Espesor de tejido adiposo epicárdico en escolares y adolescentes con obesidad, sobrepeso, y normopeso / Epicardial adipose tissue thickness in children and adolescents with obesity, overweight, and normal weight

Objetivo: Determinar la relación del espesor del tejido adiposo epicárdico (TAE) con el estado nutricional (obesidad, sobrepeso y normopeso) en escolares y adolescentes. Métodos: Estudio observacional, analítico y transversal. Participaron 53 escolares y adolescentes de 6 a 18 años, distribuidos de acuerdo al índice de masa corporal (IMC) en normopeso, sobrepeso y obesidad. Se tomaron medidas antropométricas y de tensión arterial (TA). Se midió el espesor del TAE por ecocardiografía bidimensional. Resultados: Hubo 21 (39,6%) participantes con normopeso, 13 (24,5%) con sobrepeso y 19 (35,9%) con obesidad. El espesor del TAE fue significativamente mayor en el grupo de obesos (3,24±0,46 mm) en comparación con sobrepeso (2,79±0,37 mm; p<0,003) y normopeso (2,20±0,34 mm; p<0,0001), y en el grupo de sobrepeso al compararlo con normopeso (p=0,0001). El espesor del TAE no fue diferente según edad y sexo. Se observó una correlación positiva estadísticamente significativa del espesor del TAE con el IMC (r=0,766; p=0,0001), la circunferencia de cintura (r=0,684; p=0,0001) y la TA sistólica (r=0,376; p=0,005). El análisis de regresión lineal múltiple mostró que el IMC (p=0,0001) fue la variable que más influyó sobre el espesor del TAE. Conclusión: El espesor del TAE aumenta con la adiposidad desde la edad escolar y la adolescencia, y podría ser una herramienta para evaluar riesgo cardiovascular.

Objective: To determine the ratio of the thickness of epicardial adipose tissue (EAT) with nutritional status (obesity, overweight and normal weight) in children and adolescents. Methods: Observational, analytical and cross-sectional study. Fifty-three children and adolescents from 6 to 18 years old were included, distributed according to body mass index (BMI) in obese, overweight and normal weight. Anthropometric measures and blood pressure (BP) were taken. TAE thickness was measured by two-dimensional echocardiography. Results: Twenty-one participants (39.6%) had normal weight, 13 (24.5%) overweight and 19 (35.9%) obesity. The thickness of EAT was significantly higher in the obese group (3.24±0.46 mm) compared to overweight (2.79±0.37 mm, p<0.003) and normal weight (2.20±0.34 mm; p<0.0001), and in the overweight group as compared with normal weight (p=0.0001). TAE thickness was no different by age and gender. A positive statistically significant correlation of thickness of EAT with BMI (r=0.766; p=0.0001), waist circumference (r=0.684; p=0.0001) and systolic BP (r=0.376; p=0.005) was observed. The multiple linear regression analysis showed that BMI (p=0.0001) was the variable that most influenced the thickness of EAT. Conclusion: The thickness of EAT increases with adiposity from school age and adolescence and could be a tool to assess cardiovascular risk.

Reference values of waist circumference and waist/hip ratio in children and adolescents of Mérida, Venezuela: comparison with international references.

OBJECTIVE: To collect regional reference values of waist circumference (WC), and waist/hip ratio (WHR) in children and adolescents from Merida, Venezuela, and to compare them to international references. SUBJECTS AND METHODS: A total of 919 students aged 9-17 years from public and private educational establishments were assessed. Weight, height, WC, and WHR were measured. Outliers (± 3 SD Z-Score) were excluded from the data collected. Percentile distribution of the tested variables was done by age and sex. RESULTS: Fifty-one percent of subjects were female, and 52.7% were from public institutions. WC (p=0.001) and WHR (p=0.0001) were statistically higher in boys. With advancing age, WC increased in both sexes, while WHR showed the opposite behavior (p=0.0001 for both). The 90th percentile (pc) for WC ranged from 69.7 and 83.6 cm in girls and from 69.2 and 86.7 cm in boys. The 90th pc values of WHR ranged from 0.79 and 0.91 in girls and from 0.86 and 0.93 in boys. Overall, our WC and WHR values were lower than North American values and similar to those of some Latin American references. CONCLUSION: Percentile reference charts for WC and WHR specific for age and sex, obtained from a representative sample of children and adolescents from Mérida, Venezuela, are provided. They may be used regionally, both for individual assessment and to implement prevention policies.

Limited Weight Loss or Simply No Weight Gain following Lifestyle-Only Intervention Tends to Redistribute Body Fat, to Decrease Lipid Concentrations, and to Improve Parameters of Insulin Sensitivity in Obese Children.

Objectives. To investigate whether lifestyle-only intervention in obese children who maintain or lose a modest amount of weight redistributes parameters of body composition and reverses metabolic abnormalities. Study Design. Clinical, anthropometric, and metabolic parameters were assessed in 111 overweight or obese children (CA of 11.3 ± 2.8 years; 63 females and 48 males), during 8 months of lifestyle intervention. Patients maintained or lost weight (1-5%) (group A; n: 72) or gained weight (group B). Results. Group A patients presented with a decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P < .005 and P < .05, resp.), BMI (P < .0001), z-score BMI (P < .0001), waist circumference (P < .0001), fat mass (P < .005), LDL-C (P < .05), Tg/HDL-C ratio (P < .05), fasting and postprandial insulin (P < .005), and HOMA (P < .005), while HDL-C (P < .05) and QUICKI increased (P < .005). Conversely, group B patients had an increase in BMI (P < .0001), waist circumference (P < .005), SBP (P < .005), and in QUICKI (P < .005), while fat mass (P < .05), fasting insulin (P < .05), and HOMA (P < .05) decreased. Lean mass, DBP, lipid concentrations, fasting and postprandial glucose, postprandial insulin, and ultrasensitive C-reactive protein (CRP) remained stable. Conclusions. Obese children who maintain or lose a modest amount of weight following lifestyle-only intervention tend to redistribute their body fat, decrease blood pressure and lipid levels, and to improve parameters of insulin sensitivity.

[Obesity in schoolchildren from Merida, Venezuela: association with cardiovascular risk factors]. / Obesidad en escolares de Mérida, Venezuela: asociación con factores de riesgo cardiovascular.

OBJECTIVE: To investigate the prevalence of obesity and associated cardiovascular risk factors in schoolchildren in our city, given the influence of these factors on the development of atherosclerosis. METHODS: We studied a representative sample of second grade students composed of 370 children aged 7.82+/-0.62 years (47.8% girls and 52.2% boys); 52.4% were from public schools and 47.6% were from private schools. Surveys were performed and anthropometric measurements, blood pressure (BP) values and glucose and lipid profiles in capillary blood were determined. RESULTS: A total of 9.7% (36 schoolchildren) were obese and 13.8% were overweight. There were no differences according to sex or school system. Abdominal obesity was observed in 69.4% (p<0.0001), normal-high BP (90-97th percentile) in 27.8% (p<0.0001), dyslipidemia in 66.7% (p<0.05) and metabolic syndrome in 38.9% (p<0.0001) of the obese children compared with 1.3%, 5.1%, 48.9% and 0.4% of the children with normal weight, respectively. No association was found between fasting hyperglycemia and obesity. There were no cases of hypertension or diabetes mellitus. The risk (odds ratio) for normal-high BP, dyslipidemia, abdominal obesity and metabolic syndrome was 6.3, 2.2, 60.9, and 70.2 times higher in obese children than in non-obese children, respectively. A positive and significant correlation was found between waist circumference and body mass index with BP and the atherogenic indexes triglycerides/high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C and low-density lipoprotein cholesterol/HDL-C (p=0.0001). CONCLUSIONS: Compared with cities in other countries, the city of Mérida, Venezuela, has an intermediate prevalence of overweight and obesity in schoolchildren. The high frequency of cardiovascular risk factors in the obese and its positive correlation with adiposity highlights the need to implement population-based strategies for its prevention in childhood.

The triglyceride/HDL-cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors.

OBJECTIVES: To determine the presence of traditional and emergent cardiovascular risk factors and to evaluate the triglyceride/high-density lipoprotein cholesterol (Tg/HDL-C) ratio as a marker for cardiovascular disease and metabolic syndrome (MS) in obese children. MATERIAL AND METHODS: Sixty-seven prepubertal children of both sexes, between the ages of 6 and 12 yr, 20 normal-weight children, 18 overweight, and 29 obese subjects, were studied. Anthropometric measures, blood pressure, body mass index (BMI), and fat mass (FM), were measured. Plasma glucose, serum insulin, lipid profile, C-reactive protein (CRP), and leptin concentrations were quantified. Glucose and insulin concentrations 2 h post-glucose load were determined. The Tg/HDL-C ratio, homeostasis model assessment index (HOMA), and quantitative insulin sensitivity check index (QUICKI) were calculated. RESULTS: Systolic, diastolic, and mean blood pressures (MBP), low-density lipoprotein cholesterol (LDL-C), Tg/HDL-C, total cholesterol/HDL-C, LDL-C/HDL-C ratios, basal and 2 h postload insulin, CRP, and leptin were significantly higher and the QUICKI index were lower in the obese group. MBP, Tg/HDL-C ratio, HOMA, CRP, and leptin levels showed a positive and significant correlation and QUICKI a negative correlation with abdominal circumference, BMI, and FM. The Tg/HDL-C ratio correlated positively with MBP. The frequency of MS in the obese group was 69%. While Tg/HDL-C ratio, CRP, and leptin were higher and the values of QUICKI were lower in subjects with MS, it was the Tg/HDL-C ratio and the BMI that significantly explained the MS. CONCLUSIONS: Obesity increases the cardiovascular risk in childhood. The Tg/HDL-C ratio could be a useful index in identifying children at risk for dyslipidemia, hypertension, and MS.