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European Heart Journal Advance Access originally published online on February 1, 2008
European Heart Journal 2008 29(6):792-799; doi:10.1093/eurheartj/ehm633
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure

Yacine Aggoun{dagger}, Nathalie J. Farpour-Lambert*,{dagger}, Laetitia M. Marchand, Emmanuelle Golay, Albane B.R. Maggio and Maurice Beghetti

Paediatric Cardiology Unit, Department of Child and Adolescent, University Hospitals of Geneva, 6, rue Willy-Donze, 1211 Geneva 14, Switzerland

Received 19 March 2007; revised 25 November 2007; accepted 20 December 2007; online publish-ahead-of-print 1 February 2008.

* Corresponding author: Tel: +41 22 382 45 93, Fax: +41 22 382 45 04, Email: nathalie.farpourlambert{at}hcuge.ch

Aims: To determine whether impaired brachial endothelial (flow-mediated dilation, FMD) and smooth muscle function (nitroglycerin-mediated dilation, NTGMD), and remodelling of the common carotid artery (CCA) develop before puberty in obese children.

Methods and results: Arterial intima–media thickness (IMT), FMD and NTGMD were measured by high-resolution ultrasound in 48 obese and 23 lean pre-pubertal children (8.8 ± 1.5 years old). We assessed central pulse pressure, incremental elastic modulus (Einc), casual and ambulatory systolic (SBP) and diastolic blood pressure (DBP), and body fatness by DXA. Obese children had significantly lower FMD (4.5 ± 4.0 vs. 8.3 ± 1.7%), NTGMD (19.0 ± 9.0 vs. 25.8 ± 6.1%), and increased Einc (13.9 ± 5.2 vs. 10.4 ± 5.2 mmHg/102), ambulatory SBP (121.3 ± 12.6 vs. 106.6 ± 7.1, mmHg), and DBP (69.1 ± 5.7 vs. 63.7 ± 4.5) than lean subjects, whereas IMT was not augmented. Ambulatory systolic hypertension was present in 47% of obese subjects. FMD, NTGMD, and Einc were correlated with body fatness, body mass index, and blood pressure (BP).

Conclusion: Impaired endothelial and smooth muscle functions and altered wall material develop before puberty in obese children, however remodelling of the CCA is not yet present. Arterial dysfunction may be considered as the first marker of atherosclerosis and is associated with elevated BP. Ambulatory blood pressure monitoring may be a potential tool to improve risk stratification in obese children.

Key Words: Obesity • Endothelium • Arteries • Hypertension • Cardiovascular disease • Child • Paediatrics

{dagger} The first two authors contributed equally.


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