Risk Factors For Cardiovascular Diseases In Obese Children And Endothelial Function

Objective:Along with the rapid socio-economic development and the improvement of people's living standards,the prevalence of childhood obesity has considerably increased in many regions of the world,and has become a familiar nutritional disease in clinical pediatrics.In order to prevent and intervene the occurrence of cardiovascular disease,we investigate and analyse the causes of simple obesity,to guide reasonable dietary and healthy lifestyle of children and provide a theoretical basis for the prevention of cardiovascular disease.1.Investigate the characteristics of metabolism in simple obese children including lipid profiles,lipoprotein,glucose and insulin.2.Investigate the impact of simple obesity on children's cardiovascular system, including endothelium-derived factors blood pressure,endothelium-dependent vasodilatation function,diastolic function and contractile function of heart to explore the mechanism of endothelial dysfunction in obese children,and to provide the basis for preventing cardiovascular complications in adult.3.Investigate the relationship between environmental factors and simple obesity through patient histories and living habits.Methods:1.Study subjects.We studied 53(43male) obese children and adolescents(mean age 11.2±1.6years,range9-14 years).Subjects were eligible with weight the 95th percentile of the WHO and China's Nutrition Association reference data for weight and height. Exclusion criteria were secondary or genetic obesity and the use of any drug therapy 28 (18male) normal weight healthy subjects(mean age 11.5±0.6 years,range 8-13 years) were the control group,matched to the sex and age.2.Questionnaire All of the participating children completed a structured questionnaire detailing their personal history of disease,pubertal development and lifestyle characteristics.3.Anthropometric measurements Height,weight,waist and hip circumference were recorded respectively.We calculated their body mass index(BMI) as body weight(kg) divided by the square of their height(m)and waist-hip ratio.Systolic blood pressure (SBP) and diastolic blood pressure(DBP) were measured4.Biochemical measurements After a 8-h overnight fast,measurements for plasma glucose and insulin,serum triglycerides,total cholesterol,high-density lipoprotein(HDL)cholesterol,apolipoprotein AandB,low density lipoproteins, high-sensitivity C-reactive protein(hs-CRP)and endothelin(ET)were made in all subjects,and calculat insulin resistance index(HOMA-IR=fasting insulin×fasting glucose/22.5).5 Color Doppler Echocardiography measurements5.1 Study the endothelium-dependent vasodilation function in children with obesity. during reactive hyperemia.Brachial diameter was measured with high-resolution ultrasound.5.2 Detect Diastolic function(E.A.E/A) and systolic function(LVEF,CO.SV.CI) of heart with echocardiography and the occurrence of fatty liver in obese childrenResults:1.Weight,BMI,WC,WHR were higher in the obese children than in control group,which shows significant difference(P＜0.01).2.There is of FINS,IR index,plasmaTG,TCH,LDL-C were higher,and HDL-C,APOA were lower in the obese children than in control group,respectively(all p＜0.01 or p＜0.05).GLU were not significant difference in two group.3.ET,hs-CRP and systolic and diastolic pressure in obese group were higher than control group,which shows significant difference(p＜0.05).4.The increased percentage of brachial artery diameter at hyperemic condition (DF%)was lower in obese children comparing with those normal controls.The DF% correlated negatively withET,positive with D_f,while D_f correlated with HDL-C,BMI and SV.5.LVEF and CI were lower,and CO,SV,E and Awere higher in obese group(all p＜0.01 or p＜0.05).E/A were not significant difference in two group.6.There were 42(79.2%) had fatty liver in 53 obese children,moderate or servere 28 cases.7.Survey shows that high risk factors for children obesity included eating more, high-cholesterol diet and less physical activity.Conclusion:1.There were dyslipidaemia and IR in obese children,which were two of cardiovascular risk factors.HDL-C,APOA,FINS and IR index correlate with weight,BMI and WC. LDL-C correlate with WC and WHR.2.Endothelium-dependent vasodilation function was impaired in obese children. Systolic function of heart decrease,but diastolic function were not significant difference in two group.3.To modify the eating and activity behavior is key to prevent obesity of children.