Increased carotid intima-media thickness and associations with cardiovascular risk factors in obese and overweight children and adolescents.

Objective: Overweight and obesity in children and adolescents contribute to the development of overweight and obesity in adulthood and subsequent cardiovascular disease. It was the aim of the trial to assess vascular status and associations with cardiovascular risk factors.

Methods: Eighty-one overweight or obese children and adolescents (age 13.6 +/- 2.7 years, 62% females) hospitalised for weight reduction were consecutively recruited. In all subjects carotid intima-media thickness (IMT), body-mass index (BMI), body composition, serum lipid and blood glucose concentrations, CRP, TSH, uric acid and blood pressure values were measured.

Results: Mean IMT was 0.48 +/- 0.09 mm. Twenty-nine subjects (36%) had an IMT <0.45 mm, 32 (40%) an IMT > or =0.450.50 mm. Comparing children with low carotid IMT (<0.45 mm, n = 29 (36%)) with those with higher values (> or =0.45 mm, n = 52 (64%)), there were significant differences: Those with higher IMT had higher weight (73.5 +/- 17.6 vs 91.1 +/- 24.0 kg, p = 0.001), higher BMI (28.6 +/- 4.4 vs 32.7 +/- 5.5 kg/m(2), p = 0.001) and BMI-SDS (2.23 +/- 0.57 vs 2.61 +/- 0,50, p = 0.002), higher fatmass (26.3 +/- 9.5 vs 37.1 +/- 15.2 kg, p = 0.001) and a higher percentage of fat in relation to total body weight (35.2 +/- 5.5 vs 39.5 +/- 7.8 %, p = 0.010), as well as higher systolic (117.7 +/- 6.9 vs 124.6 +/- 10.6 mmHg, p = 0.004) and diastolic blood pressure values (64.4 +/- 5.5 vs 68.6 +/- 6.7 mmHg, p = 0.008), and higher serum uric acid concentrations (385.6 +/- 91.7 vs 439.9 +/- 100.5 micromol/l, p = 0.023). There was a correlation between IMT and height (r = 0.237, p = 0.033), weight (r = 0.442, p<0.001), BMI (r = 0.482, p<0.001), BMI-SDS (r = 0.449, p<0.001), fatmass (r = 0.482, p <0.001), percentage of fat (r = 0.412, p<0.001), TSH (r = 0.238, p = 0.037), uric acid (r = 0.238, p = 0.040) as well as systolic (r = 0.359, p = 0.001) and diastolic blood pressure values (r = 0.359, p = 0.001) measured spontaneously and systolic blood pressure values registered during 24 h monitoring (r = 0.344, p = 0.004). Performing multivariate analysis, an association between IMT and BMI was found (R-square = 0.263, beta = 0.525, p<0.001).

Conclusions: In overweight and obese children and adolescents there is a significant association between carotid IMT and weight, BMI, BMI-SDS, blood pressure, as well as various other metabolic parameters. Based on these and other epidemiological data, demonstrating the continuing and significant increase in incidence of overweight and obesity in childhood and adolescence, comprehensive strategies for the long-term prevention and the treatment of risk factors should be emphasized with an early start in childhood.