ESPE Abstracts

Introduction: Childhood obesity is known to be associated with an increased risk of cardiovascular and metabolic complications in adulthood.

Objectives: To evaluate precocious cardiovascular sonographic modifications in a cohort of overweight (OW) and obese (OB) children and adolescents brought to Outpatient Clinic of Pediatric Endocrinology for first evaluation, compared with normal weight controls. 2) To investigate the association between clinical and metabolic variables and cardiovascular sonographic parameters; 3) to evaluate their relation with two different phenotypes of obesity: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO).

Material and methods: Fifty-nine OW and OB children and adolescents (range 6-16 years) and twenty matched lean controls underwent to anthropometric, biochemical, echocardiographic and sonographic evaluation of carotids and ascending aorta (AA) assessment. OW and OB subjects were divided in MHO and MUHO, according to Camhi et al definition (J Obes 2013:984613).

Results: OB and OW children showed significantly higher systolic blood pressure (SBP), left ventricular (LV) dimensions, carotid artery intima-media thickness (CIMT), Beta-index, carotids pulse wave velocity (PWV), and significantly lower peak early diastolic velocity/peak late diastolic velocity-ratio (E/A-ratio), compared to controls. Among OB and OW children, BMI SD, HOMA-index and SBP were positively related with left atrial (LA) and LV dimension and mass, and with epicardial fat (P-Lax). Moreover, SBP was positively related with PWV. BMI SD was negatively related with E/A-ratio. BMI SD, SBP, uric acid (UC), triglycerides (Tg) were significant predictors of LA and LV dimension and P-Lax, while SBP and duration of obesity were predictors of AA diameters and stiffness. Furthermore, BMI SD (P=0.018), waist circumference (WC) (P=0.001), hip circumference (P=0.009), WC/height-ratio (P=0.001), HOMA-index (P=0.004), Tg (P=0.013), UC (P=0.013), SBP (P=0.001), LV dimension and mass (P=0.012), P-Lax (P=0.028), CIMT (P=0.011), PWV (P=0.002), Beta-index (P=0.026), Aortic stiffness (P=0.006) were significantly higher among MUHO compared to MHO children.

Conclusions: Precocious detection of cardiovascular modifications were associated with severity, duration and MUHO phenotype of childhood obesity. MUHO, characterized by higher prevalence of metabolic alterations and early cardiovascular modifications, determines an increased cardiometabolic risk since the pediatric age. Distinction between MHO e MUHO phenotypes is important to plan a personalized approach for the follow-up in obese children.