Santé et Mouvement Consultation, Service of Paediatric Specialties, Department of Child and Adolescent, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
Obesity Prevention and Care Program "Contrepoids", Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
Eur J Clin Invest. 2018 Sep;48(9):e12995. doi: 10.1111/eci.12995. Epub 2018 Aug 6.
Childhood obesity is associated with premature cardiovascular complications. However, little is known about the effect of a family-based behavioural intervention on the relationship between arterial function, blood pressure and biomarkers in pre-pubertal children with obesity.
This was a single centre randomized controlled trial (RCT) including 74 children randomized to a 6-month behavioural intervention to treat obesity. In 48 children (13 controls and 35 interventions), we assessed: serum level of cytokine (CCL2), adiponectin, and neutrophil product (MMP-8), as well as carotid intima-media thickness, flow-mediated dilation (FMD), nitroglycerin-mediated dilation; arterial stiffness (incremental elastic modulus, Einc), pulse wave velocity (PWV), resting and 24-hour blood pressure (BP).
At baseline, resting systolic BP was positively associated with MMP-8 levels which was significantly higher in children with hypertension (P = 0.033). Biochemical markers were not related to endothelial function at baseline, but they globally increased after 6 months in the intervention group. The significant increase of CCL2 levels in the intervention group was associated with a decrease in diastolic BP. Furthermore, adiponectin change was positively related to a change in FMD and negatively to change in Einc and PWV.
The usefulness of serum biomarkers for the detection of cardiovascular diseases is not well established in children. In our population, MMP-8 concentration was higher in hypertensive children. Furthermore, behavioural interventions resulted in a paradoxical increase in some biomarkers in children, with potentially beneficial effects detected with CCL2 changes. Caution should be taken when using nonspecific serum biomarkers for the clinical monitoring of children with obesity.
儿童肥胖与心血管并发症的发生有关。然而，对于基于家庭的行为干预对肥胖前期儿童的动脉功能、血压和生物标志物之间关系的影响知之甚少。
这是一项单中心随机对照试验（RCT），纳入了 74 名肥胖儿童，随机分为 6 个月的行为干预组进行治疗。在 48 名儿童（13 名对照组和 35 名干预组）中，我们评估了以下内容：血清细胞因子（CCL2）、脂联素和中性粒细胞产物（MMP-8）水平，以及颈动脉内膜中层厚度、血流介导的扩张（FMD）、硝酸甘油介导的扩张；动脉僵硬（弹性模量增量，Einc）、脉搏波速度（PWV）、静息和 24 小时血压（BP）。
在基线时，静息收缩压与 MMP-8 水平呈正相关，高血压儿童的 MMP-8 水平明显升高（P=0.033）。生化标志物与内皮功能在基线时无相关性，但在干预组 6 个月后均有总体升高。干预组 CCL2 水平的显著升高与舒张压的降低有关。此外，脂联素的变化与 FMD 的变化呈正相关，与 Einc 和 PWV 的变化呈负相关。
血清生物标志物在儿童心血管疾病检测中的作用尚未得到充分证实。在我们的人群中，高血压儿童的 MMP-8 浓度较高。此外，行为干预导致一些生物标志物在儿童中出现矛盾性增加，CCL2 变化检测到潜在的有益效果。在监测肥胖儿童的临床时，应谨慎使用非特异性血清生物标志物。
