Adiposity status and arterial system in childhood and adolescence
Authors: Yanina Zócalo, Daniel Bia
Journal: The Lancet Child & Adolescent Health (2019)

Overweight and obesity, defined as abnormal or excessive fat accumulation that might impair health, track from childhood and adolescence to adulthood, a stage in which an excess in body fat is clearly associated with increased cardiovascular risk.1WHOObesity and overweight.http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweightDate: 2017Date accessed: April 1, 2019Google Scholar Cardiovascular changes associated with obesity have been observed during childhood or adolescence itself and can be modified as a result of proper interventions.2Ayer J Charakida M Deanfield JE Celermajer DS Lifetime risk: childhood obesity and cardiovascular risk.Eur Heart J. 2015; 36: 1371-1376Crossref PubMed Scopus (117) Google Scholar However, findings have not always been consistent and there are still several gaps in the understanding of the link between adiposity and cardiovascular changes in early life. Differences in individuals' characteristics, techniques and parameters used to estimate body fat,2Ayer J Charakida M Deanfield JE Celermajer DS Lifetime risk: childhood obesity and cardiovascular risk.Eur Heart J. 2015; 36: 1371-1376Crossref PubMed Scopus (117) Google Scholar methodological approaches, and cardiovascular parameters analysed (eg, central vs peripheral, local vs regional, structural vs functional) might help to explain the conflicting data.3Garcia-Espinosa V Bia D Castro J et al.Peripheral and central aortic pressure, wave-derived reflection parameters, local and regional arterial stiffness and structural parameters in children and adolescents: impact of body mass index variations.High Blood Press Cardiovasc Prev. 2018; 25: 267-280Crossref PubMed Scopus (17) Google Scholar Proper assessment, analysis, and interpretation of data regarding adiposity status require measuring precise indicators and considering accurate definitions of the different conditions (eg, overweight and obesity or arterial organ damage). In turn, to evaluate the cardiovascular impact of adiposity status, parameters sensitive to fat content should be identified and analysed controlling for covariates. In this context, Frida Dangardt and colleagues' Article4Dangardt F Charakida M Georgiopoulos G et al.Association between fat mass through adolescence and arterial stiffness: a population-based study from the Avon Longitudinal Study of Parents and Children.Lancet Child Adolesc Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2352-4642(19)30105-1Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar published in The Lancet Child & Adolescent Health contributes to the understanding of adiposity status and its effects in children and adolescents, highlighting how various parameters used to assess adiposity differ in their association with vascular properties. The authors studied 3423 participants of the Avon Longitudinal Study of Parents and Children who had longitudinal adiposity measures (ie, total and trunk fat mass index [FMI]) collected between ages 9–17 years and analysed their associations with aortic stiffness at 17 years measured by carotid-femoral pulse wave velocity (PWV). The authors found that a persistently high total FMI and trunk FMI during adolescence was associated with greater aortic stiffness compared with lower FMI (PWV 0·15 m/s per kg/m2, 95% CI 0·05–0·24; p=0·0044 for total FMI and 0·15 m/s per kg/m2, 0·06–0·25; p=0·0021 for trunk FMI). The association was independent of the presence or absence of metabolic abnormalities and remained significant after covariate adjustment. The adverse association was not apparent when body-mass index (BMI) or waist-to-height ratio were considered. Moreover, in 33% of the adolescents, the adiposity status was misclassified by BMI. These findings emphasise the relative insensitivity of BMI in differentiating lean mass from fat mass in adolescents. In Dangardt and colleagues' findings, FMI emerges as the measure most associated with aortic stiffness rather than other more commonly used anthropometric indices of adiposity (eg, BMI and waist-to-height ratio). Therefore, fat mass indicators such as FMI should be considered when analysing the cardiovascular impact of adiposity status or when estimating cardiovascular risk associated with overweight and obesity in adolescence. The clinical meaning of the statistical association between aortic stiffness and fat mass should be assessed in further studies. A multiparametric approach could be useful in the evaluation of adiposity status and its cardiovascular impact, making it possible to identify the most suitable parameters for these purposes. The effects of overweight and obesity have been shown to vary depending on the haemodynamic or arterial parameters analysed.3Garcia-Espinosa V Bia D Castro J et al.Peripheral and central aortic pressure, wave-derived reflection parameters, local and regional arterial stiffness and structural parameters in children and adolescents: impact of body mass index variations.High Blood Press Cardiovasc Prev. 2018; 25: 267-280Crossref PubMed Scopus (17) Google Scholar Furthermore, in children and adolescents, a hierarchical order has been observed in the haemodynamic and arterial changes associated with variations in body mass.3Garcia-Espinosa V Bia D Castro J et al.Peripheral and central aortic pressure, wave-derived reflection parameters, local and regional arterial stiffness and structural parameters in children and adolescents: impact of body mass index variations.High Blood Press Cardiovasc Prev. 2018; 25: 267-280Crossref PubMed Scopus (17) Google Scholar Further research would be useful to identify the best combination of adiposity and vascular parameters to describe the biological links between overweight or obesity and early cardiovascular changes. In Dangardt and colleagues' work,4Dangardt F Charakida M Georgiopoulos G et al.Association between fat mass through adolescence and arterial stiffness: a population-based study from the Avon Longitudinal Study of Parents and Children.Lancet Child Adolesc Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2352-4642(19)30105-1Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar the association between FMI and aortic stiffness was amplified in the presence of a metabolically unhealthy phenotype—characterised as the presence of three or more cardiovascular risk factors—adding to the knowledge of the vascular impact of the clustering of such risk factors in adolescence. An analysis of the potential significance of other cofactors associated with arterial stiffness (eg, heart rate, cardiac output, aortic blood pressure) would be of value,5Zocalo Y Marin M Curcio S et al.Increases in peripheral systolic pressure levels and Z-score associate gradual aortic pressure increase and functional arterial impairment in children and adolescents.Curr Hypertens Rev. 2018; 14: 170-182Crossref PubMed Scopus (6) Google Scholar as would be an assessment of the relative contribution of the analysed covariates to the vascular changes associated with the adiposity status. The evaluation of growth trajectories has been proposed as a valuable way of analysing variables over time, taking into account the interindividual differences in the variables themselves and in the effect of covariates.6Araújo J Barros H Ramos E Li L Trajectories of total and central adiposity throughout adolescence and cardiometabolic factors in early adulthood.Int J Obes. 2016; 40: 1899-1905Crossref Scopus (15) Google Scholar In their longitudinal analysis, Dangardt and colleagues4Dangardt F Charakida M Georgiopoulos G et al.Association between fat mass through adolescence and arterial stiffness: a population-based study from the Avon Longitudinal Study of Parents and Children.Lancet Child Adolesc Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2352-4642(19)30105-1Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar classified participants into groups according to longitudinal fat mass: high, middle, and low trajectories. The authors described differences in the association between FMI and PWV depending on the trajectory considered. Compared with the low trajectory, persistently high total FMI between 9 and 17 years of age was associated with greater PWV at 17 years (PWV 0·07 m/s per kg/m2, 95% CI 0·01–0·14, p=0·027). The association remained significant after adjusting for several cofactors, including current Z-score of BMI (at 17 years) and birthweight. Similarly, persistently high trunk FMI was associated with greater PWV and retained this association after multivariable adjustment. Hence, the importance of considering the trajectories in data analysis and interpretation is reinforced. Aortic stiffness was not evaluated before age 17 years,4Dangardt F Charakida M Georgiopoulos G et al.Association between fat mass through adolescence and arterial stiffness: a population-based study from the Avon Longitudinal Study of Parents and Children.Lancet Child Adolesc Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2352-4642(19)30105-1Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar but the authors found similar PWV values between participants who lost fat mass during adolescence and those who had normal fat mass throughout the study period. This finding supports the conception of childhood and adolescence as windows for optimal implementation of effective strategies of control and prevention of overweight or obesity and its cardiovascular impact. Finally, as the authors stated, further interventional studies are needed to assess whether aggressive weight loss and metabolic control strategies during adolescence could provide long-term vascular benefits or reverse existing alterations. We declare no competing interests. Association between fat mass through adolescence and arterial stiffness: a population-based study from The Avon Longitudinal Study of Parents and ChildrenPersistently high fat mass during adolescence was associated with greater arterial stiffness and was further aggravated by an unfavourable metabolic profile. Reverting to normal FMI in adolescence was associated with normal PWV, suggesting adolescence as an important period for interventions to tackle obesity in the young to maximise long-term vascular health. Full-Text PDF Open Access