Study of early cardiovascular complications in obese children

ABSTRACT

Obesity is a common and increasing problem all over the world. It has deleterious effects on many organ systems especially on the cardiovascular system. Dyslipidemia is the basic underlying factor for arteriosclerosis. Soluble adhesion molecules are suggested to play a role in early stages of thermogenesis. The aim of this study was to investigate the changes in serum lipids, fasting blood sugar, blood pressure and echocardiographic findings in obese children and to determine which of the currently applied clinical parameters for assessment of childhood obesity best predicts these changes. The study aimed also to investigate whether the soluble adhesion molecules, slCAM-1 and sVCAM-1, are related to the serum lipid profile in obese children. The study was carried out on 36 obese children. Their age ranged from 7 to 13 years [mean = 8.78 +/- 7.58 years]. Twenty-two normal non-obese children were included as a control group. Obesity was defined as BMI above 95" percentile for age and sex. Anthropometric measurements [including weight, height, waist circumference, hip circumference, mid- arm circumference, and triceps skin fold thickness], and blood pressure were measured. Fasting blood sugar and serum lipids [triglycerides, total cholesterol, HDL-C, LDL- C] were determined colorimetric ally, while serum soluble adhesion molecules slCAM-1 and sVCAM-1 were determined by ELlSA technique. Echocardiographic examination was done for each child. The results showed that obese children had significantly higher systolic and diastolic blood pressure [119.4, 79.5 vs. 110.8, 69.6 mm Hg], fasting blood sugar [78.1 vs. 66.9 mg/dL], triglycerides [103.5 vs. 83.6 mg/dL], and total cholesterol [159.9 vs. 136.5 mg/dL], but had significantly lower HDL-C [62.06 vs. 73.75 mg/dL] respectively than control children did. Obese children had significantly increased left ventricular posterior waN thickness [0.92 vs. 0.59 mm], interventricular septum thickness [7.02 vs. 0.59 mm], left ventricular end-diastolic dimension [4.03 vs. 3.78 mm] and ejection fraction [70.6% vs. 68.1%] compared with normal children. BMI was the best obesity parameter that correlated well with most of the cardiovascular risk factors [r ranged from .39 to .76]. Waist and mid-arm circumferences were still good parameters correlating with cardiovascular risk factors. Serum levels of SICAM-1 and sVCAM-1 were correlated with triglycerides levels [P=4.04 and 0.02], while sVCAM-1 levels were negatively correlated with HDL-C [P = 0.006]. So adhesion molecules may play a role in early atherogenesis secondary to dyslipidemia. Preventive and therapeutic measures are highly needed to control childhood obesity and its complications. Additional studies are clearly needed to establish normal values for adhesion molecules in childhood to allow the identification of children who would be mostly benefited by the implementation of preventive and therapeutic programs to decelerate the evolution of atherosclerotic process