P a t h o p h y s i o l o g y / C o m p l i c a t i o n s Early Signs of Cardiovascular Disease in Youth With Obesity and Type 2 Diabetes ESLIHAN GUNGOR, MD JANINE JANOSKY, PHD RINA THOMPSON, RN, MPH, RVT SILVA ARSLANIAN, MD
equivalent, Kruskal-Wallis. Bivariate rela-
IM SUTTON-TYRRELL, PHD
tionships were examined with Spear-man’s correlation analysis because IMTand aPWV were not normally distributed. Data are presented as means Ϯ SE. Statis-
Atherosclerotic cardiovascular dis- byTannercriteria(10)(Table1).Type2 ticalsignificancewassetatPՅ0.05.As
formin with insulin (5), insulin alone (1),
be used to establish risk of CVD, the val-
atherosclerosis is early in childhood with
progression toward clinically significant
tion to lifestyle modification. None of the
subjects had a family history of hereditary
cluded from statistical analysis (14). Data
from type 2 diabetic patients taking insu-
lin (n ϭ 6) were excluded from fasting
(aPWV), a measure of arterial stiffness, are
tiple linear regression was used to evalu-
erosclerosis that have been used as surro-
gate measures of cardiovascular events in
various adult studies (4 –9). Data regard-
ing IMT and arterial stiffness in children
for glucose, insulin, C-peptide, adiponec-
are limited despite the increasing tide of
tin, lipid profile, high-sensitivity C-reac-
RESULTS — Clinical, biochemical, and
obesity and type 2 diabetes. Therefore, in
this pilot study, we aimed 1) to evaluate
was not different among the three groups.
type 2 diabetes and 2) to investigate the
ponectin level were used as surrogate es-
timates of insulin sensitivity (11–12).
was highest in the type 2 diabetic subjects
RESEARCH DESIGN AND
jects (496.9 Ϯ 15.2) (Table 1). In the total
METHODS — We studied 20 adoles-
group, after controlling for systolic blood
pressure (because increased arterial stiff-
ness is directly related to pulsatile blood
cantly with BMI (r ϭ 0.50), fasting insulin
(r ϭ 0.46), fasting glucose (r ϭ 0.38),
age, sex, ethnicity, and puberty assessed
HOMA-IS (r ϭ Ϫ0.52), HbA1c (r ϭ0.28), triglycerides (r ϭ 0.27), and hs-
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
CRP (r ϭ 0.47) (P Ͻ 0.001– 0.042). A
From the 1Division of Pediatric Endocrinology Metabolism and Diabetes Mellitus, Children’s Hospital of
Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; the 2Department of
Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and the3
Division of Biostatistics, Department of Family Medicine and Clinical Epidemiology, University of Pitts-
burgh, School of Medicine, Pittsburgh, Pennsylvania.
Address correspondence and reprint requests to Silva Arslanian, MD, Division of Endocrinology, Chil-
revealed total R2 ϭ 0.357 (P ϭ 0.002),
dren’s Hospital of Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213. E-mail:
HOMA-IS (R2 ϭ 0.272, P ϭ 0.011) and
Received for publication 12 November 2004 and accepted in revised form 19 January 2005.
HbA1c (⌬R2 ϭ 0.085, P ϭ 0.066). Abbreviations: aPWV, aortic pulse wave velocity; CVD, cardiovascular disease; hs-CRP, high-sensitivity
C-reactive protein; IMT, intima media thickness; HOMA-IS, homeostasis model assessment of insulin sen-sitivity. CONCLUSIONS — In the present
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
2005 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be herebymarked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
DIABETES CARE, VOLUME 28, NUMBER 5, MAY 2005
Atherosclerosis in youth Table 1—Clinical and biochemical characteristics of study subjects
Data are means Ϯ SE. Significant post-hoc comparisons with Bonferroni adjustment, P Ͻ 0.025. *Normal weight vs. obese; †obese vs. type 2 diabetic; ‡type 2diabetic vs. normal weight.
mal-weight control subjects (P ϭ 0.006)
abetic youth in our study (after adjusting
suggests that obesity alone is associated
obese adults in a previous study (13) and
Acknowledgements — This work was sup-
ϳ40-year-old men in the Baltimore Lon- nonobese adults (13) and in obese French ported by U.S. Public Health Service Grantsgitudinal Study of Aging (6), suggestive of
RO1 HD27503 (to S.A.) and K24 HD01357(to S.A.), The Pittsburgh Foundation Grant
increased risk for premature aging of car-
(to N.G.), Children’s Hospital of Pittsburgh
diabetes. These findings may reflect early
RR00084, to S.A. and N.G.), The University of
Pittsburgh Obesity Nutrition Research Center
(DK046204 from the National Institute of Di-
tectable structural changes. With increas-
abetes and Digestive and Kidney Diseases, to
functional changes may progress to struc-
(to N.G.), and the Renziehausen Trust Fund
tural changes if left without intervention.
diabetic compared with obese subjects.
This proposal is consistent with a study in
American Diabetes Association 64th Scientific
Sessions, 4 – 8 June 2004 in Orlando, Florida.
endothelial activation (21). Our findings
of low adiponectin level in the obese and
type 2 diabetic subjects with evidence of
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28 CHESTERVILLE RD CHELTENHAM 3192 Heartburn Hiatus hernia is a common finding at gastroscopy AND MAY CAUSE NO SYMPTOMS. What Is HEARTBURN (gastro-oesophageal reflux)? Gastroesophageal reflux is the return of the stomach's contents back up into the oesophagus. There is a sphincter, or muscle in the lower oesophagus. Normally, the sphincter opens to allow food to
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