Lactancia materna, obesidad y síndrome metabólico en la edad escolar / Breastfeeding, obesity and metabolic syndrome at school age

INTRODUCCIÓN: La lactancia materna (LM) puede ser un factor protector de la obesidad y sus complicaciones metabólicas. OBJETIVO: Determinar la asociación entre el antecedente de amamantamiento y la presencia de obesidad, síndrome metabólico (SM) y resistencia insulínica (RI). PACIENTES Y MÉTODOS: Estudio transversal en 20 escuelas públicas de Santiago, Chile. Se evaluó antropometría, presión arterial, perfil lipídico, glicemia, insulinemia e índice HOMA. Los padres respondieron una encuesta sobre el antecedente de LM. Se definió SM según criterios de Cook y RI como HOMA > percentil 90. RESULTADOS: Se recibieron 3.278 encuestas válidas. La edad promedio fue de 11,4 ± 1 años, siendo 52,3% mujeres. La mayoría (98,2%) recibió LM, con una prevalencia de 15,9% de obesidad versus 18,6% en los que no la recibieron (p = 0,039). Hubo una tendencia no significativa a que SM y sus componentes, excepto RI, fueran más prevalentes en el grupo no amamantado. Los escolares que recibieron LM por 3-6 meses presentaron una menor prevalencia de obesidad y de algunos componentes de SM que los que recibieron menor tiempo o no la recibieron; el efecto fue inverso cuando la LM se prolongó por más de 9 meses. CONCLUSIONES: La prevalencia de obesidad fue mayor en los escolares que no fueron amamantados. Durante el primer semestre, la LM de mayor duración se asoció a menor prevalencia de obesidad y complicaciones metabólicas.

INTRODUCTION: Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications. OBJECTIVE: To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR). PATIENTS AND METHODS: Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS). RESULTS: 3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months. CONCLUSIONS: The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.

La razón cintura estatura en escolares no varía con el género, la edad ni la maduración puberal / Waist-to-height ratio does not change with gender, age and pubertal stage in elementary school children

Background: Waist-to-height ratio (WHtR) is a cardiometabolic risk indicator in children. A value greater than or equal to 0.55 is an effective screening tool for identifying obese children with metabolic syndrome. However, it is unclear whether this cutoff can be applied equally to any age or gender. Aim: To analyze the variability of WHtR by age, gender and pubertal stage in elementary school children. Patients and Methods: Cross-sectional study in 2,980 school children (6-14 years old, 51% male) of Santiago, Chile. We measured weight, height and waist circumference and calculated body mass index and WHtR. Pubertal stage was assessed and classified as peripubertal (Tanner I and II) and pubertal (Tanner III, IV and V). Results: The mean age was 9.9 ± 2.3 years, with no gender difference (p = 0.5). Eighty one percent of boys and 59.4% of girls were peripubertal (p < 0.001). The association between age-adjusted WHtR by gender and pubertal stage was not significant (p = 0.409). Therefore mean, standard deviation and percentiles of WHtR were calculated without sex and pubertal stage segmentations. Conclusions: Since WHtR does not vary with age, gender and pubertal status in elementary school children, it is possible to use a single cutoff value, previously defined in this population, to identify children with cardiometabolic risk.

La presión arterial es un importante marcador de ateroesclerosis subclínica en niños / Association of carotid intima media thickness with blood pressure and HDL cholesterol in children

Background: Cardiovascular risk factors must be controlled since childhood. Aim: To assess the association of carotid intima media thickness (CIMT) with the components of the metabolic syndrome in Children. Material and Methods: Cross sectional assessment of 299 children aged 11.5 ± 0.9years (58% women) with and without metabolic syndrome components. Anthropometric parameters and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipids. CIMT was measured using high resolution ultrasound. Results: Ninety three percent of children were post puberal, 64% were overweight and 25% had metabolic syndrome. Mean and maximum CIMT correlated with systolic blood pressure (r = 0.21 and 0.21 respectively p < 0.01). Children with a CIMTover the 75th percentile had higher blood pressure and lower HDL cholesterol. A stepwise logistic regression accepted both variables as predictors of CIMT with odds ratios for mean CIMT of 1.46 (1.19-1-79) and 0.81 (0.7-0.94) perfive units of change, respectively. Conclusions: In this group of children systolic blood pressure and HDL cholesterol are associated to CIMT.

Relación colesterol total a HDL y colesterol no HDL: los mejores indicadores lipídicos de aumento de grosor de la íntima media carotidea / Total/HDL cholesterol ratio and non HDL cholesterol as predictors for increased intima media thickness

Background: LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. Aim: To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. Material and Methods: Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile. Results: Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. MeanIMTwas 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). Conclusions: Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Insulinemia e índice HOMA en niños y adolescentes chilenos / Normal plasma insulin and HOMA values among chilean children and adolescents

Background: Plasma insulin and HOMA (homeostasis model assessment) index, used to determine insulin resistance, do not have local standard values for children and adolescents in Chile. Aim: To establish the normal reference intervals for insulin and HOMA in children and adolescents aged 10-15 years, according to sex and puberal maturation. Material and Methods: A cross-sectional study of 2,153 children and adolescents from Puente Alto County was performed, during 2009 and 2010. Anthropometry and self-report of puberal maturation were assessed. Fasting glucose (hexoquinase) and insulin blood levels (chemiluminiscence), were determined and HOMA index was calculated. Percentile distributions of these variables were calculated. Results: The reference group included only subjects with normal body mass index and fasting blood glucose (n = 1,192). Girls had higher insulin and HOMA values than boys (12.5 ± 6.0 and 9.1 ± 4.9 μϋ/mL (p < 0.01) and 2.7 ± 1.4 and 2.1 ± 1,1 (p < 0.01), respectively). Subjects with Tanner I and IIpuberal stages had lower insulin and HOMA mean values than subjects with Tanner III and IV (9.0 ± 4.3 and 12.5 ± 6.2μϋ/ml (p < 0.01) and2.0 ± 1 and2.8 ± 1.4 (p < 0.01), respectively). Conclusions: The 90th percentile of insulin and HOMA distributions according to sex and maturation, was selected as the upper cut-off point to identify individuals with insulin resistance. HOMA cutoff point for Tanner I and II boys was 3.2, for Tanner I and II girls was 4.1, for Tanner III and IV boys was 4.2 and for Tanner III and IV girls was 5.0.

Perfil de riesgo cardiovascular en adultos jóvenes asintomáticos con grosor íntima media carotídeo elevado / Cardiovascular risk factors among young subjects with high carotid intima media thickness

Background: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. Aim: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). Material and Methods: We studied 689 subjects (50 percent women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. Results: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). Conclusions: There is a negative influence of cardiovascular RF on CIMT among young subjects.

Hipertensión arterial: el factor de riesgo más importante para grosor íntima-media carotídeo elevado y placa carotídea en adultos de Santiago / Risk factors for a high carotid intima media thickness among healthy adults

Background: Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors. Aim: To determine attributable risk factors for a high CIMT among healthy adults. Material ana Methods: A sample of 1270 individuáis (636 males and 634 femóles) aged 44 ±11 years, was studied. Blood pressure, weight, height, lipidprofile and blood glucose were measured in all. CIMT and thepresence of atheroscleroticplaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes. Results: Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and thepresence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57 percent, respectively. Conclusions: In this sample, the main risk factor for a high CIMT was hypertension.

Strain y strain rate auricular izquierdo evaluado por speckle tracking está relacionado a PCR ultrasensible en adolescentes obesos / Speckle tracking derived left atrial strain and strain rate are related to high sensitive C reactive protein in obese adolescents

Introducción: La obesidad y el síndrome metabólico están asociados a un tamaño auricular izquierdo (AI) aumentado y mayor riesgo cardiovascular. El strain y strain rate longitudinal determinado por speckle tracking son herramientas novedosas en la evaluación de la función AI. Objetivo: evaluar el strain y strain rate AI en adolescentes obesos y su relación con biomarcadores de riesgo cardiovascular. Métodos: se incluyeron adolescentes consecutivos con un z-índice de masa corporal (z-IMC) > 1 en ritmo sinusal sin otra comorbilidad y un grupo control pareado por edad y sexo. Se registraron las características clínicas y ecocardiográficas con evaluación del strain AI: onda s (LASs), onda a (LASa) y strain rate AI: onda s (LASRs), onda a (LASRa) por speckle tracking. Se midió adiponectina y PCR ultrasensible. Se utilizó t-Student, chi-cuadrado y correlación de Pearson. Resultados: Se incluyeron 15 sujetos por grupo de edad promedio de 13 años, 47 por ciento hombres sin diferencia entre ambos grupos. Los pacientes con sobrepeso presentaron significativamente mayores niveles de PCR us respecto del grupo control, 0,5 +/- 0,1 mg/L vs 1,4 +/- 0,3, p = 0,04 y menores de LASs (44 +/- 1,8 vs 32 +/-1,1 por ciento;p<0,01), LASa ( -1,7 +/- 0,3 vs -0,7 +/- 0,3 1/s; p<0,01), LASRs ( 1,7 +/- 0,07 vs 1,3 +/- 0,03 por ciento; p<0,01), LASRa (-1,8 +/- 0,1 vs -1,2 +/-0,08 1/s;p<0,01). En el grupo con sobrepeso se encontró una correlación negativa significativa entre LASs, LASRs y PCR ultrasensible (R: -0,62; p < 0,01 y R: -0,58: p = 0,02 respectivamente). Conclusiones: El strain y strain rate AI se encuentran reducidos en adolescentes obesos y estos parámetros de función AI se correlacionan con un estado inflamatorio aumentado. La importancia clínica de estos hallazgos requieren mayor investigación.

Background: Obesity is an emerging problem in children worldwide and a well-known risk factor for atrial fibrillation (AF) in adulthood. There is some evidence that functional and structural changes responsible for the development of AF may arise early in life. Left atrial (LA) strain and strain rate, assessed by speckle tracking, are indices of LA function and correlate with the development of AF. Objective: To evaluate LA strain and strain rate in obese adolescents and their correlation with plasma levels of high sensitive C reactive protein (hs-CRP) and adiponec-tin, two markers of cardiovascular risk. Methods: Fifteen obese adolescents, age 13 +/- 0.2 yr, body mass index (BMI)-z-score 1.9 +/- 0.16 and 15 lean controls were recruited. All patients underwent transtho-racic echocardiography with evaluation of LA strain and strain rate: a wave (LASa and LASRa) and s wave (LASs and LASRs). Plasma levels of hs-CRP was determined. Student's t test, chi-square and Pearson correlation were used for statistical analysis. Results: Obese patients had a lower LASs (44 +/- 1.8 vs 32 +/- 1.1 percent, p < 0.01), LASa (- 1.7 ± 0.3 vs - 0.7 +/- 0.1, p < 0.01), LASRs (1.7 +/- 0.07 vs 1.3 +/- 0.03, p < 0.01) and LASRa (- 1.8 +/- 0.1 vs - 1.2 +/- 0.08, p < 0.01). Plasma hs-CRP levels were significantly higher in the obese group and displayed a significant inverse correlation with LASs (r: - 0.62, p < 0.01) and LASRs (r: - 0.58, p = 0.02). Conclusion: Obese adolescents had an impaired LA function compared to age-matched lean subjects, which correlated with an increased inflammatory state. It is likely that LA dysfunction may predispose to AF later in life.

Índice cintura estatura y agregación de componentes cardiometabólicos en niños y adolescentes de Santiago / Waist height ratio, ultrasensitive c reactive protein and metabolic syndrome in children

Background: Waist to height ratio and ultrasensitive C-reactive protein are predictors of the presence of the metabolic syndrome in children. Aim: To determine the proportional risk of metabolic syndrome component clustering in children, using waist to height ratio and ultrasensitive C-reactive protein. Material and Methods: Anthropometric measures, blood pressure, fasting serum lipid profle, blood glucose and ultrasensitive C-reactive protein were determined in 209 children aged 11.5 ± 2 years (50 percent females). The presence of the metabolic syndrome as a function of waist to height ratio and C-reactive protein was modeled using logistic regression equations. The risk of clustering one, two or more components of the metabolic syndrome was calculated. Results: Metabolic syndrome was present in 5 percent of all children and 18 percent of those that were obese. The cut off points for waist to hip ratio and ultrasensitive C-reactive protein were 0.55 and 0.61 mg/L, respectively. For each 0.01 increment in waist to height ratio, the odds ratio of increasing one component of the metabolic syndrome was 1.2 (1.15-1.25) or 15 to 25 percent. The odds ratio for log-transformed ultrasensitive C-reactive protein was 1.62 (1.26-2.09). Excluding waist circumference, the odds ratio of adding one or more components of the metabolic syndrome was 1.05 (1.01-1.09) per 0.01 increment in waist to height ratio, but the odds ratio for C-reactive protein was no longer significant. Conclusions: Waist to height ratio and ultrasensitive C-reactive protein predict the risk of clustering components of the metabolic syndrome in these children.

Validación de un puntaje de riesgo cardiovascular en niños españoles aplicado a una población de escolares de Santiago de Chile / Association between a cardiovascular risk score and early markers of atherosclerotic disease in Chilean children

Background: A cardiovascular risk score for children, that includes traditional risk factors, obesity, sedentary habits and a family history of cardiovascular disease, has been recently proposed by Spanish researchers. Aim: To apply this score in school age children in Santiago de Chile and correlate its results with markers of subclinical atherosclerotic disease. Material and Methods: Retrospective analysis of data obtained from 209 children, aged 11.5 ± 2 years, studied between 2005 and 2006. Weight, height, blood pressure, ultrasound measurement of carotid intimamedia thickness and fow mediated dilatation of brachial artery and ultrasensible C reactive protein (us PCR) were measured. The Spanish cardiovascular risk score was calculated and correlated with ultrasound parameters and C reactive protein. Results: According to the score, 173 children (83 percent) had a low cardiovascular risk, 28 (13 percent) an intermediate risk and 8 (4 percent) a high risk. There was no association between the cardiovascular risk score and carotid intima-media thickness, fow mediated arterial dilatation and us PCR. Conclusions: No significant association was observed between the proposed cardiovascular risk score and early markers of atherosclerotic disease in this group of children.

Razón cintura estatura como predictor de riesgo cardiometabólico en niños y adolescentes / Waist-Height ratio as a predictor if cardio-metabolic risk in children

En niños, la obesidad general y visceral se asocian con mayor riesgo cardiometabólico. El aumento en la prevalencia del síndrome metabólico (SM) en niños y adolescentes empeora el riesgo cardiovascular. Necesitamos contar con nuevos marcadores que permitan predecir el SM en niños. Objetivo: Comparar índice de masa corporal (zIMC) con razón cintura estatura (RCE) como predictores de SM en niños chilenos. Método: Estudio transversal en 618 escolares, edad 10.8 +/- 1.9 años, 51.6 por ciento mujeres, 190 eutróficos, 174 sobrepeso, 254 obesos, estrato socioeconómico medio y medio bajo, área urbana de Santiago. Determinamos peso, talla, circunferencia de cintura, presión arterial, perfil lipídico y glicemia. Diagnóstico de SM basado en la presencia de > 3 criterios de Cook. El SM se modeló en función de RCE y z score IMC , con modelos de regresión logística. Se usaron curvas ROC para comparar RCE y zIMC como predictores de SM. Punto de corte según índice de YOUDEN. Resultados: La prevalencia de SM fue 15.37 por ciento. Promedio de z IMC + 1.22 +/- 0.90 y de RCE 0.52 +/-0.07. Punto de corte óptimo para SM: RCE 0.55 (sensibilidad 72 por ciento, especificidad 70 por ciento) yzIMC: 1.76 (sensibilidad 71 por ciento, especificidad 74 por ciento). Conclusión: RCE y zIMC predicen igualmente el riesgo cardiometabólico en niños y adolescentes. Dada la mayor facilidad de calcular RCE, la transforma en mejor herramienta definiendo riesgo en este grupo. El punto de corte > 0.55 sería buen predictor de SM en niños y adolescentes.

Among children both general and visceral obesity are associated with increased cardio-metabolic risk. The increasing prevalence of the metabolic syndrome (MS) in children and adolescents increases cardiovascular risk. Studies of new clinical markers which can easily and accurately predict MS in children and adolescents are needed. Aim: To compare zBMI and waist to height ratio (WHR) as predictors of MS in Chilean children. Method: We performed a crossectional study of 618 schoolchildren, age 11 +/- 2 years, 52 percent females, 190 eutrophic, 174 overweight, 254 obese, from middle and low social economic strata from the Santiago urban area. We determined weight, height, waist circumference, blood pressure and fasting lipids and glycemia. MS diagnosis was based on the presence of > 3 Cook criteria. MS was modeled in function of WHR and z score BMI, through logistic regression models. ROC curves were used to compare zBMI and WHR as predictors of MS. The cut off point by YOUDEN index was used. Results: The prevalence of MS was 15 percent. Mean zBMI was +1.22 +/- 0.90 and WHR 0.52 +/- 0.07. Cut off point for MS were: WHR 0,55 (sensitivity 72 percent, specificity 70 percent)and zBMI: 1.76 (sensitivity 71 percent, specificity 74 percent). Conclusions: Both WHR and zBMI similarly predicted cardio metabolic risk in children and adolescents. The greater feasibility of calculating WHR makes it a good tool for defining risk in this group. A cut off point >0.55 might be a good predictor of MS in children and adolescents.

Modificación del grosor intima-media carotídeo según factores de riesgo clásicos y síndrome metabólico con o sin inflamación / Relation of intima-media thickness, traditional risk factors and metabolic syndrome in subjects with or without inflammation

El grosor intima-media carotideo (CIMT) es un marcador de aterosclerosis subclinica y eventos isquémicos cerebrales y coronarios. Si bien los valores normales promedio en Chile, han sido publicados, no existen datos locales de cómo se modifica el CIMT según la carga de factores de riesgo (FR) cardiovascular. Objetivos: Analizar la modificación del CIMT según la carga de FR clásicos, presencia de síndrome metabólico (SMET) y SMET más inflamación. Métodos: Hombres y mujeres de Santiago sin antecedente de eventos isquémicos previos, nivel socio económico medio, medio bajo y medio alto. En todos se realizó encuesta sobre antecedentes demográficos, FR cardiovascular, y medición de PA, IMC, cintura, y perfil lipídico, glicemia y proteína C-reactiva ultrasensible (ePCR) en ayuno. Para diagnóstico de SMET se usó NCEP ATPIII (2001), y para inflamación, ePCR> 2 mg/L (valor de corte de > riesgo porAHA). El CIMT se midió en carótida común derecha e izquierda con software MATH®. Resultados: Se incluyeron en el análisis 999 sujetos (508 hombres), edad promedio 43.8 +/- 11 años. La prevalencia de HTA fue 30 por ciento, dislipidemia 68 por ciento, tabaquismo 47 por ciento, y SMET 24 por ciento. El CIMT medio promedio fue 0.61 +/- 0.1 mm y la ePCR promedio 2.22 mg/L. La modificación del CIMT medio (mm) según número de FR (edad>45/55 hombre/mujer, diabetes, HTA, colesterol total > 200, HDL < 40/50, tabaquismo e historia familiar), fue la siguiente: 0 FR= 0.55 +/- 0.08; 1-2 FR= 0.59 +/- 0.091; > 3 FR= 0.67 +/- 0.12 (p < 0.0001). Asimismo, el CIMT aumentó según el puntaje de Framingham: < 5 por ciento = 0.58 +/- 0.09; 5-10 por ciento= 0.66 +/- 0.11; > 10-20 por ciento= 0.68 +/- 0.11; >20 por ciento > o = 0.76 +/- 0.14 (p < 0.0001). El CIMT fue significativamente mayor en los sujetos con SMET, y se incrementa en forma significativa cuando se adiciona ePCR>2 mg/L. En el modelo de regresión múltiple, el CIMT se asocia en forma conjunta a Framingham (p < 0.0001) y SMET+ePCR>2...

Carotid intima-media thickness (CIMT) is a marker for cerebral and coronary ischemic events. Normal values for CIMT in Chile have been published but the relation of CIMT to level of risk factors (RF) is unknown. Aim. To analyze the relation of CIMT to level of traditional RF and the presence of metabolic syndrome (MS), with or without inflammation. Methods. Males and females living in Santiago, Chile, with no prior history of ischemic events, of a low, medium or high socio-economic level, were studied. Demographic data, and presence of RF were obtained. Blood pressure, BMI, waist, blood lipids, blood glucose and US-CRP were measured in the fasting state. The presence of MS was defined by the NCEP-ATP III (2001) criteria. Inflammation was defined as US-CRP >2mg/L (the cut off point for increased risk, according to the AHA). CIMT was measure in both carotid arteries using the MATH® software. Results. 999 subjects (508 males), aged 43 +/- 11 years old. The prevalence of hypertension (HT) was 30 percent, dyslipidemia 68 percent, tobacco use 41 percent and MS 24 percent. Mean CIMT was 0.61 +/- 0.1 mm and US-PCR was 2.22 mg/L. CIMT according to number of RF - age > 45/55 (male/female), diabetes, HT, total cholesterol > 200 mg/dl, HDL < 40/50 mg/dl, tobacco use and family history- were: 0 RF: 0.55 +/- 0.08; 1-2 RF: 0.59 +/- 0.091; >3 RF: 0.67 +/- 0.12 (p < 0.0001). CIMT according to Framingham scores was: < 5 percent: 0.58 +/- 0.09; 5 - 10 percent: 0.66 +/- 0.11; 10 - 20 percent: 0.68 +/- 0.11 and > 20 percent: 0.76 +/- 0.14 (p < 0.0001). CIMT was significantly greater in subjects with MS and more in the group with US-PCR > 2mg/L. In multiple regression analysis, CIMT was jointly associated to Framingham score (p < 0.0001) and presence of MS + US-PCR >2 mg/L (p=0.01) (r2=0.19 for the model). Conclusion. CIMT increases in relation to traditional RF load and the presence of MS. An increased atherosclerotic risk in subjects with MS+inflammation (US-PCR > 2 mg/L)...

Marcadores de aterosclerosis temprana y síndrome metabólico en niños / Early markers for atherosclerosis and metabolic syndrome in children

Background: The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk. Aim: To evaluate components of MS in children and to correlate them with surrogate markers of atherosclerosis andsubclinical inflammation. Material and methods: We studied 209 children aged 11.5 ± 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels,glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) andcarotid intima-media thicknes (IMT). For diagnosis of MS we adapted Cook’s criteria. Results: Five percent of all children and 18% of those with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant. Conclusions: Children with overweight presented a higher risk of a clustering ofMS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein.

Soplos en pediatría ambulatoria / Heart murmurs in ambulatory pediatrics

La auscultación de un soplo cardíaco es un hallazgo frecuente en pediatría y la mayoría de las veces es un soplo fisiológico y no refleja cardiopatía, sin embargo, los médicos deben realizar un acertado análisis para derivar a especialista a los niños que sí requieren evaluación y estudio.

Proteína C-reactiva y su relación con adiposidad, factores de riesgo cardiovascular y aterosclerosis subclínica en niños sanos de la Región Metropolitana / C-reactive protein in relation to adiposity, cardiovascular risk factor and subclinical atherosclerosis in healthy children from Santiago, Chile

Introducción: La proteína C-reactiva ultrasensible (PCRus) es un marcador de riesgo (FR) emergente. En adultos, se asocia a la mayoría de los FR metabólicos, al desarrollo de diabetes y predice eventos cardiovasculares futuros. Dado que la aterosclerosis puede comenzar en la niñez, es importante conocer los niveles de este marcador y sus relaciones con los FR clásicos en la población pediátrica. Objetivo: Determinar los niveles de PCRus y establecer su relación con medidas antropométricas de adiposidad, FR tradicionales y medidas de aterosclerosis subclínica en niños de Santiago. Método: Estudio prospectivo en hijos de sujetos sanos de la zona urbana de Santiago. En todos los niños se realizó una encuesta sobre FR clásicos, se evaluó antropometría, maduración puberal y perfil lipídico, glicemia y PCR ultrasensible (Dade Behring) en muestra de sangre en ayunas. En todos se realizó además estudio de función endotelial por dilatación mediada por flujo en arteria braquial (DMF) y del grosor íntima-media carotídeo (IMT). Resultados: Se incluyeron en este análisis 88 niños (51 por ciento hombres), edad 10 +/- 2 (promedio DS) años. La PCRus del grupo fue 0.88 +/- 1.47 mg/L (mediana = 0.38 mg/L). En ambos sexos, la PCRus se correlacionó en forma directa a índice de masa corporal (IMC, expresado en puntaje z), a estimación clínica de grasa corporal: masa grasa total (MGT), grasa troncal, perímetro de cintura (PC) y a colesterol LDL (p<0.04). Los niños en el tercil superior de PCR presentaron mayor: zIMC, MGT, PC y LDL que los niños en los terciles inferiores (ver tabla). Los factores de riesgo para determinar una PCR elevada, en forma aislada, fueron: zIMC (OR=2.25 {1.25-4.04}), MGT (OR=1.09 {1.03-1.15}) y PC (OR=1.06 {1.01-1.11}). No se demostró asociación entre PCRus y DMF o IMT. Conclusión: La PCRus se asocia en forma directa a índices de adiposidad y a colesterol LDL en niños...

Background: Ultrasensitive C-reactive protein (USCRP) is an emergent cardiovascular risk factor (RF). In adults, USCRP is associated to most metabolic RF, to diabetes and future cardiovascular events. Since atherosclerosis may develop in childhood, the relation of USCRP to classic RF in children deserves attention. Aim: To correlate USCRP levels with adiposity, traditional RF and subclinical atherosclerosis in children from Santiago Methods: Children from healthy parents living in urban areas of Santiago were prospectively studied. A survey of traditional RF, anthropometric measurements, pubertal maturation, serum lipid profile, serum blood sugar level and USCRP (Dade Behring) were determined in all children in a fasting sample. Endothelial function was assessed by flow mediated vasodilation of the brachial artery (FMD) and intimal media thickness (IMT) Results: 88 children (51 percent males) aged 10 +/-2 years were studied. Mean USCRP was 0.88 mg/L(SD 1.47, median 0.38). In both gender groups USCRP was directly correlated to body mass index (BMI, z score), total body fat (TBF) , central adiposity measured by skin folds, waist circumference (WC) and LDL cholesterol (p<0.04). Children at top tercile USCRP level exhibited greater BMI, total body fat, central adiposity, WC and LDL level as compared to those in the lower USCRP tercile (Table). Independent predictors of high CRP levels were BMI (OR 2.55, 95 percent CI1.25-4.04), MGT (OR 1.09 (1.03-1.15)) and WC (OR 1.06 (1.01-1.11)). There was no association between USPCR and FMV or IMT. Conclusion: USCRP is directly associated to adiposity indices and serum LDL level in children. This study showed no association of USCRP and indices of subclinical atherosclerosis. Follow up of these children will help determine whether subclinical inflammation will predict the appearance of atherosclerosis when they reach adult age.