Francisco Aguilar

Added Impact of Obesity and Insulin Resistance in Nocturnal Blood Pressure Elevation in Children and Adolescents

The aim of the present study was to analyze the relationship between insulin resistance and the ambulatory blood pressure components in obese children and adolescents. Eighty-seven overweight and obese white children and adolescents of both sexes, of European origin from 6 to 18 years of age (mean age: 10.9±2.7 years), were selected. Obesity was defined on the basis of a threshold body mass index z score >2 (Coles least mean square method) and overweight with a body mass index from the 85th to 97th percentile. A validated oscillometric method was used to measure ambulatory BP (Spacelabs 90207) during 24 hours. Fasting glucose and insulin were measured, and the homeostasis model assessment index was calculated. Subjects were grouped into tertiles of homeostasis model assessment index. No significant differences in terms of age, sex, and body mass index z score distribution were observed among groups. When adjusted by age, sex, and height, nocturnal systolic blood pressure and heart rate were significantly higher in subjects in the highest homeostasis model assessment index tertile (>4.7) as compared with those of the other groups, whereas no differences were observed for awake systolic blood pressure or heart rate. Whereas body mass index z score was more closely related with blood pressure and heart rate values, waist circumference was strongly related with insulin resistance. Moreover, both waist circumference and insulin resistance were mainly associated with higher nocturnal but not with awake blood pressure. The early increment of nocturnal blood pressure and heart rate associated with hyperinsulinemia may be a harbinger of hypertension-related insulin resistance and may contribute to heightened cardiovascular risk associated with this condition.

Influence of Concurrent Obesity and Low Birth Weight on Blood Pressure Phenotype in Youth

The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those subjects with low birth weight who became obese. The lowest BP values were present in nonobese subjects in the absence of low birth weight. In the middle, with similar BP values, were nonobese subjects with low birth weight and obese subjects in the absence of low birth weight. No interaction existed between obesity and low birth weight in the office (P=0.165) or ambulatory (P=0.603) systolic BP values. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in the nonobese low birth weight group when compared with the other groups after controlling for height, heart rate, and diastolic BP. A significant interaction between low birth weight and obesity (P<0.005) existed. In conclusion, although the low birth weight children who become obese have the highest systolic BP values, the presence of obesity blunts the increment of the reflecting wave observed in low birth weight subjects.

The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth.

Objectives Obesity is an increasingly frequent problem among children and adolescents, and may lead to blood pressure (BP) increase. The aim of the present study was to assess the prevalence of hypertension, white-coat and masked hypertension in obese adolescents making systematic use of both office BP and 24-h ambulatory BP measurement. The impact of different degrees of obesity on BP and heart rate variability was also investigated. Methods Office and ambulatory BP were obtained in 285 overweight and obese Caucasian adolescents (11–18 years old) and in 180 age- and sex-matched controls. The extent of obesity was quantified using body mass index z score. Results A significant positive relationship between body mass index z score and both office and ambulatory systolic BP was found after adjusting for age and height in both boys and girls. Obese youths had not only higher BP levels, but also higher BP variability compared with controls. Among obese youths, 20.8% had abnormal BP conditions, 6.6% were white-coat hypertensives, 9.2% were masked hypertensives and 5% were sustained hypertensives. Conclusions The prevalence of these abnormal BP conditions, which can be identified thanks to ambulatory BP monitoring, further emphasizes the usefulness of this diagnostic tool in obese youths.

First-year blood pressure increase steepest in low birthweight newborns

Aim The present research has been undertaken prospectively to study the impact of birthweight and growth pattern on blood pressure changes from birth through the first year of life. Methods Parents of newborns born at term (gestational age > 37 weeks) after uncomplicated pregnancies and in the absence of perinatal illness were randomly invited to allow their children to participate in the study. One hundred and forty-nine (84 male and 65 female) newborns were included in the present analysis. The newborns were divided into four groups according to birthweight: < 2500 g (n = 23); 2500–2999 g (n = 39); 3000–3500 g (n = 48); and > 3500 g (n = 39). Results At birth systolic and diastolic blood pressure were significantly lower and heart rate was significantly higher in those children with the lowest birthweight as compared to those in the other groups. During the first month of life a significant trend, inversely related to birthweight, was present for systolic as well as diastolic blood pressure. After the first month of life, at 3, 6, 9 and at 12 months, systolic and diastolic blood pressure were similar across birthweight groups. In a multiple regression analysis, birthweight was a positive independent determinant of systolic blood pressure at birth and an inverse independent determinant of the increment of systolic blood pressure during the first month of life and of the systolic blood pressure at the end of the first year. Conclusions In summary, the present study goes further towards understanding blood pressure changes in low birthweight babies. Beginning at birth, both blood pressure values, as well as changes in blood pressure, provide information about the impact of intrauterine life on the risk of developing hypertension later in life.

Associations of birth weight and postnatal weight gain with cardiometabolic risk parameters at 5 years of age.

The present prospective study assessed the impact of birth weight (BW) and postnatal weight gain on blood pressure and metabolic profile during the first 5 years of life. One hundred thirty-nine newborns (63 women) born at term after uncomplicated pregnancies and in the absence of perinatal illness were included. Subjects were divided according to size at birth in small, appropriate, and large for gestational age. After the initial evaluation on the second day of life, infants were followed up at 6 months and 2 and 5 years. Anthropometric parameters and blood pressure were measured at each visit and metabolic assessment was performed at 5 years of age. Among the BW groups, mothers did not differ in terms of age, smoking, and weight gain during pregnancy. BW was a positive determinant of systolic blood pressure at birth. Afterward, current weight was the strongest determinant, becoming significant at 2 years of age and progressively increasing in influence. At 5 years insulin, the homeostasis model assessment index and triglycerides were dependent on BW, current weight, and postnatal weight gain. In addition, BW was positively associated with high-density lipoprotein-cholesterol and inversely so to uric acid. A positive relationship among insulin, blood pressure values, and uric acid was observed even early in life. In conclusion, the acceleration of early infant weight gain may aggravate the effects of low BW. Multiple interactions between hemodynamic and metabolic parameters foreshadow the clustering of cardiometabolic risk factors later in life.

Exercise intervention in childhood obesity: a randomized controlled trial comparing hospital-versus home-based groups

OBJECTIVE The aim of this study was to compare the effect of a hospital clinic group- versus home-based combined exercise-diet program for the treatment of childhood obesity. METHODS One hundred ten overweight/obese Spanish children and adolescents (6-16 years) in 2 intervention groups (hospital clinic group-based [n = 45] and home-based [n = 41]) and a sex-age-matched control group (n = 24) were randomly assigned to participate in a 6-month combined exercise (aerobic and resistance training) and Mediterranean diet program. Anthropometric values (including body weight, height, body mass index, BMI-Z score, and waist circumference) were measured pre- and postintervention for all the participants. Percentage body fat was also determined with a body fat analyzer (TANITA TBF-410 M). RESULTS Our study showed a significant reduction in percentage body fat and body mass index Z-score among both intervention-group participants (4%, 0.16, hospital clinic group-based; 4.4%, 0.23, home-based; P < .0001). There was also a significant reduction in waist circumference in the home-based group (4.4 cm; P = .019). Attendance rates at intervention sessions were equivalent for both intervention groups (P = .805). CONCLUSIONS The study findings indicate that a simple home-based combined exercise and Mediterranean diet program may be effective among overweight and obese children and adolescents, because it improves body composition, is feasible and can be adopted on a large scale without substantial expenses.

Prevalence and factors related to urinary albumin excretion in obese youths.

Objectives: The aim of the present study is to assess whether obesity is associated with urinary albumin excretion and what the main determinants are. Methods: One hundred and thirty-four obese white children and adolescents of both sexes, ranging from 9 to 18 years of age (mean age 12.6 ± 2.0), were included in the study. Obesity was defined on the basis of a threshold BMI z-score of more than 2 (Coles LMS method) and overweight with a BMI from the 85th to 95th percentile. Office blood pressure was measured using a mercury sphygmomanometer. Urinary albumin excretion was measured in the first voiding urine of the morning and expressed in albumin/creatinine ratio in mg/g. Reproducibility of the urinary albumin excretion was studied by the Bland and Altman technique in a subgroup. Triglycerides, uric acid, fasting glucose and insulin were measured and the homeostatic model assessment (HOMA) index was calculated. Results: The prevalence of microalbuminuria was 2.4%. No differences in the prevalence of microalbuminuria were observed when the different groups of obesity degree were compared (0, 2.2 and 0% in overweight, moderate and severe obese, respectively). A significant relationship emerged between the Log urinary albumin excretion and BMI z-score, waist circumference, Log triglycerides, fasting insulin and HOMA index, adjusted by age and sex. In a multiple regression analysis, the main determinants of Log urinary albumin excretion were sex, waist circumference and Log triglycerides. In 17% of the individuals who fulfil criteria for metabolic syndrome, urinary albumin excretion was significantly higher than those without. Conclusion: The prevalence of elevated urinary albumin excretion is not prominent in obese children, and when it is increased, it depends mainly on metabolic factors.

Determinants of Cardiometabolic Risk Factors in the First Decade of LifeNovelty and Significance: A Longitudinal Study Starting at Birth

The present prospective study assessed the association of birth weight (BW) and growth pattern on cardiometabolic risk factors in a cohort followed from birth to 10 years of age. One hundred and forty-five subjects (73 girls) who fulfilled the inclusion criteria and had all their data recorded at birth and at 5 years were enrolled. Of these, 100 (52 girls) also recorded data at 10 years. Anthropometric measurements, office and 24-hour blood pressure, and metabolic parameters were obtained. At 5 years, both BW and current weight were determinants of blood pressure and metabolic parameters; however, as the subjects got older, the impact of body size increased. Higher BW and maternal obesity increased the risk of becoming obese at 5 years while this was reduced if breastfeeding. Maternal obesity was the only factor associated with becoming obese at 10 years. Twenty-two children at 10 years had insulin values ≥15 U/L, some of whom were persistent from 5 years while in others it increased afterward. Subjects with insulin values ≥15 U/L showed significant higher values of office systolic blood pressure, triglycerides, and uric acid and lower values of high-density lipoprotein than did those with normal insulin values. Highest weight gain from 5 to 10 years and lowest BW were the main determinants of high insulin levels. In conclusion, although BW was a proxy of the events during fetal life and projected its influence later, the influence of gaining weight was a key determinant in the risk to develop obesity and metabolic abnormalities.

URIC ACID IS ASSOCIATED WITH CARDIOMETABOLIC RISK FACTORS IN OVERWEIGHT AND OBESE CHILDREN AND ADOLESCENTS

Objective: This study examined the association of serum uric acid (UA) with levels of cardiometabolic risk factors in overweight and moderate obese children and adolescents. Design and method: Three hundred and thirty three Caucasians of both sexes (149 females), of European origin, from 5 to 18 years of age (mean age 11.4 2.6) were included. Overweight and obesity were defined based on the extended international body mass index cut-offs. The subjects were divided into 3 groups according to serum UA: <5 mg/dl n = 118 subjects (35%); UA 5-6 mg/dl n = 130 subjects (39%) or UA>6 mg/dl n = 85 subjects (26%). Fasting blood was obtained and uric acid, glucose, insulin, and lipid profile, were measured. Likewise office BP and 24-hour ABPM were assessed. Hyperinsulinemia was defined from norms for pubertal stage. Abnormal fasting lipids were defined from normative data (Daniels et al, 2008). Subjects were qualified as normotensive, high-normal or hypertensive according to the ESH criteria (Lurbe et al, 2016). Results: There were significant differences among groups regarding, BMI, waist, fasting insulin, office SBP and night-time SBP increasing progressively across the serum UA groups. Controlling by age and sex, uric acid was significantly correlated with BMI (r = 0.27, p = 0.000), waist (r = 0.33; p = 0.000), birth weight (r = −0.11; p = 0.05), office SBP (r = 0.21; p = 0.000), daytime SBP, (r = 0.16; p = 0.03), nighttime SBP (r = 0.24; p = 0.000), insulin (r = 0.25; p = 0.000), and Log Tryglicerides (r = −0.137; p = 0.019). In a multiple regression analysis sex, waist, birth weight, SBP (office, daytime and nighttime), were independent determinants of uric acid when age, BMI, HDL-C and insulin were included (R2 = 0.29). The prevalence of hyperinsulinemia, low HDL-C, high-normal BP, and hypertension in each UA group are shown in the Figure. Figure. No caption available. Conclusions: In overweight and moderate obese children and adolescents there is a trend toward greater prevalence of cardiometabolic risk factors as the uric acid values rose. The role of hyperuricemia and its association with cardiometabolic risk factors should receive more attention, beginning in early childhood.

DIFFERENCES IN THE PREVALENCE OF BLOOD PRESSURE CONDITIONS USING ESH VS AAP GUIDELINES IN CHILDREN AND ADOLESCENTS

Objective: The objective is to assess differences in the prevalence of blood pressure (BP) conditions according to the European Society of Hypertension (ESH) guidelines (Lurbe, J Hypertens 2016) and the American Academy of Pediatrics (AAP) (Flynn, Pediatrics 2017) in children and adolescents. Design and method: Four thousand two hundred and ninety-six Caucasians of both sexes (1941 females), of European origin, from 5 to 18 years of age (mean age 11.5 3.3) in the absence of antihypertensive treatment were included. Overweight and obesity (n = 2243) were defined based on the extended international body mass index cut-offs. Office BP was measured in the non-dominant arm with cuff and bladder size adjusted to upper-arm girth. The three measurements of each office visit were averaged for analysis. Twenty-four-hour ambulatory BP monitoring was performed by using Spacelabs monitor 90207. Subjects were qualified as true normotensive (N), white-coat (WC), masked (M) or sustained hypertensive (HTN) according to the ESH and AAP criteria for office BP, and reference values for 24-hour ambulatory BP (Wühl, J Hypertens 2002). Results: The prevalence of N, WC, M and HTN were significantly different when the ESH or AAP were applied. Overall, the largest differences were observed in the prevalence of WC, which was double when the AAP criteria were used. The differences were larger for boys, older than 13 years of age. The presence of obesity did not reduce the higher prevalence of WC by the AAP criteria. In contrast, M was slightly higher when the ESH criteria were applied. The impact on the prevalence of WC and M is shown in the figure. Figure. No caption available. Conclusions: When applying the AAP criteria, compared with that of the ESH, the main difference is the higher prevalence of WC, especially in boys aged 13 years or older. The consequence is an increment of the HTN work-up in children and adolescents.