Comparison of some cardiometabolic - PowerPoint Presentation

Slide1

Comparison of some

cardiometabolic risk factors in peri-urban adolescent school learners in mthatha, South Africa. Presented by BN Nkeh-Chungag

Cardiometabolic

risk factors in adolescentsThere is no universal consensus on the definition of cardiometabolic risk factors in childrenThe International Diabetes Federation attempted to standardize the definition of these risk factors however the National Cholesterol Education Program and Adult Treatment Panel III (NCEP-ATP III) covers children betterHypertension is an important risk factor which tends to be neglected in children and adolescentsDescribed by African Union as Africa’s second challenge only after AIDS

Prevalence of hypertension in adolescents

Hypertension. 2013; 62: 247-254

Children

whose

BMI or WC were

in the top

25%

for their age group were about twice as likely to have elevated blood pressure as children with measurements in the bottom

25%.

African-American children had a

28%

higher risk of elevated blood pressure than Caucasians

Were low HT rates due to low prevalence or poor diagnostic methods?

The use of percentiles for age, sex and height has been a challengeHowever there is a trend for higher HT prevalence rates in South African childrenHypertension in South African adolescents

http://www.hypertension.org.za/monthly-theme/hypertension-in-adolescents-the-race-against-time

http://www.health24.com/Diet-and-nutrition/Weight-loss/Obesity-are-our-children-doomed-20130725

South African Demographic and Health Survey 2004.www.gov.za/documents/download.php?f=90139

Prevalence of hypertension in rural South African children –

2005Ellisras study. Monyeki et al, 2005. International Journal of Epidemiology. 2006;35:114–120

Prevalence of hypertension in rural South African children/adolescents –

2012Limpopo locations. Moselakgomo et al 2012, Rev Paul Pediatr. 30:562-9

In the current study we investigated the risk factors for

cardiometabolic diseases in a peri-urban adolescent population.

Cohort

Females

Males

N

410

283

127

Age

15±0.07

15±0.08

15.3±0.1

Weight

64±0.8

65±0.9

62.4±1.4

Height

161±0.4

159±0.4

166.2±0.8

*

BMI

25±0.3

26±0.4

*

22.5±0.5

WC

77±0.6

79±0.7

*

73.8±1

HC

98±0.7

101±10.8

*

91±1

Demographic and general information on participants

Males

Females

Total

Lean

OW/OB

Total

Lean

OW/OB

N

127

97

30

283

137

146

MSBP

121.9±1

120±1.3

125.6±1.7

*

118±0.6

114.6±1.1

120.3±0.9

*

MDBP

72±0.7

71.3±1

74.7±1.3

*

72±1.4

70.9±0.8

72.9±0.5

*

Note:

Total

= all males or females, lean= BMI<85

th

percentile for age and gender; - overweigh/obese (OW/OB)= BMI ≥85

th

percentile,

BMI- Body mass

index,

*

p<0.05.

Blood pressure by

gender and body

size

Prevalence of hypertension in adolescents

Hypertension

Pre-hypertension

Normotensive

Whole cohort (n=391)

83 (21.2%)

48 (12.3%)

260 (66.5%)

Males (n=118)

26 (22.0%)

16 (13.6%)

76 (64.4%)

Females (n=273)

57 (20.9%)

32 (11.7%)

184 (73.4%)

Lean (BMI<85

th

%) (n=224)

37 (16.5%)

25 (11.1%)

162 (72.3%)

Overweight (BMI≥85

th

<95

th

%)

(n=84 )

25 (29.8%)

13 (15.5%)

46 (54.7%)

Obese (BMI≥95

th

%) (n=78)

13 (16.7%)

16 (20.5%)

49 (62.8%)

Female

MaleP-valueBMI25.7±0.322.6±0.4

0.001SBP118.5±0.7

122.1±1

0.003

DBP

71.9±0.5

71.8±0.8

0.82

Triglycerides

0.77±0.02

0.8±0.030.48

HDL

1.56±0.02

1.34±0.03

0.001

Glucose

4.6±0.04

0.47±0.06

0.13

Risk factors for metabolic syndrome

Number of risk factors for metabolic syndrome

Lean ParticipantsObese participantThree or more

risk

factors

10

43

Two risk

factors

32

59

One risk factor7547No risk factor

101

0

Risk factors or metabolic syndrome in lean

vs

obese

Metabolic syndrome was defined

by the NCEP with modification,

Silveira

et al, 2013

Cohort

FemalesMalesNumber (n/%)370257 (69.5%)113 (30.5%)Overweight/Obese

112 (30.3%)94

28

Metabolic Syndrome

53 (14.3%)

33 (12.8%)#

20 (17.7%)#

Two

risk factors

92

6924One risk factor

122

86

36

No risk factor

103

68

34

Prevalence of the metabolic syndrome

Metabolic syndrome was defined

by the NCEP with modification,

Silveira

et al, 2013

Hs-CRP and

Adiponectin levels Cohort

Participant with metabolic

syndrome

Without

metabolic syndrome

P-value

HS-CRP

2.02 ±0.41

1.72±0.17

0.51

Adiponectin

14.33±2.5

16.83±0.9

0.36

Participant with metabolic

syndrome

Females

Males

P-value

Hs-CRP

1.67±0.31

2.68±1.7

0.30

Adiponectin

14.5±2.3

13.5±10.8

0.81

Influence of BMI on CVD markers

BMI > 5

th < 85

th

%

BMI > 85

th

%

p-value

hs

-CRP (mg/l)

1.44

±

0.16

2.42

±0.3

0.002**

Adiponectin

(

µ

g/ml

)

17.4

±1.8

14.7

±1.2

0.16

Influence of WC on CVD markers

WC

≤ 80 cm

WC > 80 cm

p-value

hs

-CRP (mg/l)

1.4

±0.2

2.8

±0.4

0.0001

Adiponectin

(

µ

g/ml

)17.2±1.114.9±1.30.2*Body size effect on CVD markers

Lean

Overweight/ObeseP-valueTCh/HDL2.67±0.052.95±0.07

0.001

LDL/HDL

1.65±0.13

1.71±0.56

0.71

TRIG/HDL

0.53±0.19

0.58±0.03

0.08

Atherosclerosis indices

TChol/HDL

LDL/HDL

TGL/HDL

MDBP

R

0.038

0.039

0.087

95% CI

-0.202 - 0.274

-0.201-0.275

-0.154 - 0.319

p-value

0.751

0.741

0.467

MSBP

R

0.232

0.248

0.167

95% CI

-0.066 - 0.446

0.0106-0.459

0.074 - 0.390

p-value

0.049

*

0.036

*

0.160

hs-CRP

R

0.266

0.277

0.039

95% CI

0.030 - 0.483

0.041-0.483

-0.201- 0.275

p-value

0.023

*

0.019

*

0.74

Pearson correlations between various atherosclerosis indices

with BP and Hs-CRP

TChol/HDL

LDL/HDL

TGL/HDL

MDBP

R

0.038

0.039

0.087

95% CI

-0.202 - 0.274

-0.201-0.275

-0.154 - 0.319

p-value

0.751

0.741

0.467

MSBP

R

0.232

0.248

0.167

95% CI

-0.066 - 0.446

0.0106-0.459

0.074 - 0.390

p-value

0.049

*

0.036

*

0.160

hs-CRP

R

0.266

0.277

0.039

95% CI

0.030 - 0.483

0.041-0.483

-0.201- 0.275

p-value

0.023

*

0.019

*

0.74

Conclusion

Cardiometabolic risk factors were greater in overweight/obese adolescents Cardiometabolic risks were greater in males than in females Hs-CRP was significiantly increased in adolescents with higher BMI

Adiponectin levels were significantly decreased in

overweight /obese adolescents

Thank you