Search

Background and aim: To compare cardiometabolic risk profile and preclinical signs of target organ damage in youth with normal and elevated blood pressure (BP), according to the American Academy of Pediatrics (AAP) guidelines. Methods and results: This cross-sectional multicenter study included 2739 youth (5-17 year-old; 170 normal-weight, 610 overweight and 1959 with obesity) defined non hypertensive by the AAP guidelines. Anthropometric, biochemical and liver ultrasound data were available in the whole population; carotid artery ultrasound and echocardiographic assessments were available respectively in 427 and 264 youth. Elevated BP was defined as BP >= 90th to = 120/80 to

To investigate the anthropometric and metabolic correlates of different patterns of left ventricular (LV) geometry in a cohort of outpatient children with high prevalence of obesity.Anthropometric measures, lipid profile, blood pressure (BP), fasting plasma glucose (FPG), and echocardiographic variables were evaluated in 281 white children (6-16 years), of whom 105 were obese and 105 were morbidly obese. Patterns of LV geometry were defined as follows: normal geometry, eccentric LV hypertrophy (LVH), concentric LV remodeling, and concentric LVH.One hundred forty-eight children exhibited normal LV geometry, 53 eccentric LVH, 36 concentric LV remodeling, and 44 concentric LVH. The 4 groups differed in body mass index, waist circumference, waist-to-height ratio, triglycerides/high-density lipoprotein cholesterol ratio (Tg/HDL-C), and BP (P.05-.0001). A statistically significant impairment of diastolic function (expressed as greater E/E', P.002) was observed across patterns of LV geometry. Among anthropometric measures, waist-to-height ratio showed better performance in relation to LVH, with an optimal cut-point of 0.58, compared with body mass index and waist circumference. Children with concentric LVH exhibited the worst metabolic risk profile, with greater prevalence of visceral obesity, high Tg/HDL-C, high BP, and high-normal FPG, than children with normal LV geometry.In children with high levels of obesity, an unfavorable "cardiometabolic phenotype" can be identified, which includes concentric LVH, visceral obesity, high BP, high Tg/HDL-C, and high-normal FPG.

Objective: To analyze the prevalence of the metabolic syndrome (MetS) defined by three sets of Adult Treatment Panel III (ATPIII)-derived criteria, and the ability of each definition to identify insulin-resistance (IR) in a wide cohort of outpatient children. Subjects and methods: Seven hundred and twenty-four children consecutively observed in the Outpatient Pediatric Clinic of Pozzuoli Hospital during the period 2004–2009 were included in the study. Diagnosis of the MetS was made using three definitions: Cook, Jolliffe (which adopt age- and gender-specific cut-points) and de Ferranti. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). IR was defined by the 90th percentile of HOMA-IR in healthy non-obese Italian children grouped by gender and Tanner stage. The ability of each definition to identify IR was evaluated in terms of sensitivity and specificity. Results: The prevalence of the MetS in the overall cohort was 11, 12 and 24% using Cook, Jolliffe and de Ferranti criteria, respectively. Sensitivity and specificity in relation to IR were 19 and 94% with Cook criteria, 21 and 92% with Jolliffe criteria, and 39 and 84% with de Ferranti criteria. Conclusions: The prevalence of the MetS in children increases with increasing body weight. Among the three definitions analyzed, de Ferranti identifies a larger number of children with the MetS. The prediction of IR is weak with all definitions; on the contrary, the absence of MetS identifies fairly well children with low degree of IR.

The impact of central adiposity on left ventricular (LV) mass in childhood obesity has been little explored. This study evaluates whether central obesity influences LV mass and function in obese children.Biochemical, anthropometric and echocardiographic measurements were taken in obese (n=111, mean age 10.6+/-2.5 years) and non-obese children (n=30, mean age 10.8+/-3.0 years). Left ventricular function was analyzed by conventional and tissue Doppler echocardiography. LV mass was calculated according to the Penn convention and indexed for height(2.7) (LVM(i)). The obese group showed increased levels of LVM(i) as compared to the non-obese group (35.7+/-8.5 vs 23.5+/-2.8 g/h(2.7), p0.0001). Among obese children, we observed a significant increase of LVM(i) across tertile of waist-height ratio (WHtR). The subjects identified by the highest tertile of WHtR, as compared to subjects identified by the lowest tertile, showed higher levels of BMI (29.5+/-5.4 vs 31.0+/-5.0 kg/m(2), p0.0001) and LVM(i) (32.1+/-6.5 vs 37.1+/-8.5 g/h(2.7), p0.01). Among obese children a positive correlation (standardized for age and gender) was found between LVM(i) and BMI (r=0.282, p0.01) and WHtR (r=0.334, p0.0001). To analyze the independent predictors of LVM(i), a stepwise linear regression analysis was performed using age, gender, BMI, blood pressure, heart rate, HOMA-IR and WHtR as independent variables. LVM(i) was independently associated only with WHtR (beta=0.309, t=3.238, p=0.002).Obese children show an increased LVM(i) and a preserved LV function. Central adiposity is the major determinant of left ventricular mass.