الفهرس 
Childhood ObesityOnly 14 pages are availabe for public view
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Abstract
The prevalence of obesity in all age groups has increased dramatically over the past 30 years. Obesity rates in Egypt have reached 66%, being the fifth worldwide after American Samoa 93.5%, Kiribati 81.5%, USA 66.7%, and Germany 66.5%. The International Obesity Task Force (IOTF) stated that worldwide one in 10 children is overweight.
The adverse medical and psychosocial effects of obesity in children have been well-established. Childhood obesity is associated with the development of several risk factors for heart disease, including hyperlipidemia, hyperinsulinemia and hypertension. Each of the mentioned factors can increase the CVD risk independently. Even after adjusting for these risk factors, obesity remains directly associated with CVD. Deaths due to CVD have been linked directly to obesity.
Visceral adipose tissue predicts unfavorable cardiovascular and metabolic risk more than total adiposity.
Epicardial fat tissue is clearly metabolically active and an important source of both pro and anti inflammatory adipokines which might significantly affect cardiac function and morphology.
Epicardial adipose tissue is suspected to directly interact with the myocardial tissue. Recent evidences suggest that cardiac adiposity could locally modulate the morphology and function of the heart and works as an easy and reliable biomarker and therapeutic target. EAT and LVH were assessed as markers for cardiac adiposity and predictors for the risk of future CAD.
This study aimed to evaluate obese children with epicardial adipose tissue and abnormal cardiac morphology via echocardiography as a reliable indicator of visceral obesity and its relation to the degree of obesity, lipid profile, arterial blood pressure and insulin resistance.
The study included 98 obese children (defined as having BMI SDS >+2) aged between 4-15 years and 34 age and sex matched normal weight controls. In all subjects, anthropometric measurments were assessed in the form of weight, height and waist circumference. BMI was calculated and arterial blood pressure was assessed. Anthropometric and ABP assessments were made using standardized equipments and techniques. Three consecutive measurements were taken and the mean was recorded. All the measurements were blotted on gender specific growth charts developed by WHO, 2007.
Blood samples were taken after 10 hours of fasting to assess serum total cholesterol, TGA, HDL-C, LDL-C, CRP, fasting glucose and fasting insulin levels using standardized laboratory techniques. Total cholesterol and HDL-C levels were assessed using CHOD-PAP method. TGA and FBS were assessed using quantitative enzymatic techniques. Fasting insulin was assessed using ELISA technique. CRP was assessed using latex-enhanced nephlometry technique. LDL-C was calculated and insulin resistance, too, was calculated according to HOMA module.
Two dimensional echocardiography (Vivid 7, GE Vingmed, Horten, Norway) was performed to all studied children to evaluate presence of EAT and LVH. Epicardial fat thickness was measured on the free wall of the right ventricle from parasternal long axis view while the patient is lying supine and breathing gently. Epicardial adipose tissue is usually seen as an echo-free or if it is massive, hyper-echoic space. Three measurements were taken and averaged to demonstrate epicardial fat thickness (normal >1mm). Echocardiography was used to assess the left ventricular hypertrophy when the left myocardial wall is more than 0.78 cm thick.
Results of the study revealed that 42.4% of patients had heights above the 95th percentile specific for age and sex. However, 11.4% of the controls had heights above the 95th percentile. Waist circumference of 36.6% of patients was above 95th percentile specific for age and sex. Results of the study were not sex related.
As regards arterial blood pressure data, 48.5% of patients had stage I (95th-97th %) systolic hypertension, 53.5% had stage I (95th-97th %) diastolic hypertension and 1% had stage II (> 97th %) systolic hypertension.
As for laboratory data, 54.5% of patients had hypercholesterolemia (170mg/dl), 60.6% had hypertriglyceridemia ( 150 mg/dl), 33.3% had increased LDL-C ( 129mg/dl) and 43.4 % had decreased HDL-C (<38 mg/dl). As regards insulin resistence, 16.2% of patients had elevated FBS (100 g/dl), 30.3% had elevated FSI (13.5U/ml) and 48.5% had insulin resistance according to HOMA ( 2.5). Positive CRP was detected in 69.7% of patients.
Concerning echocardiographic data, 79.8% of patients had increased left ventricular myocardial thickness (normal > 78 mm) and 75.8% of patients had increased adipose tissue thickness (normal > 1 mm).
WC and ABP readings were found to be higher in patients in comparison to controls.
Higher levels of serum cholesterol, triglycerides and LDL-C; and lower levels of serum HDL-C were found in patients more than in control. In addition, insulin resistance and CRP were detected in patients more than in control.
As regards EAT and LVH, they were found to be increased in patients more than in controls.
Statistically significant direct correlations were found between EAT and LVH with BMI, WC and ABP.
Statistically significant direct correlations between LVH and EAT with hypertriglyceridemia, hypercholesterolemia, insulin resistance and CRP were found. Also, we found statistically significant indirect correlation between EAT and HDL-C in obese children.
There was a statistically significant positive correlation between EAT and LVH.
In conclusion: Of the studied obese children, 36.6% were found to have increased waist circumference indicating predilection to abdominal obesity; 48.5% had systolic hypertension, 54.5% had diastolic hypertension, 54.5% had hypercholesterolemia, 60.6% had hypertriglyceridemia, 48.5% had insulin resistence and 69.7% had elevated CRP. As regards echocardiographic data, 79.8% of patients had LVH and 75.8% had increased EAT. EAT and LVH were found to be statistically directly correlated to WC, ABP, hyperlipidemia, insulin resistence and CRP. This indicates that obesity associated increased cardiovascular risk depends not only on presence of hypertension, hyperlipidemia or insulin resistence, but also on presence of EAT and LVH as independent risk factors for cardiovascular complications.