ESPN 54th Annual Meeting

ESPN 2022


 
Cardiovascular risk factors in obese children. Determination by case-control design of carotid intima media thickness by ultrasound as a predictor of cardiovascular risk
MARIA CRISTINA ONTORIA BETANCORT 1 MARIA TERESA RODRIGUEZ BELLO 1 CARLOS MARICHAL HERNANDEZ 1 JORGE DE LUIS YANES 2 MARIA ISABEL LUIS YANES 1 VICTOR MANUEL GARCIA NIETO 1

1- HOSPITAL UNIVERSITARIO NTRA SEñORA DE LA CANDELARIA, SANTA CRUZ DE TENERIFE, SPAIN
2- HOSPITAL UNIVERSITARIO GREGORIO MARAñON.MADRID
 
Introduction:

  Obesity is a major childhood health problem. Central or abdominal obesity has been linked to various complications, such as high blood pressure, dyslipidemia, insulin resistance and diabetes mellitus, constituting the so-called "metabolic syndrome". Early ultrasound study of carotid intima media thickness (CIMT) could detect subclinical atherosclerotic lesions. In the pediatric age, studies related to obesity, cardiovascular risk factors and atherosclerosis are limited.To determine the CIMT of both common carotids as a marker of subclinical atherosclerosis by ultrasound measurement in obese children and children with a normal body mass index (BMI) and to determine its relationship with variables related to cardiovascular risk

Material and methods:

 Observational case-control study. We studied 69 children of both sexes, between 6 and 14 years old, with a diagnosis of obesity or body mass index (BMI) higher than +2 SD of the mean according to the reference population. A control group of 76 healthy children with similar characteristics was assigned. A history of cardiovascular risk in first-degree relatives was analyzed. In both study groups, somatometry was performed with determination of BMI and waist circumference and complete physical examination with measurement of blood pressure, as well as the determination of analytical parameters related to childhood obesity. Obese children underwent oral glucose overload and abdominal ultrasound and, for all children, carotid ultrasound to determine CIMT

Results:

 Obese children showed significantly (p<0.001) a higher frequency of high blood pressure, hypertriglyceridemia, decreased HDL-c and insulin resistance compared to non-obese children.The mean CIMT was higher in obese children (0.46±0.09 for the right carotid and 0.45±0.09 for the left carotid) than in healthy children (0.33±0.04 on the right and 0.36±0.04 on the left) (p<0.001). These differences were present since prepubertal times (<0.001). Of these, BMI was the variable that was independently associated with the CIMT of both carotids (p< 0.001). The right CIMT was higher in obese patients with hyperuricemia (p=0.039) and insulin resistance (p=0.01).. Children with hepatic steatosis (50% of obese patients) had a higher CIMT for both carotids (p=0.003) compared to obese children with normal liver ultrasounds. Likewise, the presence of hepatic steatosis was independently associated with increased thickness of the right (p=0.002) and left (p=0.001) intima media.

Conclusions:

 

The obese subjects in the sample presented a higher frequency of parameters associated with cardiovascular risk. The thickness of the intima media of both carotids was significantly higher in both prepubertal and pubescent obese children relative to non-obese children.The thickness of the intima media of both carotids was directly correlated with multiple variables related to cardiovascular risk, with BMI and the presence of hepatic steatosis being the variables that showed an independent association with the CIMT of both carotid arteries.