Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study

Background Epidemiological studies suggest that obesity-induced atheroscler osis may start in childhood, but this process has never been demonstrated. We looked for arterial changes and investigated their relation to cardiovas cular risk factors in obese children. Methods Non-invasive ultrasonographic measurements were made in 48 severely obese children and 27 controls to investigate arterial mechanics and endot helial function. Plasma lipid concentrations, indices of insulin resistance , and body composition were assessed in the obese children. Findings The obese children had significantly lower arterial compliance tha n the healthy controls (median 0.132 [0.022-0.273], vs 0.143 [0.112-0.237] mm(2).mm Hg; p=0.02) and lower distensibility (0.60 [0.10-1.00] vs 0.70 [0. 50-1.10] mm Hg-1.10(-2); p=0.0001). Conversely, the obese children had high er values than the controls for wall stress (3.36 [2.00-5.01] vs 2.65 [2.13 -3.54] mm Hg.10(2); p=0.0001) and incremental elastic modulus (1.68 [0.72-1 0.8] vs 0.96 [0.64-1.47]; p=0.0001). Endothelium-dependent and independent function were also lower in the obese than in the control children. An andr oid fat distribution was positively correlated with indices of insulin resi stance and plasma triglyceride concentrations and was negatively correlated with plasma HDL-cholesterol concentration and arterial compliance. Endothe lial dysfunction was correlated with low plasma apolipoprotein A-1 and with insulin resistance indices. Interpretation Severe obesity in children is associated with arterial wall stiffness and endothelial dysfunction. Low plasma apolipoprotein A-1, insul in resistance, and android fat distribution may be the main risk factors fo r these arterial changes, which are of considerable concern as possible ear ly events in the genesis of atheroma.