Arun S. Kinare

Carotid arterial stiffness in overweight and obese Indian children

Abstract Objective: The aim of the study was to evaluate carotid arterial stiffness and intima media thickness (IMT) in obese children in comparison with healthy children, and to examine associations of lipid profile and blood pressure with carotid artery morphology. Methods: Anthropometric and blood parameters were assessed in 44 overweight, 95 obese (6–17 years) and 69 healthy age-matched normal children. Percent body fat was measured by dual-energy X-ray absorptiometry and stiffness and IMT of the common carotid artery were evaluated using Aloka α 10 equipment. Results: Anthropometric and lipid parameters were significantly higher in overweight and obese than in normal children (p<0.05). Stiffness (β), pulse wave velocity (PWV), elastic modulus (Ep) and blood pressure were significantly higher in obese and overweight children than in normal children (p<0.05). However, overweight and obese children did not show any significant difference in IMT compared with normal children (p>0.1). Significant positive correlation of PWV, β and Ep and negative correlation of arterial compliance with body fat and triglyceride was noted (p<0.05). Different multinomial regression models for each e-Tracking parameter indicated that the relative risk of hypertension was highest with high PWV, followed by LDL cholesterol, Ep and body fat. Conclusion: PWV may be considered an important marker for evaluation of early functional changes of the carotid artery in children and adolescents.

Maternal and paternal height and BMI and patterns of fetal growth: The Pune Maternal Nutrition Study

We examined the differential associations of each parents height and BMI with fetal growth, and examined the pattern of the associations through gestation. Data are from 557 term pregnancies in the Pune Maternal Nutrition Study. Size and conditional growth outcomes from 17 to 29 weeks to birth were derived from ultrasound and birth measures of head circumference, abdominal circumference, femur length and placental volume (at 17 weeks only). Parental height was positively associated with fetal head circumference and femur length. The associations with paternal height were detectible earlier in gestation (17–29 weeks) compared to the associations with maternal height. Fetuses of mothers with a higher BMI had a smaller mean head circumference at 17 weeks, but caught up to have larger head circumference at birth. Maternal but not paternal BMI, and paternal but not maternal height, were positively associated with placental volume. The opposing associations of placenta and fetal head growth with maternal BMI at 17 weeks could indicate prioritisation of early placental development, possibly as a strategy to facilitate growth in late gestation. This study has highlighted how the pattern of parental–fetal associations varies over gestation. Further follow-up will determine whether and how these variations in fetal/placental development relate to health in later life.

Arterial stiffness in obese children: Role of adiposity and physical activity

Objective: To explore association of adiposity and physical activity with arterial stiffness and to propose optimal waist circumference cutoffs, corresponding to 90th percentile of NHANES (National Health and Nutrition Examination Survey) for Indian children and adolescents. Materials and Methods: Data on weight, height, waist circumference, physical activity and right Carotid artery Intima-Media-Thickness (CIMT), pulse wave velocity (PWV), elasticity modulus (Ep), stiffness index(β), arterial compliance (AC) were assessed in 250 children (72 normal-weight and 178 overweight/obese) aged 6-17 years from Pune city, India. Body composition was measured using Dual energy X-ray absorptiometry. Results: Total, 37.1% normal-weight and 98.2% overweight/obese children had high adiposity (>95th body fat percentile). Positive association of PWV and Ep (r = 0.5) also β(r = 0.25) with BMI (Body Mass Index), waist circumference and body fat (P < 0.05) was observed. Physical activity was inversely associated with PWV (r =-0.2), β(r =-0.13), Ep (r =-0.12) and positively with AC (r = 0.12) (P < 0.05). PWV significantly increased with increasing body fat for each tertile of physical activity (P < 0.05). Regression analysis revealed waist circumference, BMI, body fat and physical activity as independent associates for PWV after adjusting for age (P < 0.05). The cutoff of waist circumference yielding sensitivity and specificity for predicting the risk of high PWV was (−0.43, −0.44) for boys and girls with sensitivity in boys (girls) of 78% (87%) and specificity in boys (girls) 51% (70%). The observed cutoffs are less than the NHANES-III cutoff values of waist circumference for 90th percentiles according to age and sex. Conclusion: High adiposity and low physical activity are adversely related to arterial stiffness in Indian children.

Diet and exercise intervention, with special reference to micronutrients, reduces cardiometabolic risk in overweight children

Objective: To study the effect of lifestyle intervention in the presence of multivitamin-zinc supplementation in improving the cardiometabolic status of overweight children. Materials and Methods: Data were evaluated in 74 overweight children (11.3 ± 2.9 years) randomly assigned to three groups of intervention for 4 months as follows: group A: diet-exercise counseling with multivitamin-zinc supplementation; group B: diet-exercise counseling; and group C: placebo. Anthropometric, biochemical, carotid arterial and lifestyle parameters were assessed. Results: Lifestyle counseling resulted in significant reduction in inactivity, energy and fat intakes and increase in micronutrient density of diets and physical activity in groups A and B in comparison to group C. Percent decline in body fat was more in group A than in groups B and C. Percent change in triglycerides (–13.7%) was significantly higher in group A than in groups B (–5.9%) and C (5.7%). Pulse wave velocity and elasticity modulus reduced and arterial compliance improved significantly in group A than in group B. Conclusion: Multivitamin-zinc supplementation with lifestyle intervention has a positive effect of on the cardiometabolic status of overweight children.

Hypercholesterolemia with Carotid Plaque Formation in a Four Year-old Indian Boy

A four year-old male child, first product of a non-consanguineous marriage, presented with a single complaint of a lump on the right buttock for the last two months and no other significant history. There was no relevant past or family history. On examination, the childs height was 100 cm (z-score -0.11, target height 164 cm), weight 14.6 kg (z-score -0.2) and BMI 14.6 (zscore -0.19). Thus, this child had normal anthropometric characteristics when compared with an ethnically ageand sex-matched population. The child was of normal appearance, and general and systemic examinations were normal. Cutaneous examination revealed an asymptomatic well circumscribed, painless raised swelling on the left buttock, with multiple small plaques, yellowish brown in colour and about 5.5 χ 3 cm in size (Fig. 1). There was a second small swelling on the left buttock about 1 χ 1 cm with similar characFig. 2