OR48-4 Endothelial Dysfunction & Subclinical Inflammation in Inner City Bronx Obese Adolescent Population

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR48-Insulin Resistance & Metabolic Syndrome: From Clinical Physiology to Clinical Care
Tuesday, June 18, 2013: 9:15 AM-10:45 AM
Presentation Start Time: 10:00 AM
Room 304 (Moscone Center)
Chhavi Agarwal*1, Hillel W Cohen2, Radhika H Muzumdar3 and Jill P Crandall4
1Children's Hospital at Montefiore, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY, 3Children's Hospital of Montefiore, Bronx, NY, 4Albert Einstein College of Med, Bronx, NY
Cardiovascular disease (CVD) is the major cause of death in developed countries. Although overt coronary heart disease rarely manifests during childhood, atherosclerosis can begin by the second decade of life. Since childhood obesity may increase that risk, identifying reliable risk markers of early vascular disease in childhood is vital.  Assessment of endothelial dysfunction (EnD) using reactive hyperemia peripheral arterial tonometry (RH-PAT) is a promising marker of early atherosclerosis. Objective: To investigate if morbid obesity in children is associated with early abnormalities of EnD, and whether EnD differences may be mediated by obesity related inflammation and insulin resistance. Methods: Cardiovascular risk factors, adipocytokines, and EnD were evaluated in obese adolescents, with and without hyperglycemia, and compared to healthy, lean controls. A total of 51 adolescents (12-18years) were enrolled. BMI in the obese group (n=37) was ≥95th percentile for age and sex and the lean group (n=14) was between 5th-85th percentiles. Based on oral glucose tolerance tests, the obese group was further subdivided into 2 groups, with normal or impaired glucose tolerance. There were no patients with diabetes in the study. Fasting glucose, insulin, lipids, adipocytokines, CRP were measured and EnD was determined using RH-PAT. T-tests and linear regression were used for unadjusted and adjusted analyses respectively. Results: Obese subjects had statistically significantly lower RH-PAT score compared to lean controls (1.70±0.02 VS 1.98±0.09,P=0.02), indicating more EnD, and the association persisted after adjusting for age, sex and ethnicity (P=0.02). There was no significant difference in RH-PAT score in obese subjects with and without hyperglycemia (p=0.9).Obese subjects were more insulin resistant [higher HOMA] (p=0.03), had higher Leptin (p=0.004), hs CRP (p=0.0004), and TNF-α (p=0.03) compared to lean subjects. When adjusted for insulin resistance or adipocytokines, the β coefficient for BMI was reduced in each case >10%; consistent with both insulin resistance and inflammation mediating the association of BMI with EnD. Conclusion: Obese subjects have higher cardiovascular risk burden as evidenced by elevated HOMA, Leptin, TNF-α, CRP and lower RH-PAT score suggesting greater EnD. This highlights that obesity in children is a risk factors for adult CVD. Identification of EnD by noninvasive, ambulatory methods such as RH-PAT may allow for earlier intervention while it is still reversible. Whether such earlier, individually tailored medical therapy for at-risk obese children will yield better health outcomes needs further study.

Nothing to Disclose: CA, HWC, RHM, JPC

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