risk factors in peri urban adolescent school learners in mthatha South Africa Presented by BN NkehChungag Cardiometabolic risk factors in adolescents There is no universal consensus on the definition of ID: 920196
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Slide1
Comparison of some
cardiometabolic risk factors in peri-urban adolescent school learners in mthatha, South Africa. Presented by BN Nkeh-Chungag
Slide2Cardiometabolic
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
Slide3Prevalence 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
Slide4Were 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
Slide5South African Demographic and Health Survey 2004.www.gov.za/documents/download.php?f=90139
Slide6Prevalence of hypertension in rural South African children –
2005Ellisras study. Monyeki et al, 2005. International Journal of Epidemiology. 2006;35:114–120
Slide7Prevalence of hypertension in rural South African children/adolescents –
2012Limpopo locations. Moselakgomo et al 2012, Rev Paul Pediatr. 30:562-9
Slide8In the current study we investigated the risk factors for
cardiometabolic diseases in a peri-urban adolescent population.
Slide9Cohort
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
Slide10Males
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
Slide11Prevalence 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%)
Slide12Female
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
Slide13Number 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
Slide14Cohort
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
Slide15Hs-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
Slide16Influence 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
Slide17Lean
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
Slide18TChol/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
Slide19Conclusion
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
Slide20Thank you