RESUMO

INTRODUCTION: Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications. OBJECTIVE: To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR). PATIENTS AND METHODS: Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS). RESULTS: 3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months. CONCLUSIONS: The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.

Assuntos

RESUMO

INTRODUCCIÓN: La lactancia materna (LM) puede ser un factor protector de la obesidad y sus complicaciones metabólicas. OBJETIVO: Determinar la asociación entre el antecedente de amamantamiento y la presencia de obesidad, síndrome metabólico (SM) y resistencia insulínica (RI). PACIENTES Y MÉTODOS: Estudio transversal en 20 escuelas públicas de Santiago, Chile. Se evaluó antropometría, presión arterial, perfil lipídico, glicemia, insulinemia e índice HOMA. Los padres respondieron una encuesta sobre el antecedente de LM. Se definió SM según criterios de Cook y RI como HOMA > percentil 90. RESULTADOS: Se recibieron 3.278 encuestas válidas. La edad promedio fue de 11,4 ± 1 años, siendo 52,3% mujeres. La mayoría (98,2%) recibió LM, con una prevalencia de 15,9% de obesidad versus 18,6% en los que no la recibieron (p = 0,039). Hubo una tendencia no significativa a que SM y sus componentes, excepto RI, fueran más prevalentes en el grupo no amamantado. Los escolares que recibieron LM por 3-6 meses presentaron una menor prevalencia de obesidad y de algunos componentes de SM que los que recibieron menor tiempo o no la recibieron; el efecto fue inverso cuando la LM se prolongó por más de 9 meses. CONCLUSIONES: La prevalencia de obesidad fue mayor en los escolares que no fueron amamantados. Durante el primer semestre, la LM de mayor duración se asoció a menor prevalencia de obesidad y complicaciones metabólicas.

INTRODUCTION: Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications. OBJECTIVE: To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR). PATIENTS AND METHODS: Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS). RESULTS: 3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months. CONCLUSIONS: The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.

Assuntos

RESUMO

This paper describes a 4-month pilot study that tested the suitability of a physical activity intervention for first graders (children aged 6 and 7 years) in a public school in Santiago, Chile. Teachers were trained to deliver the programme in the classroom during the school day. Teachers were surveyed to determine if this intervention fit within their curriculum and classroom routines and they reported in a focus group that it was suitable for them. All children actively participated in the programme and positive changes in their attitudes towards physical activity were observed by their teachers. Anthropometrics, blood pressure and hand grip strength were measured in the students. A significant reduction was observed in children with high waist circumference ≥ 90th percentile, and in mean systolic blood pressure. However, statistical power values for those comparisons were rather low. Anthropometry and hand grip strength were not modified. The latter calculations and the lack of a control group are showing the weaknesses of this pilot study and that further research with a larger sample size and an experimental design is strongly needed.

RESUMO

BACKGROUND: Growing evidence shows that metabolic syndrome (MetS) is already starting in childhood however there is no consensus regarding how to diagnose this condition in pediatric population. Studies in adults show that altered levels of specific micro-RNAs are related with components of the MetS. OBJECTIVE: We determined the plasma levels of four MetS-associated micro-RNAs (miR-126, miR-132, mir-145 and Let-7e) in 10 to 12 years old children with or without MetS traits. DESIGN: Pediatric subjects were selected from a cohort of 3325 school-age children, and clustered by the absence (control, n = 30), or the presence of 1 (n = 50), 2 (n = 41) or 3 (n = 35) MetS traits according to Cook´s criteria. Micro-RNAs were isolated from plasma, and levels of miR-126, miR-132, miR-145 and Let-7e were determined by Taqman qPCR. RESULTS: Regression analysis of the different MetS traits regarding the different miRNAs analyzed showed that Let-7e presented a negative association with HDL-C levels, but a positive correlation with the number of MetS traits. Levels of miR-126 presented a positive correlation with waist circumference, waist to hip ratio, BMI, and plasma triglycerides and VLDL-C. Levels of miR-132 showed a positive correlation with waist to hip ratio. Plasma levels of Let-7e were increased (~3.4 fold) in subjects with 3 MetS traits, and showed significant AUC (0.681; 95%CI = [0.58, 0.78]; p < 0.001) in the ROC analysis which were improved when miR-126 was included in the analysis (AUC 0.729; p < 0.001). In silico analysis of the interaction of proteins derived from mRNAs targeted by Let7 and miR-126 showed an important effect of both Let-7e and miR-126 regulating the insulin signaling pathway. CONCLUSIONS: These results suggest that changes in the plasma levels of Let-7e and miR-126 could represent early markers of metabolic dysfunction in children with MetS traits.

Assuntos

RESUMO

BACKGROUND: Waist-to-height ratio (WHtR) is a cardiometabolic risk indicator in children. A value greater than or equal to 0.55 is an effective screening tool for identifying obese children with metabolic syndrome. However, it is unclear whether this cutoff can be applied equally to any age or gender. AIM: To analyze the variability of WHtR by age, gender and pubertal stage in elementary school children. PATIENTS AND METHODS: Cross-sectional study in 2,980 school children (6-14 years old, 51% male) of Santiago, Chile. We measured weight, height and waist circumference and calculated body mass index and WHtR. Pubertal stage was assessed and classified as peripubertal (Tanner I and II) and pubertal (Tanner III, IV and V). RESULTS: The mean age was 9.9 ± 2.3 years, with no gender difference (p = 0.5). Eighty one percent of boys and 59.4% of girls were peripubertal (p < 0.001). The association between age-adjusted WHtR by gender and pubertal stage was not significant (p = 0.409). Therefore mean, standard deviation and percentiles of WHtR were calculated without sex and pubertal stage segmentations. CONCLUSIONS: Since WHtR does not vary with age, gender and pubertal status in elementary school children, it is possible to use a single cutoff value, previously defined in this population, to identify children with cardiometabolic risk.

Assuntos

RESUMO

INTRODUCTION: The association of prenatal growth with nutritional status, metabolic syndrome (MS), and insulin resistance (IR) was studied in school-age children. METHODS: A retrospective cohort study was designed linking present data of children with perinatal records. 3325 subjects were enrolled. Anthropometry, blood pressure (BP), and pubertal status were assessed. Blood lipids, glucose, and insulin were measured. Linear associations were assessed using the Cochran-Armitage test. Odds ratios and nonlinear associations were computed. RESULTS: 3290 children (52% females, mean age of 11.4 ± 1 years) were analyzed. Prevalence of obesity, stunting, MS, and IR was 16.0%, 3.6%, 7.3%, and 25.5%, respectively. The strongest positive association was between birth weight (BW) and obesity (OR 2.97 (95% CI 2.01-4.40) at BW ≥ 4,000 g compared to BW 2,500-2,999). The strongest inverse association was between birth length (BL) and stunting (OR 8.70 (95% CI 3.66-20.67) at BL < 48 cm compared to BL 52-53 cm). A U-shaped association between BL and BP ≥ 90th percentile was observed. Significant ORs were also found for MS and IR. Adjustments for present fat mass increased or maintained the most prenatal growth influences. CONCLUSIONS: Prenatal growth influences MS, IR, and nutritional status. Prenatal growth was more important than present body composition in determining these outcomes.

Assuntos

RESUMO

Background: Waist-to-height ratio (WHtR) is a cardiometabolic risk indicator in children. A value greater than or equal to 0.55 is an effective screening tool for identifying obese children with metabolic syndrome. However, it is unclear whether this cutoff can be applied equally to any age or gender. Aim: To analyze the variability of WHtR by age, gender and pubertal stage in elementary school children. Patients and Methods: Cross-sectional study in 2,980 school children (6-14 years old, 51% male) of Santiago, Chile. We measured weight, height and waist circumference and calculated body mass index and WHtR. Pubertal stage was assessed and classified as peripubertal (Tanner I and II) and pubertal (Tanner III, IV and V). Results: The mean age was 9.9 ± 2.3 years, with no gender difference (p = 0.5). Eighty one percent of boys and 59.4% of girls were peripubertal (p < 0.001). The association between age-adjusted WHtR by gender and pubertal stage was not significant (p = 0.409). Therefore mean, standard deviation and percentiles of WHtR were calculated without sex and pubertal stage segmentations. Conclusions: Since WHtR does not vary with age, gender and pubertal status in elementary school children, it is possible to use a single cutoff value, previously defined in this population, to identify children with cardiometabolic risk.

Assuntos

RESUMO

INTRODUCTION AND OBJECTIVES: Plasma lipid levels in children and adolescents are evaluated with international references. The objective was to describe them in Chilean students, to compare them with the most used reference (Lipids Research Clinics Program) and the cut-off points recommended in 2011. METHODS: Cross-sectional study in 3325 children, 10 to 14 years of age. Anthropometry and auto-report of pubertal development were performed. A 12 hours fast blood sample was taken to measure total (TC), highdensity lipoprotein cholesterol (HDLC) and triglycerides (TG). Low-density lipoprotein cholesterol (LDLC) was calculated with Friedewald formula. Variables were described, Hochberg test for multiple comparisons and stepwise lineal regression were applied. The degree of agreement between local percentiles and the two international references was studied. RESULTS: We studied 3,063 children, 11.4 ± 0.9 years old, 53% girls, 20.9% pre-pubertal, 22.6% had overweight, and 15.8% obesity. Averages: TC: 159.2 ± 28.3, HDLC: 51.9 ± 12.1, LDLC: 89.0 ± 31.5 and TG: 93.2 ± 60 mg/dL. Boys had higher HDLC: 53.3 ± 12.2 vs. 50.6 ± 11.8 mg/dL and lower TG: 86.2 ± 58.2 vs. 99.5 ± 61.7 mg/dL than girls (p < 0,001). Influences of nutritional status, sex and age were significant. We founded high agreement with the reference for TC and LDLC, but HDLC levels were lower and TG were higher, for their cut-off points: percentiles 10th and 95th, respectively. CONCLUSIONS: Blood lipids were influenced by nutritional status, sex and age. Percentile values were comparable to the international reference except for HDLC and TG, showing a more atherogenic pattern.

Introducción: Las concentraciones de lípidos sanguíneos en niños y adolescentes se evalúan utilizando referencias internacionales. Objetivos: Describir las concentraciones de lípidos sanguíneos en una población de escolares chilenos y compararlas con la referencia más utilizada (Lipid Research Clinics Program) además de los puntos de corte recomendados en 2011. Métodos: Estudio transversal en 3.325 escolares de 10 a 14 años de edad. Se realizó antropometría, auto-reporte de desarrollo puberal y medición en ayunas de colesterol total (CT), colesterol unido a lipoproteínas de alta densidad (CHDL) y triglicéridos (TG). El colesterol unido a lipoproteínas de baja densidad (CLDL) se calculó con fórmula de Friedewald. Se realizó descripción, regresión múltiple y estudio de concordancia. Resultados: Se incluyeron 3.063 niños de 11,4 ± 0,9 años de edad, 53% mujeres, 20,9% pre-púberes; 22,6% con sobrepeso y 15,8% con obesidad. Los promedios fueron: CT: 159,2 ± 28,3, CHDL: 51,9 ± 12,1, LDL: 89,0 ± 31,5 y TG: 93,2 ± 60 mg/dL. Los hombres tuvieron mayor CHDL: 53,3 ± 12,2 vs 50,6 ± 11,8 mg/dL y menor TG: 86,2 ± 58,2 vs 99,5 ± 61,7 mg/dL que las mujeres (p < 0,001). Con regresión múltiple se encontró influencia del estado nutricional y edad en todos los lípidos y del sexo en la mayoría. Comparados con la referencia hubo concordancia en CT y CLDL, pero los niños chilenos presentaron mayores niveles de TG sobre el percentil 50 y menores niveles de CHDL bajo percentil 50. Conclusiones: Las concentraciones de lípidos sanguíneos estuvieron influidas por el estado nutricional, edad y sexo. En comparación a la referencia, se encontró un patrón de mayor riesgo cardiovascular en los niños chilenos.

Assuntos

RESUMO

BACKGROUND: The origin of most non-communicable diseases (NCDs) is in early life. Consequently obtaining information on risk factors for NCDs is important for preventive purposes. However, there is no information available on the prevalence of obesity, metabolic syndrome (MS) and insulin resistance (IR) in Chilean children. OBJETIVES: To determine the prevalence of nutritional status, MS and IR, and secondly, to study the associations among them. METHODS: Cross-sectional study conducted during 2009-2011 in 20 public schools of Puente Alto County, Santiago, Chile. Anthropometry, blood pressure and pubertal status were assessed. A blood sample was obtained for determination of lipids, blood glucose and insulin. Abnormal Homeostasis model assessment index (HOMA-IR) was based on a national standard. RESULTS: 3325 children had a mean age of 11.4 ± 1 years old (range 10-15 years). The prevalence of obesity, MS and IR was 16.1%, 7.3% and 25.9%, respectively. The prevalence of IR and MS was higher in obese children. MS and IR were strongly associated with an OR of 8.0 (95% CI= 5.9-10.7). Multivariate analysis showed that all MS components were associated to IR. CONCLUSIONS: There is a relatively high prevalence of risk factors in this sample of children. The strong positive association between nutritional status, IR and MS points out the need to early identify risk factors for NCDs allowing for prevention.

RESUMEN Introducción: Las principales enfermedades crónicas no transmisibles pueden iniciarse en la niñez, por lo que el conocimiento de sus factores de riesgo puede colaborar en su prevención. No existe información acerca de su prevalencia conjunta en escolares chilenos. Objetivos: Determinar la prevalencia del estado nutricional, síndrome metabólico (SM) y resistencia a la insulina (RI) en escolares, y conocer la asociación entre ellos. Métodos: Estudio transversal en 20 escuelas públicas de la comuna de Puente Alto, Santiago, Chile (2009-2011). Se evaluó antropometría, presión arterial, estado puberal. Se obtuvo una muestra sanguínea para determinar lípidos, glucosa, insulina plasmática. El indice de HOMA, homeostasis model assessment (en español: modelo de evaluación de la homeostasis) se utilizó para estimar RI con un patrón nacional. Resultados: 3325 niños con edad promedio 11,4 ± 1 años (rango 10-15 años). La prevalencia de obesidad, SM y RI fue 16,1%, 7,3% y 25,9%, respectivamente. La prevalencia de RI y SM fue mayor en los obesos. SM se asoció fuertemente a RI: OR: 8,0 (95% CI= 5,9-10,7). El análisis multivariado mostró que todos los componentes del SM se asociaron con RI. Conclusiones: Este estudio realizado en la comuna más poblada de Chile, demostró una alta prevalencia relativa de obesidad, RI y SM en escolares de escuelas públicas pertenecientes a un área de bajos ingresos. La clara asociación positiva demostrada entre estado exceso ponderal, RI y SM, acentúa la importancia de la identificación temprana de los factores de riesgo de ECNT con propósitos preventivos.

Assuntos

RESUMO

Background: Cardiovascular risk factors must be controlled since childhood. Aim: To assess the association of carotid intima media thickness (CIMT) with the components of the metabolic syndrome in Children. Material and Methods: Cross sectional assessment of 299 children aged 11.5 ± 0.9years (58% women) with and without metabolic syndrome components. Anthropometric parameters and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipids. CIMT was measured using high resolution ultrasound. Results: Ninety three percent of children were post puberal, 64% were overweight and 25% had metabolic syndrome. Mean and maximum CIMT correlated with systolic blood pressure (r = 0.21 and 0.21 respectively p < 0.01). Children with a CIMTover the 75th percentile had higher blood pressure and lower HDL cholesterol. A stepwise logistic regression accepted both variables as predictors of CIMT with odds ratios for mean CIMT of 1.46 (1.19-1-79) and 0.81 (0.7-0.94) perfive units of change, respectively. Conclusions: In this group of children systolic blood pressure and HDL cholesterol are associated to CIMT.

Assuntos

RESUMO

Background: LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. Aim: To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. Material and Methods: Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile. Results: Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. MeanIMTwas 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). Conclusions: Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Assuntos

RESUMO

BACKGROUND: Cardiovascular risk factors must be controlled since childhood. AIM: To assess the association of carotid intima media thickness (CIMT) with the components of the metabolic syndrome in Children. MATERIAL AND METHODS: Cross sectional assessment of 299 children aged 11.5 ± 0.9 years (58% women) with and without metabolic syndrome components. Anthropometric parameters and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipids. CIMT was measured using high resolution ultrasound. RESULTS: Ninety three percent of children were post puberal, 64% were overweight and 25% had metabolic syndrome. Mean and maximum CIMT correlated with systolic blood pressure (r = 0.21 and 0.21 respectively p < 0.01). Children with a CIMT over the 75th percentile had higher blood pressure and lower HDL cholesterol. A stepwise logistic regression accepted both variables as predictors of CIMT with odds ratios for mean CIMT of 1.46 (1.19-1-79) and 0.81 (0.7-0.94) per five units of change, respectively. CONCLUSIONS: In this group of children systolic blood pressure and HDL cholesterol are associated to CIMT.

Assuntos

RESUMO

BACKGROUND: LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. AIM: To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. MATERIAL AND METHODS: Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile. RESULTS: Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. Mean IMT was 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). CONCLUSIONS: Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Assuntos

RESUMO

Background: Plasma insulin and HOMA (homeostasis model assessment) index, used to determine insulin resistance, do not have local standard values for children and adolescents in Chile. Aim: To establish the normal reference intervals for insulin and HOMA in children and adolescents aged 10-15 years, according to sex and puberal maturation. Material and Methods: A cross-sectional study of 2,153 children and adolescents from Puente Alto County was performed, during 2009 and 2010. Anthropometry and self-report of puberal maturation were assessed. Fasting glucose (hexoquinase) and insulin blood levels (chemiluminiscence), were determined and HOMA index was calculated. Percentile distributions of these variables were calculated. Results: The reference group included only subjects with normal body mass index and fasting blood glucose (n = 1,192). Girls had higher insulin and HOMA values than boys (12.5 ± 6.0 and 9.1 ± 4.9 μϋ/mL (p < 0.01) and 2.7 ± 1.4 and 2.1 ± 1,1 (p < 0.01), respectively). Subjects with Tanner I and IIpuberal stages had lower insulin and HOMA mean values than subjects with Tanner III and IV (9.0 ± 4.3 and 12.5 ± 6.2μϋ/ml (p < 0.01) and2.0 ± 1 and2.8 ± 1.4 (p < 0.01), respectively). Conclusions: The 90th percentile of insulin and HOMA distributions according to sex and maturation, was selected as the upper cut-off point to identify individuals with insulin resistance. HOMA cutoff point for Tanner I and II boys was 3.2, for Tanner I and II girls was 4.1, for Tanner III and IV boys was 4.2 and for Tanner III and IV girls was 5.0.

Assuntos

RESUMO

Background: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. Aim: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). Material and Methods: We studied 689 subjects (50 percent women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. Results: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). Conclusions: There is a negative influence of cardiovascular RF on CIMT among young subjects.

Assuntos

RESUMO

BACKGROUND: Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors. AIM: To determine attributable risk factors for a high CIMT among healthy adults. MATERIAL AND METHODS: A sample of 1270 individuals (636 males and 634 females) aged 44 ± 11 years, was studied. Blood pressure, weight, height, lipid profile and blood glucose were measured in all. CIMT and the presence of atherosclerotic plaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes. RESULTS: Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and the presence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57%, respectively. CONCLUSIONS: In this sample, the main risk factor for a high CIMT was hypertension.

Assuntos

RESUMO

Background: Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors. Aim: To determine attributable risk factors for a high CIMT among healthy adults. Material ana Methods: A sample of 1270 individuáis (636 males and 634 femóles) aged 44 ±11 years, was studied. Blood pressure, weight, height, lipidprofile and blood glucose were measured in all. CIMT and thepresence of atheroscleroticplaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes. Results: Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and thepresence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57 percent, respectively. Conclusions: In this sample, the main risk factor for a high CIMT was hypertension.

Assuntos

RESUMO

BACKGROUND: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. AIM: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). MATERIAL AND METHODS: We studied 689 subjects (50% women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. RESULTS: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). CONCLUSIONS: There is a negative influence of cardiovascular RF on CIMT among young subjects.

Assuntos

RESUMO

BACKGROUND: Plasma insulin and HOMA (homeostasis model assessment) index, used to determine insulin resistance, do not have local standard values for children and adolescents in Chile. AIM: To establish the normal reference intervals for insulin and HOMA in children and adolescents aged 10-15 years, according to sex and puberal maturation. MATERIAL AND METHODS: A cross-sectional study of 2,153 children and adolescents from Puente Alto County was performed, during 2009 and 2010. Anthropometry and self-report of puberal maturation were assessed. Fasting glucose (hexoquinase) and insulin blood levels (chemiluminiscence), were determined and HOMA index was calculated. Percentile distributions of these variables were calculated. RESULTS: The reference group included only subjects with normal body mass index and fasting blood glucose (n = 1,192). Girls had higher insulin and HOMA values than boys (12.5 ± 6.0 and 9.1 ± 4.9 µÏ‹/mL (p < 0.01) and 2.7 ± 1.4 and 2.1 ± 1,1 (p < 0.01), respectively). Subjects with Tanner I and II pubertal stages had lower insulin and HOMA mean values than subjects with Tanner III and IV (9.0 ± 4.3 and 12.5 ± 6.2µÏ‹/ml (p < 0.01) and2.0 ± 1 and2.8 ± 1.4 (p < 0.01), respectively). CONCLUSIONS: The 90th percentile of insulin and HOMA distributions according to sex and maturation, was selected as the upper cut-off point to identify individuals with insulin resistance. HOMA cutoff point for Tanner I and II boys was 3.2, for Tanner I and II girls was 4.1, for Tanner III and IV boys was 4.2 and for Tanner III and IV girls was 5.0.

Assuntos

RESUMO

Introducción: La obesidad y el síndrome metabólico están asociados a un tamaño auricular izquierdo (AI) aumentado y mayor riesgo cardiovascular. El strain y strain rate longitudinal determinado por speckle tracking son herramientas novedosas en la evaluación de la función AI. Objetivo: evaluar el strain y strain rate AI en adolescentes obesos y su relación con biomarcadores de riesgo cardiovascular. Métodos: se incluyeron adolescentes consecutivos con un z-índice de masa corporal (z-IMC) > 1 en ritmo sinusal sin otra comorbilidad y un grupo control pareado por edad y sexo. Se registraron las características clínicas y ecocardiográficas con evaluación del strain AI: onda s (LASs), onda a (LASa) y strain rate AI: onda s (LASRs), onda a (LASRa) por speckle tracking. Se midió adiponectina y PCR ultrasensible. Se utilizó t-Student, chi-cuadrado y correlación de Pearson. Resultados: Se incluyeron 15 sujetos por grupo de edad promedio de 13 años, 47 por ciento hombres sin diferencia entre ambos grupos. Los pacientes con sobrepeso presentaron significativamente mayores niveles de PCR us respecto del grupo control, 0,5 +/- 0,1 mg/L vs 1,4 +/- 0,3, p = 0,04 y menores de LASs (44 +/- 1,8 vs 32 +/-1,1 por ciento;p<0,01), LASa ( -1,7 +/- 0,3 vs -0,7 +/- 0,3 1/s; p<0,01), LASRs ( 1,7 +/- 0,07 vs 1,3 +/- 0,03 por ciento; p<0,01), LASRa (-1,8 +/- 0,1 vs -1,2 +/-0,08 1/s;p<0,01). En el grupo con sobrepeso se encontró una correlación negativa significativa entre LASs, LASRs y PCR ultrasensible (R: -0,62; p < 0,01 y R: -0,58: p = 0,02 respectivamente). Conclusiones: El strain y strain rate AI se encuentran reducidos en adolescentes obesos y estos parámetros de función AI se correlacionan con un estado inflamatorio aumentado. La importancia clínica de estos hallazgos requieren mayor investigación.

Background: Obesity is an emerging problem in children worldwide and a well-known risk factor for atrial fibrillation (AF) in adulthood. There is some evidence that functional and structural changes responsible for the development of AF may arise early in life. Left atrial (LA) strain and strain rate, assessed by speckle tracking, are indices of LA function and correlate with the development of AF. Objective: To evaluate LA strain and strain rate in obese adolescents and their correlation with plasma levels of high sensitive C reactive protein (hs-CRP) and adiponec-tin, two markers of cardiovascular risk. Methods: Fifteen obese adolescents, age 13 +/- 0.2 yr, body mass index (BMI)-z-score 1.9 +/- 0.16 and 15 lean controls were recruited. All patients underwent transtho-racic echocardiography with evaluation of LA strain and strain rate: a wave (LASa and LASRa) and s wave (LASs and LASRs). Plasma levels of hs-CRP was determined. Student's t test, chi-square and Pearson correlation were used for statistical analysis. Results: Obese patients had a lower LASs (44 +/- 1.8 vs 32 +/- 1.1 percent, p < 0.01), LASa (- 1.7 ± 0.3 vs - 0.7 +/- 0.1, p < 0.01), LASRs (1.7 +/- 0.07 vs 1.3 +/- 0.03, p < 0.01) and LASRa (- 1.8 +/- 0.1 vs - 1.2 +/- 0.08, p < 0.01). Plasma hs-CRP levels were significantly higher in the obese group and displayed a significant inverse correlation with LASs (r: - 0.62, p < 0.01) and LASRs (r: - 0.58, p = 0.02). Conclusion: Obese adolescents had an impaired LA function compared to age-matched lean subjects, which correlated with an increased inflammatory state. It is likely that LA dysfunction may predispose to AF later in life.

Assuntos