico antropométrico de sobrepeso ou obesidade

Ricco¹,

Ricco²,

Nogueira‐de‐Almeida³

et al. 2010

Rev. paul. pediatr.

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OBJETIVO: O excesso de peso é um grande problema de saúde pública em todo o mundo, atingindo crianças e adolescentes. O presente estudo teve por objetivo verificar se a condição de portador de sobrepeso se associa à presença de fatores de risco à saúde. MÉTODOS: Foram estudados 84 sujeitos entre seis e 17 anos, constituindo-se um grupo de 34 pacientes portadores de sobrepeso e outro de 50 obesos, atendidos em ambulatório de Nutrologia Pediátrica da Universidade de Ribeirão Preto (Unaerp), durante o período de outubro de 2004 a outubro de 2005. Foram obtidas as variáveis: pressão arterial, circunferência abdominal, glicemia de jejum, glicemia de segunda hora, colesterol total, HDL-c, LDL-c e triglicérides. Comparam-se os dois grupos por meio de duas abordagens estatísticas: comparação entre as distribuições dos valores absolutos (teste de Mann-Whitney) e entre as frequências de valores considerados alterados (teste exato de Fisher). RESULTADOS: Quanto à primeira abordagem, verificou-se diferença estatística apenas para o HDL-c, com maiores valores para o subgrupo de portadores de sobrepeso de seis a dez anos. Quanto à segunda comparação, verificou-se diferença estatística para a circunferência abdominal (segundo os critérios de Freedman), HDL-c e glicemia de jejum, com maiores frequências de valores alterados entre os obesos. CONCLUSÕES: Os portadores de sobrepeso apresentaram alterações indicativas de prejuízos à sua saúde, semelhantemente aos obesos, sendo necessário também incluí-los nos programas de prevenção e tratamento.

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“…88,89 Following the recent recommendation of Grundy 14 regarding metabolic risk-factor clustering in adults, we propose a new comprehensive approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) in children and adolescents. Taking into account the pediatrician's role in preventing future diseases, 90 we need first to direct our efforts towards collecting data on all the plausible variables to provide us with an overall picture, and then to select those variables with solid evidence to substantiate their relevance. In Figure 1, we outline a multilevel global approach to examining patients.…”

Section: Minor Concernsmentioning

confidence: 99%

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

et al. 2007

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Background: The diagnostic criteria of the metabolic syndrome (MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. Objectives: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. Results: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis; the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. Conclusion: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.

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Pediatric Precursors of Adult Cardiovascular Disease: Noninvasive Assessment of Early Vascular Changes in Children and Adolescents

Cited by 97 publications

References 73 publications

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

Estudo comparativo de fatores de risco em crianças e adolescentes com diagnóstico antropométrico de sobrepeso ou obesidade

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

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