Pediatric Obesity – ABC CARDIOL

IJCS

Letter to the Editor

Comments on "Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Areas in the Backlands of Bahia – A Cross-Sectional Study"

Dear Editor,

I recently came across the article titled “Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Areas in the Backlands of Bahia – A Cross-Sectional Study,” and I felt compelled to write in. First and foremost, I want to commend the authors for tackling a subject that’s growing more urgent with each passing year. Childhood obesity and elevated blood pressure are emerging earlier and becoming more frequent across the globe, and this study makes a meaningful contribution by examining the problem in a region that’s often overlooked.

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IJCS

Original Article

Childhood Obesity and Systemic Arterial Hypertension in Children and Adolescents: A Cross-Sectional Study

Rafaella Farias da Franca Almeida et al. Lívia Menezes Escorel Letícia Odete Guedes de Andrade Carvalho Camila Batista Gaudêncio … Lara Ataide Diniz Marcela Leite Marina Romero Costa Alice Barbosa Maia Berenice Lempek dos Santos Michelle Barros de Aguiar Patrícia Vidal de Negreiros Nóbrega Eugênia Moreira Fernandes Montenegro Débora Alencar de Menezes Athayde Jessica Laureano Martins

Abstract

Background:

The increase in obesity cases and the lack of screening and diagnosis of childhood hypertension highlight the need to examine these comorbidities in children.

Objectives:

To investigate the relationships between systemic arterial hypertension (SAH) and childhood obesity (CO) in pediatrics and correlate the obesity level, abdominal circumference (AC), family history, and physical activity (PA) variables.

Methods:

This cross-sectional study assessed age, sex, height, weight, body mass index (BMI), AC, family history, PA, CO, and blood pressure (BP) percentiles. The Chi-square test, Fisher’s Exact test, and Spearman’s correlation were used for data analysis, with a statistical significance level of 5%.

Results:

After applying the inclusion and exclusion criteria, 30 patients aged between 3 and 18 years (incomplete) were evaluated at three different moments. The results showed that 83.3% (n = 25) of the patients were obese and 16.70% (n = 5) had severe obesity. Among them, 20% (n = 6) were diagnosed with SAH. Data showed an independence between CO and SAH (p = 0.702) and between SAH and PA time (p = 0.748). No correlations were observed between SAH and AC (p = 0.313). The history of SAH in first-degree relatives was significantly associated with the diagnosis of SAH (p = 0.004).

Conclusion:

This study showed no correlation between CO and SAH in the evaluated sample, supporting the need for further research in the area.

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ABC

Editorial

Waist Circumference: A Simple Measure for Childhood Obesity?

Luciana Nicolau Aranha et al. Gláucia Maria Moraes de Oliveira

Childhood obesity has been increasing all over the world and considered one of the major challenges in public health. The prevalence increased from less than 1% in 1975 to 5.6% and 7.8% among girls and boys, respectively, in 2016. No less worrying are the recent data from the Brazilian Institute of Geography and Statistics (IBGE) showing that in 2008-2009, 51.4% of boys and 43.8% of girls aged between 5 and 9 years were overweight or obese.

Obese children and adolescents are five times more likely to become obese adults. Besides, childhood obesity has been associated with hypertension, insulin resistance, diabetes mellitus, dyslipidemia, and increased morbidity and mortality in adult life. Therefore, it is important to screen for excess body fat in this population and create strategies to prevent the development of chronic diseases in the future.

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ABC

Letter to the Editor

Childhood Obesity, MMP-9 Levels, and Vitamin D

Zeynep Cerit

Dear Editor,

I have read the article entitled “MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese” by Andrade et al., recently published in journal, with great interest. The investigators reported that obese children and adolescents present higher mean intima-media thickness (IMT), plasma matrix metalloproteinase (MMP)-9 and MMP-9/tissue inhibitor of metalloproteinase-1 ratio compared to the non-obese. Thus, these findings indicate that this group presents a risk profile for early atherosclerosis.

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ABC

Original Article

Playful Interventions Increase Knowledge about Healthy Habits and Cardiovascular Risk Factors in Children: The CARDIOKIDS Randomized Study

Fátima H. Cecchetto et al. Daniela B. Pena Lucia C. Pellanda

Abstract

Background:

Childhood obesity is an important health problem worldwide. In this context, there is a need for the development and evaluation of innovative educational interventions targeting prevention and formation of health habits.

Objectives:

To ascertain the impact of ludic workshops on children’s knowledge, self-care, and body weight.

Methods:

This was a randomized, clinical study with 79 students aged 7-11 years, conducted from March to November 2012. Anthropometric measurements were collected and two questionnaires (Typical Day of Physical Activities and Food Intake, in Portuguese, and the CARDIOKIDS, a questionnaire of knowledge about cardiovascular risk factors) were applied at baseline, at the end of intervention, and three months thereafter. The intervention consisted of eight playful workshops, which involved the presentation of a play.

Results:

Seventy-nine students were randomized to the intervention (n = 40) or the control group (n = 39). Mean age was 10.0 ± 1.1 years. After eight weeks, the intervention group showed significant improvement in the knowledge score (p < 0.001). There was an increase in physical activity scores in both groups, but with no difference between the groups at the end of intervention (p = 0.209). A reduction in the BMI percentile was observed in the intervention group, but there was no significant statistical difference between the two groups after the intervention.

Conclusions:

Playful interventions may improve knowledge and physical activity levels in children and, when combined with other strategies, may be beneficial to prevent child obesity and improve self-care.

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ABC

Original Article

MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese

Claudio Andrade et al. Adriana Bosco Valeria Sandrim Francisco Silva

Abstract

Background:

Childhood obesity is associated with increased risk of atherosclerosis and cardiovascular disease in adulthood. Increased intima-media thickness (IMT) of the carotid artery is linked to the initiation and progression of the chronic inflammatory processes implicated in cardiovascular disease. Matrix metalloproteinase-9 (MMP-9) plays an important role in the degradation of the extracellular matrix and, consequently, in the development, morphogenesis, repair and remodeling of connective tissues.

Objectives:

(i) to determine and compare the concentrations of MMP-9, tissue inhibitor of metalloproteinase -1 (TIMP-1), and MMP-9/TIMP-1 ratio in obese and non-obese children and adolescents; (ii) to investigate the association of these markers with common and internal IMT of carotid arteries.

Methods:

Cross-sectional study involving 32 obese and 32 non-obese (control) individuals between 8 – 18 years of age.

Results:

Significantly (p < 0.05) higher values of MMP-9 concentration, as well as a higher MMP-9/TIMP-1 ratio were detected in the obese group compared to control counterparts. Common and internal carotid IMT values were significantly higher (p < 0.001) in the obese group compared to the control group. Positive correlations were observed between the common carotid IMT values and MMP-9 concentrations as well as MMP-9/TIMP-1 ratio.

Conclusions:

Our data demonstrate that obese children and adolescents present higher mean IMT values, plasma MMP-9 and MMP-9/TIMP-1 ratio compared to the non-obese. Thus, these findings indicate that this group presents a risk profile for early atherosclerosis.

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ABC

Original Article

Insulin Resistance, Dyslipidemia and Cardiovascular Changes in a Group of Obese Children

António Pires et al. Paula Martins Ana Margarida Pereira Patricia Vaz Silva … Joana Marinho Margarida Marques Eduardo Castela Cristina Sena Raquel Seiça

Introduction:

Obesity-related comorbidities are present in young obese children, providing a platform for early adult cardiovascular disorders.

Objectives:

To compare and correlate markers of adiposity to metabolic disturbances, vascular and cardiac morphology in a European pediatric obese cohort.

Methods:

We carried out an observational and transversal analysis in a cohort consisting of 121 obese children of both sexes, between the ages of 6 and 17 years. The control group consisted of 40 children with normal body mass index within the same age range. Markers of adiposity, plasma lipids and lipoproteins, homeostasis model assessment-insulin resistance, common carotid artery intima-media thickness and left ventricular diameters were analyzed.

Results:

There were statistically significant differences between the control and obese groups for the variables analyzed, all higher in the obese group, except for age, high-density lipoprotein cholesterol and adiponectin, higher in the control group. In the obese group, body mass index was directly correlated to left ventricular mass (r=0.542; p=0.001), the homeostasis model assessment-insulin resistance (r=0.378; p=<0.001) and mean common carotid artery intima-media thickness (r=0.378; p=<0.001). In that same group, insulin resistance was present in 38.1%, 12.5% had a combined dyslipidemic pattern, and eccentric hypertrophy was the most common left ventricular geometric pattern.

Conclusions:

These results suggest that these markers may be used in clinical practice to stratify cardiovascular risk, as well as to assess the impact of weight control programs.

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ABC

Original Article

Elevated Blood Pressure and Obesity in Childhood: A Cross-Sectional Evaluation of 4,609 Schoolchildren

Caroline Filla Rosaneli et al. Cristina Pellegrio Baena Flavia Auler Alika Terumi Arasaki Nakashima … Edna Regina Netto-Oliveira Amauri Bássoli Oliveira Luiz César Guarita-Souza Marcia Olandoski José Rocha Faria-Neto

Background:

The incidence of obesity in children is increasing worldwide, primarily in urbanized, high-income countries, and hypertension development is a detrimental effect of this phenomenon.

Objective:

In this cross-sectional study, we evaluated the prevalence of excess weight and its association with high blood pressure (BP) in schoolchildren.

Methods:

Here 4,609 male and female children, aged 6 to 11 years, from 24 public and private schools in Maringa, Brazil, were evaluated. Nutritional status was assessed by body mass index (BMI) according to cutoff points adjusted for sex and age. Blood pressure (BP) levels above 90th percentile for gender, age and height percentile were considered elevated.

Results:

The prevalence of excess weight among the schoolchildren was 24.5%; 16.9% were overweight, and 7.6% were obese. Sex and socioeconomic characteristics were not associated with elevated BP. In all age groups, systolic and diastolic BP correlated with BMI and waist and hip measurements, but not with waist-hip ratio. The prevalence of elevated BP was 11.2% in eutrophic children, 20.6% in overweight children [odds ratio (OR), 1.99; 95% confidence interval (CI), 1.61-2.45], and 39.7% in obese children (OR, 5.4; 95% CI, 4.23-6.89).

Conclusion:

Obese and overweight children had a higher prevalence of elevated BP than normal-weight children. Our data confirm that the growing worldwide epidemic of excess weight and elevated BP in schoolchildren may also be ongoing in Brazil.

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