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1.
Sci Rep ; 11(1): 21943, 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753958

RESUMO

There is no consistent conclusion on which adiposity measure is best to predict cardiovascular risk factors in youth. The present study aims to assess the performance of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in predicting abnormal left ventricular structure in Chinese hypertensive youth. A total of 1180 youth aged 6-17 years with hypertension from the China Child and Adolescent Cardiovascular Health Study were included in this study. Logistic regression model, receiver operator characteristic (ROC) curve analysis and net reclassification improvement (NRI) method were used to assess performance of BMI, WC, and WHtR in predicting left ventricular hypertrophy (LVH) and left ventricular geometry (LVG). A 1-standard deviation increment in any of three indexes in predicting LVH and LVG were similar, e.g., with the odds ratios and 95% confidence intervals of 1.34 (1.16-1.55), 1.25 (1.08-1.45) and 1.40 (1.20-1.62), respectively. In addition, ROC analysis and NRI method confirmed the similar performance of three adiposity indexes in predicting LVH and LVG. In conclusion, BMI, WC and WHtR had similar performance in predicting abnormal left ventricular structure in Chinese hypertensive youth, but all three indexes had limited value in prediction. WHtR is a simple and convenient adiposity index for screening youth at high risk of target organ damage.

4.
J Hypertens ; 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34285150

RESUMO

OBJECTIVE: This study aims to evaluate the prevalence of hypertension and hypertension subtypes among Chinese children aged 6--17 years in a multicenter school-based sample by three separate screenings. METHODS: Students from six major cities in China (Changchun, Beijing, Jinan, Shanghai, Chongqing, and Chengdu) were recruited in this cross-sectional survey during 2012 and 2015. Each participant was seated and had three consecutive blood pressure measurements on the right arm in the morning by an automated oscillometric device and the hypertensive ones were followed to the next visit. Hypertension was diagnosed by BP references for Chinese children and adolescents in 2010. RESULTS: Data from 44 396 children aged 6--17 years were included in analysis, 50.9% of whom were boys. The prevalence of confirmed hypertension after three separate screenings was 4% in the total population, 5% in boys, and 3% in girls, respectively. The prevalence of confirmed isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH) in the total population was 2.7, 0.3 and 1%, respectively. CONCLUSION: Around 4% urban Chinese children and adolescents aged 6-17 years were hypertensive after three separate BP screenings in 2012-2015. ISH was the most frequent form of hypertension in children.

5.
J Clin Endocrinol Metab ; 106(11): e4634-e4640, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34153093

RESUMO

CONTEXT: Both obesity and inflammation are related to accelerated aging. It is not yet known whether inflammation mediates the effects of obesity on aging. OBJECTIVE: This work aims to dissect the direct effect of body mass index (BMI) and its indirect effect through C-reactive protein (CRP) on leukocyte telomere length (LTL) to determine the mediation effect of CRP on the BMI-LTL association. METHODS: The study cohort included 5451 adults (1404 Mexican American, 3114 White, and 933 Black individuals; 53.5% male; mean age = 49.2 years) from the 1999 to 2002 National Health and Nutrition Examination Survey. General mediation models were used to examine the mediation effect of CRP on the BMI-LTL association. RESULTS: After adjusting for age, race, sex, physical activity, alcohol use, and serum cotinine, the total effect of BMI on LTL was significant (standardized regression coefficient, ß = -.054, P < .001) without CRP included in the model. With inclusion of CRP in the model, the indirect effect of BMI on LTL through CRP was estimated at ß equal to -.023 (P < .001), and the direct effect of BMI on LTL in its absolute value decreased to ß equal to -.031 (P = .025). The mediation effect of CRP was estimated at 42.6%. The mediation model parameters did not differ significantly between race and sex groups. CONCLUSION: These results suggest that the inverse BMI-LTL association is partly mediated by obesity-induced inflammation. The significant direct effect of BMI on LTL with removal of the mediation effect through CRP indicates that obesity is associated with LTL attrition also through other noninflammatory mechanisms.

6.
Mol Nutr Food Res ; 65(12): e2001025, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33865240

RESUMO

SCOPE: The role of palmitoleic acid (POA) in hypertension or blood pressure remains uncertain. This study aims to investigate the epidemiological association between circulating POA and primary hypertension in humans, and subsequently evaluate the effects of exogenous POA on blood pressure and aortic remodeling in spontaneously hypertensive rats (SHRs). METHODS AND RESULTS: A case-control study of 349 hypertensive and 1396 normotensive children and adolescents is conducted, and found hypertensive cases show significant lower erythrocyte phospholipid POA than normotensive controls (p < 0.001). In conditional logistic regression model, participants in the top quartile of POA have a lower prevalence of primary hypertension than those in the bottom (multivariate-adjusted OR: 0.47, 95% CI: 0.25-0.89). In animal study, 24 SHRs are randomly assigned to n-3 PUFAs (500 mg kg-1 ), POA (500 mg kg-1 ), or vehicle (olive oil) for 8 weeks. At the end of intervention, as compared to SHRs treated with vehicle, SHRs treated with POA shows significantly decreased systolic blood pressure (SBP), improved aortic remodeling, and also decreased aortic expressions of NF-κB and its downstream proinflammatory cytokines. CONCLUSIONS: Circulating POA is inversely associated with risk of primary hypertension, and exogenous POA supplementation can decrease SBP and improve aortic remodeling by inhibiting NF-κB-mediated inflammation.

7.
Int J Obes (Lond) ; 45(7): 1457-1463, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33824403

RESUMO

OBJECTIVE: This study aimed to examine the temporal relationship between body mass index (BMI) and uric acid (UA), and their joint effect on blood pressure (BP) in children and adults. METHODS: The longitudinal cohorts for temporal relationship analyses consisted of 564 and 911 subjects examined twice 5-14 years apart from childhood to adulthood. The cross-sectional cohorts for mediation analyses consisted of 3102 children and 3402 nondiabetic adults. Cross-lagged panel analysis models were used to examine the temporal relationship between BMI and UA, and mediation analysis models the mediation effect of UA on the BMI-BP association. RESULTS: After adjusting for age, race, sex and follow-up years in children, and additionally smoking and alcohol drinking in adults, the path coefficients (standardized regression coefficients) from baseline BMI to follow-up UA (0.145 in children and 0.068 in adults) were significant, but the path coefficients from baseline UA to follow-up BMI (0.011 in children and 0.016 in adults) were not. In mediation analyses, indirect effects through UA on the BMI-systolic BP association were estimated at 0.028 (mediation effect = 8.8%) in children and 0.033 (mediation effect = 13.5%) in adults (P < 0.001 for both). Direct effects of BMI on systolic BP (0.289 in children and 0.212 in adults) were significant. The mediation effect parameters did not differ significantly between Blacks and Whites. CONCLUSIONS: Changes in BMI precede alterations in UA, and the BMI-BP association is in part mediated through BMI-related increase in UA both in children and in adults. These findings have implications for addressing mechanisms of obesity hypertension beginning in early life.

8.
Pediatr Investig ; 5(1): 3-5, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33778420
9.
Pediatr Investig ; 5(1): 12-20, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33778422

RESUMO

Importance: Several methods have been established in recent decades that allow use of spot urine to estimate dietary sodium intake. However, their accuracies have been controversial in children. Objective: To validate the performance of three commonly used methods-the Kawasaki, Tanaka, and International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) methods. Additionally, this study explored the accuracies of the Tanaka and INTERSALT methods by using spot urine samples taken at four separate times. Method: Forty-one adolescents aged 14 to 16 years completed two non-consecutive 24-hour urine collections and their mean values were used as reference data. The second-morning urine was used for assessment with the Kawasaki method; a casual spot urine and spot urine samples taken at four separate times (morning, afternoon, evening, and overnight) were used for assessment with the Tanaka and INTERSALT methods. Results: The mean differences were 1801 mg, 542 mg, 47 mg, and -31 mg for the Kawasaki, Tanaka, INTERSALT1 (with potassium), and INTERSALT2 (without potassium) methods with their required spot urine, respectively. The proportions of relative difference levels within ± 10% were 4.9% for the Kawasaki method, 19.5% for the Tanaka method, 36.6% for the INTERSALT1 method, and 36.6% for the INTERSALT2 method. Interpretation: The INTERSALT method seemed to provide minimally biased estimations of mean population sodium intake with casual spot urine. However, there is a need to be cautious regarding inconsistencies in estimation among different levels of sodium intake. The methods assessed in this study were unable to accurately estimate sodium intake at the individual level.

10.
Pediatr Investig ; 5(1): 21-27, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33778423

RESUMO

Importance: The impact of long-term burden of excessive body weight, beginning in childhood, on inflammatory status in adulthood has been poorly described. Objective: To characterize the longitudinal body mass index (BMI) trajectory from childhood and examine its relationship with inflammatory status in adulthood. Methods: We included 1285 adults who had 4-15 repeat measurements of BMI from childhood to adulthood. The area under the curve (AUC) of growth curves was calculated to characterize long-term burden (total AUC) and trends (incremental AUC) of BMI. Results: After adjusting for covariates, higher values of BMI in terms of childhood and adulthood, as well as total and incremental AUC, were strongly associated with elevated levels of adult C-reactive protein (CRP) in the four race-sex groups. There were significant differences in linear and nonlinear curve parameters between the normal and high CRP groups for all race-sex groups (P < 0.01). Compared with participants who had consistently low BMI in both childhood and adulthood, participants with high BMI in adulthood had higher CRP levels (P < 0.001), irrespective of their childhood BMI status; participants with high BMI in childhood but low BMI in adulthood had similar adult CRP levels. Interpretation: The impact of excessive body weight on inflammation is cumulative and exacerbated over time. The influence of childhood overweight/obesity on inflammatory status in adulthood can be alleviated by reducing adiposity in adulthood.

11.
Pediatr Investig ; 5(1): 28-32, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33778424

RESUMO

Importance: Extensive population-based studies have explored the prevalence of primary hypertension (HTN) in children and adolescents. However, there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN. Objective: To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting. Methods: The study cohort comprised pediatric inpatients (<18 years of age) discharged with a diagnosis of HTN from Beijing Children's Hospital during 2015-2020. Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses, family history of HTN, and findings on physical examination, as documented in their medical records. The Mann-Whitney U test, χ 2 and Fisher's exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN. Results: Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis. Among them, 458 (31.2%) had primary HTN, and 1012 (68.8%) had secondary HTN. Compared with patients had primary HTN, children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay. Moreover, children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments, 75.8% of them having obesity-related comorbidities. In contrast, most patients with secondary HTN had been managed by the Nephrology Department, renal diseases being the leading cause of their HTN (46.3%). Interpretation: Secondary HTN is more common than primary HTN in pediatric clinical settings, renal diseases being the leading cause of secondary HTN.

12.
Clin Nutr ; 40(3): 1289-1295, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32896446

RESUMO

BACKGROUND & AIMS: The rise in the prevalence of childhood obesity has increased the demand for accurately evaluating body fatness in pediatric population. The aim of this study was to provide a series of sex- and age-specific body fat reference centiles for evaluating total body fat development and fat distribution in Chinese children and adolescents using dual-energy x-ray absorptiometry (DXA). METHODS: A nationwide sample of Chinese children and adolescents aged 3-18 years (n = 12,790) was drawn from a cross-sectional survey of the China Child and Adolescent Cardiovascular Health study (2013-2019). Fat measurements, including total fat mass index (FMI), total body fat percentage (BF%), regional FMI, trunk to leg (T/L) fat ratio and android to gynoid (A/G) fat ratio, were derived from whole body DXA scans. Sex- and age-specific centiles were estimated using the lambda-mu-sigma method and then compared with values derived from the US National Health and Nutrition Examination Survey (1999-2004) and Korean National Health and Nutrition Examination Survey (2008-2011). RESULTS: During early childhood, almost all body fat parameters decreased with age, except an increase in A/G ratio. After 7 years onward, drastic upward trends of total FMI and BF% were exhibited in boys till 10 years, followed by opposite downward trends during 11-14 years; while sustained increase of FMI was shown in girls across ages accompanied by relatively constant BF% levels. Meanwhile, steady increases were noticed for A/G ratio and T/L ratio, which were more pronounced in boys. In addition, the proposed body fat references were much lower than the US but similar to Koreans despite of subtle differences. CONCLUSIONS: This is the first study to present a set of DXA-based body fat reference for Chinese children and adolescents aged 3-18 years. The new reference provides clinicians and researchers a useful tool for assessing body fat development and distribution patterns throughout early childhood and adolescence.


Assuntos
Absorciometria de Fóton , Tecido Adiposo/crescimento & desenvolvimento , Composição Corporal , Tecido Adiposo/fisiologia , Adolescente , Fatores Etários , Antropometria , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Obesidade Pediátrica/epidemiologia , Valores de Referência , República da Coreia , Fatores Sexuais , Estados Unidos
13.
J Nutr ; 151(5): 1213-1221, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33245131

RESUMO

BACKGROUND: Despite an increasing number of studies investigating the links between increased BMI and a better prognosis of cardiovascular disease, which has been termed the "obesity paradox," few of them take the lean mass into consideration. OBJECTIVES: This study aimed to explore the associations of body composition compartments, especially the lean mass, with cardiometabolic abnormalities in children and adolescents. METHODS: In a nationwide cross-sectional study of 6- to 18-y-old children (n = 8967, 50.1% boys), we measured body composition using DXA scan, and calculated BMI, fat mass index (FMI), and lean mass index (LMI). The exploratory outcomes were cardiometabolic abnormalities, including hypertension, dyslipidemia, hyperglycemia, and insulin resistance. Adjusted linear regression coefficients and ORs were calculated to assess the associations between body composition indicators and cardiometabolic abnormalities. RESULTS: Unlike BMI and FMI, LMI was inversely associated with homeostasis model assessment of insulin resistance (ß: -0.06; 95% CI: -0.09, -0.03; P < 0.001), fasting plasma glucose (ß: -0.08; 95% CI: -0.11, -0.05; P < 0.001), non-HDL cholesterol (ß: -0.10; 95% CI: -0.13, -0.08; P < 0.001), LDL cholesterol (ß: -0.12; 95% CI: -0.14, -0.09; P < 0.001), and total cholesterol (TC) (ß: -0.16; 95% CI: -0.19, -0.14; P < 0.001). After multivariable adjustment, all the odds of cardiometabolic abnormalities were increased from the lowest quartile to the highest quartile of BMI and FMI (P-trend < 0.05); however, the odds of high TC, high LDL cholesterol, hyperglycemia, and insulin resistance were decreased with LMI (P-trend < 0.05). Obese children with high LMI did not have significantly increased odds of high TC, high LDL cholesterol, and high non-HDL cholesterol compared with normal-weight children without high LMI. CONCLUSIONS: Greater lean mass may have a protective impact on high TC, high LDL cholesterol, hyperglycemia, and insulin resistance in children and adolescents. This finding suggests that the "obesity paradox" may be partly explained by high lean mass.


Assuntos
Composição Corporal , Índice de Massa Corporal , Fatores de Risco Cardiometabólico , Adolescente , Glicemia , Criança , Estudos Transversais , Feminino , Humanos , Hiperglicemia , Resistência à Insulina , Masculino , Obesidade Pediátrica
14.
Pediatr Obes ; 16(3): e12716, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32844607

RESUMO

BACKGROUND: It has been controversial whether to adjust for current body weight while examining the relationship between birthweight and blood pressure (BP). OBJECTIVE: The present study aims to partition the total effect of birthweight on BP into its direct effect and indirect effect through current body mass index (BMI). METHODS: The study cohort consisted of 6251 participants who had birthweight information with 13 443 observations on BMI and BP in pre-adolescence (4-11 years), adolescence (12-19 years), young adulthood (20-30 years) and mid-adulthood (31-58 years). General third-variable models were used to distinguish the mediation and suppression effects of current BMI on the birthweight-BP association at different ages. RESULTS: The total effect of birthweight on systolic BP measured as standardized regression coefficient (ß) without current BMI included in the model was 0.003 (P = .810) in pre-adolescents, -0.032 (P = .029) in adolescents, -0.066 (P = .002) in young adults and -0.051 (P = .023) in midlife adults. With additional adjustment for BMI, the direct effect of birthweight on systolic BP was strengthened to ß = -0.066 (P = .013), ß = -0.058 (P = .014), ß = -0.094 (P = .020), ß = -0.066 (P = .023); the suppression effects of BMI were calculated at 0.070, 0.027, 0.028 and 0.015 in the respective age groups. The decreasing trend of suppression effects with increasing age mimicked the trends of birthweight-BMI and BMI-BP correlations. CONCLUSIONS: Current body weight has a suppression effect, not a mediation effect, on the birthweight-BP association, with pre-adolescents having the greatest suppression effect. The suppression effect is predominantly determined by birthweight-BMI and BMI-BP correlations.


Assuntos
Peso ao Nascer/fisiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
J Am Heart Assoc ; 9(16): e016405, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32779511

RESUMO

Background Data are limited regarding the relationship between the life-course burden of risk factors and adult cardiac function. This study sought to examine the impact of long-term burden of body mass index (BMI) and blood pressure (BP) levels on changes in adult left ventricular (LV) structure and function in a community-based cohort. Methods and Results The longitudinal study cohort consisted of 1108 adult patients (726 White; 41.9% men; mean age, 48.2 years in the last survey) who had been examined 4 to 16 times for BMI and BP and echocardiographic LV structure and function in adulthood, with a mean follow-up period of 38.8 years. The area under the curve was used as a measure of long-term burden of BMI and BP. Adult LV mass index was significantly associated with childhood and adulthood BMI and systolic BP (SBP), and their area under the curve values (ß=0.07-0.37; P<0.05 for all). Adult LV ejection fraction was negatively associated with childhood BMI (ß=-0.08), adult BMI (ß=-0.07) and BMI area under the curve (ß=-0.07) (P<0.05 for all); the effects of SBP measures were not significant. Adult E/A ratio was negatively associated with adulthood SBP (ß=-0.13; P<0.01) and total area under the curve of SBP (ß=-0.13; P<0.01). E/e' ratio was positively associated with BMI and SBP measures. The effects of diastolic BP measures were substantially similar to those of SBP measures. Participants with LV hypertrophy, eccentric hypertrophy, and concentric hypertrophy had significantly lower LV ejection fraction and higher E/e' ratio. Conclusions These observations provide strong evidence that early-life adiposity and BP levels and their life-course cumulative burdens are associated with subclinical changes in adult LV structure and function in the general population.


Assuntos
Pressão Sanguínea , Índice de Massa Corporal , Hipertrofia Ventricular Esquerda/etiologia , Adolescente , Adulto , Fatores Etários , Área Sob a Curva , Criança , Pré-Escolar , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Estudos Longitudinais , Louisiana , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Volume Sistólico/fisiologia , Sístole/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto Jovem
16.
BMJ Open ; 10(6): e037040, 2020 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-32565476

RESUMO

OBJECTIVES: To demonstrate the accuracy and flexibility of using waist-to-height ratio (WHtR) as a screening tool for identifying children and adolescents with cardiometabolic risk (CMR) across a wide range of prevalence levels among general paediatric populations. DESIGN: A nationwide population-based cross-sectional study with all data collected at school settings in six cities of China. PARTICIPANTS: A total of 8130 children and adolescents aged 7-18 years with complete anthropometric and CMR measurements based on blood tests were recruited. OUTCOME MEASURES: Elevated blood pressure, dyslipidaemia, elevated fasting blood glucose and central obesity were measured. The primary outcome, CMRs, was defined as meeting three or more of the above risk factors. The accuracy of WHtR for identifying CMRs was evaluated using areas under the curves (AUCs) with 95% CI of the receiver operating characteristic curve. The predictability of WHtR at given CMRs prevalence levels was estimated by positive predictive value (PPV) and negative predictive value. RESULTS: Overall, 6.1% of study participants were presented with CMRs. WHtR had high AUCs ranging from 0.84 (95% CI 0.81 to 0.88) to 0.88 (95% CI 0.86 to 0.90) in the total population and age-subgroup and gender-subgroup. The overall optimal WHtR cut-off value was 0.467, with boys having a higher cut-off than girls (0.481 vs 0.456). WHtR achieved an overall sensitivity of 0.89 and PPV of 18.8% at a specificity of 0.75. The screening performance of WHtR remained satisfactory across a wide range of given CMRs prevalence levels (5%, 10% and 20%). CONCLUSION: WHtR as a screening tool could accurately and flexibly identify children affected with the clusters of three or more of CMR factors from the general paediatric population with various CMR prevalence levels. Our findings provide support for policy-making on early CMR identification and management in the high-risk group of children.


Assuntos
Doenças Cardiovasculares/epidemiologia , Programas de Rastreamento , Síndrome Metabólica/epidemiologia , Medição de Risco , Razão Cintura-Estatura , Adolescente , Glicemia/análise , Pressão Sanguínea , Criança , China/epidemiologia , Estudos Transversais , Jejum , Feminino , Humanos , Masculino , Obesidade Abdominal , Fatores de Risco
17.
BMC Cardiovasc Disord ; 20(1): 175, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295533

RESUMO

BACKGROUND: Human epididymis protein 4 (HE4) was proved to be a novel biomarker for left heart failure. The purpose of this exploratory study was to evaluate the role of HE4 in patients with idiopathic pulmonary arterial hypertension (IPAH) who usually have concurrent right heart failure. METHODS: 55 patients with newly diagnosed IPAH were continuously enrolled and serum HE4 levels were assessed at baseline. All patients were followed up from the date of blood sampling, and a composite endpoint of clinical worsening was detailedly recorded. RESULTS: Serum levels of HE4 were significantly higher in IPAH patients than healthy controls (6.9 ± 2.2 vs 4.4 ± 0.9 ng/ml, p < 0.05) and increased as cardiac function deteriorated. HE4 levels correlated with endothelin-1 (r = 0.331, p < 0.01) and right atrial pressure (r = 0.30, p < 0.03). After a mean follow-up of 20 ± 10 months, 13 patients experienced clinical worsening. Receiver operating characteristic analysis showed that HE4 levels > 6.5 ng/ml discriminated clinical worsening with a sensitivity of 92.31% and a specificity of 59.52% (area under the curve [AUC] = 0.81). Multivariate Cox regression analysis demonstrated that HE4 (χ2: 5.10; hazard ratio [HR] = 1.26; 95% confidence interval: 1.03 to 1.55, p < 0.02) and pulmonary vascular resistance (χ 2: 4.19; HR = 1.14; 95% confidence interval: 1.00-1.29, p < 0.04) were independently predictive of clinical worsening. Patients with HE4 > 6.5 ng/ml had a worse 2-year survival rate than those with HE4 ≤ 6.5 ng/ml (58.9% vs 96.2%, p < 0.001). CONCLUSIONS: Serum levels of HE4 were elevated in IPAH patients and correlated with disease severity. HE4 was an independent predictor of clinical worsening in IPAH patients.


Assuntos
Hipertensão Pulmonar Primária Familiar/sangue , Proteína 2 do Domínio Central WAP de Quatro Dissulfetos/análise , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Progressão da Doença , Hipertensão Pulmonar Primária Familiar/diagnóstico , Hipertensão Pulmonar Primária Familiar/fisiopatologia , Feminino , Humanos , Masculino , Projetos Piloto , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Regulação para Cima , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-32071197

RESUMO

OBJECTIVE: Vitamin D deficiency has recently evolved as a major public health issue worldwide. But the relationship between vitamin D and cardiovascular health in children remains unclear. Accordingly, we aimed to examine the associations between 25-hydroxyvitamin D (25(OH)D) concentrations and cardiometabolic risk factors, and to assess the possible effect modification of obesity on the associations in a Chinese pediatric population. RESEARCH DESIGN AND METHODS: A cross-sectional sample of 6091 children aged 6-18 years was obtained using a cluster sampling method. The 25(OH)D concentrations, and metabolic risk factors, including waist to height ratio, blood pressure, blood lipids, fasting blood glucose (FBG), and insulin were measured. Adjusted ORs and multiplicative or additive interaction were calculated to assess the associations and effect modification, respectively. RESULTS: Triglycerides, FBG, insulin, and homeostasis model assessment of insulin resistance were inversely associated with 25(OH)D concentrations (p<0.05) in both sexes. The OR of hyperglycemia among individuals with insufficient vitamin D was higher than those with adequate vitamin D after adjusting for covariates (OR: 1.47; 95% CI 1.26 to 1.70). Moreover, girls with insufficient vitamin D had significantly higher odds for hypertension and high total cholesterol than those with adequate vitamin D, which was not observed in boys. Thirty-two percent (95% CI 14% to 51%) of the increased odds of hyperglycemia can be explained by the interaction between insufficient vitamin D and obesity. CONCLUSIONS: Vitamin D insufficiency is associated with increased odds of various cardiometabolic risk factors in Chinese children and has a synergistic effect on hyperglycemia with obesity.


Assuntos
Fatores de Risco Cardiometabólico , Doenças Cardiovasculares/epidemiologia , Hiperglicemia/epidemiologia , Obesidade Pediátrica/epidemiologia , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Adolescente , Glicemia/análise , Doenças Cardiovasculares/sangue , Criança , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Hiperglicemia/sangue , Masculino , Obesidade Pediátrica/sangue , Prevalência , Triglicerídeos/sangue , Vitamina D/sangue , Deficiência de Vitamina D/sangue
19.
Circ Res ; 126(5): 633-643, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992136

RESUMO

RATIONALE: Data are limited regarding the influence of life-course cumulative burden of increased body mass index (BMI) and elevated blood pressure (BP) on the progression of left ventricular (LV) geometric remodeling in midlife. OBJECTIVE: To investigate the dynamic changes in LV mass and LV geometry over 6.4 years during midlife and to examine whether the adverse progression of LV geometric remodeling is influenced by the cumulative burden of BMI and BP from childhood to adulthood. METHODS AND RESULTS: The study consisted of 877 adults (604 whites and 273 blacks; 355 males; mean age=41.4 years at follow-up) who had 5 to 15 examinations of BMI and BP from childhood and 2 examinations of LV dimensions at baseline and follow-up 6.4 years apart during adulthood. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and systolic BP (SBP). After adjusting for age, race, sex, smoking, alcohol drinking, and baseline LV mass index, the annual increase rate of LV mass index was associated with all BMI measures (ß=0.16-0.36, P<0.05 for all), adult SBP (ß=0.07, P=0.04), and total AUC of SBP (ß=0.09, P=0.01) but not with childhood and incremental AUC values of SBP. All BMI and SBP measures (except childhood SBP) were significantly associated with increased risk of incident LV hypertrophy, with odds ratios of BMI (odds ratio=1.85-2.74, P<0.05 for all) being significantly greater than those of SBP (odds ratio=1.09-1.34, P<0.05 for all except childhood SBP). In addition, all BMI measures were significantly and positively associated with incident eccentric and concentric LV hypertrophy. CONCLUSIONS: Life-course cumulative burden of BMI and BP is associated with the development of LV hypertrophy in midlife, with BMI showing stronger associations than BP. Visual Overview: An online visual overview is available for this article.


Assuntos
Pressão Sanguínea , Índice de Massa Corporal , Ventrículos do Coração/crescimento & desenvolvimento , Hipertrofia Ventricular Esquerda/epidemiologia , Obesidade/epidemiologia , Adulto , Criança , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/etnologia , Masculino , Obesidade/etnologia , /estatística & dados numéricos
20.
BMJ Open Diabetes Res Care ; 7(1): e000824, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31875134

RESUMO

Objective: To investigate the association of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with cardiometabolic risk factors in children and adolescents. Research design and methods: This cross-sectional study consisted of 8460 children and adolescents aged 6-18 years from Chinese urban areas who underwent dual-energy X-ray absorptiometry scan and had metabolic risk factors measured. Results: In multivariate analysis adjusted for region, family income, age, puberty development, physical activity, and smoking, VAT and SAT were significantly associated with all metabolic risk factors for both sexes (all p<0.01). After additional adjustment for fat mass index, most of these associations remain significantly positive. In boys, SAT had greater ORs for all risk factors compared with VAT; in girls, however, SAT had greater odds for high triglycerides, smaller odds for high low-density lipid cholesterol, and similar odds for other risk factors compared with VAT. In addition, boys had greater magnitude of associations of SAT with high total cholesterol, high low-density lipid cholesterol, and low high-density lipid cholesterol compared with girls; no sex differences for VAT were observed. Conclusions: Both abdominal VAT and SAT have adverse impacts on most of the cardiometabolic risk factors in youth. However, their relative contributions differ between sexes.


Assuntos
Gordura Abdominal/fisiopatologia , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Gordura Intra-Abdominal/fisiopatologia , Doenças Metabólicas/epidemiologia , Obesidade/complicações , Gordura Subcutânea/fisiopatologia , Adolescente , Biomarcadores/análise , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Criança , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Doenças Metabólicas/etiologia , Doenças Metabólicas/patologia , Prognóstico , Fatores de Risco , Maturidade Sexual
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