Bacha Fida, Edmundowicz Daniel, Sutton-Tyrell Kim, Lee SoJung, Tfayli Hala, Arslanian Silva A
Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
Department of Medicine, Section of Cardiology, Temple University, Philadelphia, PA.
Diabetes Care. 2014 Sep;37(9):2632-9. doi: 10.2337/dc14-0193.
Obesity in adolescence has been associated with increased risk for coronary heart disease in adulthood. This study evaluated subclinical atherosclerosis in obese youth and the underlying risk factors.
Ninety obese adolescents (37 normal glucose tolerant, 27 prediabetes, and 26 type 2 diabetes) underwent evaluation of coronary artery calcifications (CACs) by electron beam computed tomography, aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT), lipids, leptin, inflammatory markers, and body composition (DEXA). A total of 68 underwent evaluation of insulin sensitivity (IS) (hyperinsulinemic-euglycemic clamp) and abdominal adiposity (computed tomography).
A total of 50% had CACs (CAC+: Agatston CAC score ≥1). CAC+ youth had higher BMI, fat mass, and abdominal fat, with no difference in sex, race, IS per fat-free mass (ISFFM), glucose tolerance, PWV, or IMT compared with the CAC- group. PWV was inversely related to IS. In multiple regression analyses with age, race, sex, HbA1c, BMI (or waist circumference), ISFFM, diastolic blood pressure, non-HDL cholesterol, and leptin as independent variables, BMI (or waist) (R(2) = 0.41; P = 0.001) was the significant determinant of CAC; leptin (R(2) = 0.37; P = 0.034) for PWV; and HbA1c, race, and age (R(2) = 0.34; P = 0.02) for IMT.
Early in the course of obesity, there is evidence of CAC independent of glycemia. The different biomarkers of subclinical atherosclerosis appear to be differentially modulated, adiposity being the major determinant of CAC, hyperglycemia, age, and race for IMT, and leptin and IS for arterial stiffness. These findings highlight the increased cardiovascular disease risk in obese youth and the need for early interventions to reverse obesity and atherosclerosis.
青少年肥胖与成年后患冠心病的风险增加有关。本研究评估了肥胖青少年的亚临床动脉粥样硬化及其潜在危险因素。
90名肥胖青少年（37名糖耐量正常、27名糖尿病前期和26名2型糖尿病患者）接受了电子束计算机断层扫描评估冠状动脉钙化（CAC）、主动脉脉搏波速度（PWV）、颈动脉内膜中层厚度（IMT）、血脂、瘦素、炎症标志物和身体成分（双能X线吸收法）。共有68名青少年接受了胰岛素敏感性（IS）（高胰岛素正葡萄糖钳夹试验）和腹部肥胖（计算机断层扫描）评估。
共有50%的人有冠状动脉钙化（CAC+：阿加斯顿CAC评分≥1）。与CAC-组相比，CAC+青少年的体重指数、脂肪量和腹部脂肪更高，在性别、种族、每无脂肪量的胰岛素敏感性（ISFFM）、糖耐量、PWV或IMT方面无差异。PWV与IS呈负相关。在以年龄、种族、性别、糖化血红蛋白、体重指数（或腰围）、ISFFM、舒张压、非高密度脂蛋白胆固醇和瘦素作为自变量的多元回归分析中，体重指数（或腰围）（R² = 0.41；P = 0.001）是CAC的显著决定因素；瘦素（R² = 0.37；P = 0.034）是PWV的显著决定因素；糖化血红蛋白、种族和年龄（R² = 0.34；P = 0.02）是IMT的显著决定因素。
在肥胖病程早期，有证据表明存在独立于血糖的冠状动脉钙化。亚临床动脉粥样硬化的不同生物标志物似乎受到不同的调节，肥胖是CAC的主要决定因素，高血糖、年龄和种族是IMT的主要决定因素，瘦素和IS是动脉僵硬度的主要决定因素。这些发现凸显了肥胖青少年心血管疾病风险增加，以及早期干预以逆转肥胖和动脉粥样硬化的必要性。
