Characterization and assessment of endothelial dysfunction in adolescents with obesity and vitamin D deficiency

Cover Page

Cite item

Abstract

Background. Obesity and vitamin D deficiency in children are widespread in economically developed countries. Among children with obesity and components of the metabolic syndrome, vitamin D deficiency is more common than in children with a normal body mass index (BMI). The growth of metabolic disorders, atherosclerosis, early onset of type 2 diabetes mellitus lead to fatal vascular accidents in young people, and therefore the search for new ways of early diagnosis of these processes is relevant.

Aim. To study of the relationship of endothelial dysfunction with vitamin D deficiency, obesity and associated metabolic disorders among adolescents in Saint Petersburg.

Materials and methods. 5 adolescents aged 14–16 years (15±0.76 years) with primary obesity were examined. Anthropometric parameters were studied: waist circumference, weight, height, calculation of BMI, stage of puberty according to Tanner. Laboratory examination included the following parameters: serum glucose, cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, insulin, 25(OH)D. Atherogenicity index (AI), insulin resistance index (HOMA-IR), vitamin D sufficiency were calculated. Endothelial function was assessed by the value of the reactive hyperemia index (RHI), automatically calculated by the EndoPAT 2000 device (Itamar Medical, Israel).

Results. All examined patients had abdominal obesity (median BMI 33.5 kg/m2 [30.9; 34.2]) and reduced vitamin D supply (median 25(OH)D 17.2 ng/ml). Hypercholesterolemia and dyslipidemia due to an increase in low density lipoproteins were diagnosed in 1 (20%) case. Dyslipidemia due to a decrease in high density lipoproteins was detected in 3 (60%) patients. An increase in IA was found in 4 (80%) people. Insulin resistance was present in 60% of the examined, the median value of HOMA-IR was 5.6. The median RHI was 1.74 [1.72; 2.13]. Optimum RHI values were observed in 2 (40%) patients; in most (60%) adolescents, the RHI values corresponded to subnormal values and were close to the lower limit of this zone. A significant inverse correlation of RHI with AI was obtained (R=-0.63, p<0.05).

Conclusion. Taking into account the risk factors previously identified in the examined patients (dyslipidemia, insulin resistance, reduced vitamin D supply), endothelial dysfunction in these patients was regarded as a cardiovascular risk factor. A manageable risk factor is a reduced supply of vitamin D, which can be corrected by an additional donation of cholecalciferol.

Full Text

Restricted Access

About the authors

Anastasiia M. Todieva

Almazov National Medical Research Centre

Email: Todieva_AM@almazovcentre.ru

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Nadezhda E. Zvartau

Almazov National Medical Research Centre

Email: nikitina0901@gmail.com
ORCID iD: 0000-0001-6533-5950

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Irina L. Nikitina

Almazov National Medical Research Centre

Author for correspondence.
Email: nikitina0901@gmail.com
ORCID iD: 0000-0003-4013-0785

D. Sci. (Med.)

Russian Federation, Saint Petersburg

References

  1. Тутельян В.А., Батурин А.К., Конь И.Я., и др. Распространенность ожирения и избыточной массы тела среди детского населения РФ: мультицентровое исследование. Педиатрия. Журнал им. Г.Н. Сперанского. 2014;93(5):28-31 [Tutel'ian VA, Baturin AK, Kon' IIa, et al. Rasprostranennost' ozhireniia i izbytochnoi massy tela sredi detskogo naseleniia RF: mul'titsentrovoe issledovanie. Pediatriia. Zhurnal im. G.N. Speranskogo. 2014;93(5):28-31 (in Russian)].
  2. Ahrens W, Pigeot I, Pohlabeln H. Prevalence of overweight and obesity in European children below the age of 10. Int J Obes. 2014;38(2):99-107. doi: 10.1038/ijo.2014.140
  3. Ebe D'Adamo, Guardamagna O, Chiarelli F, et al. Atherogenic Dyslipidemia and Cardiovascular Risk Factors in Obese Children. Int J Endocrinol. 2015;2015:912047. doi: 10.1155/2015/912047
  4. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17(2):95-107. doi: 10.1111/obr.12334
  5. Koszowska AU, Nowak J, Dittfeld A, et al. Obesity, adipose tissue function and the role of vitamin D. Cent Eur J Immunol. 2014;39(2):260-4.
  6. Walker GE, Rocotti R, Roccio M, et al. Pediatric obesity and vitamin D deficiency: a proteomic approach identifies multimeric adiponectin as a key link between these conditions. PLoS One. 2014;9(1):e83685.
  7. Belenchia AM, Tosh AK, Hillman LS, Peterson CA. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. Am J Clin Nutr. 2013;97(4):774-81.
  8. Menezes AR, Lamb MC, Lavie CJ, DiNicolantonio JJ. Vitamin D and atherosclerosis. Curr Opin Cardiol. 2014;29(6):571-7.
  9. Rusconi RE, De Cosmi V, Gianluca G, et al. Vitamin D insufficiency in obese children and relation with lipid profile. Int J Food Sci Nutr. 2015;66(2):132-4.
  10. Никитина И.Л., Тодиева А.М., Каронова Т.Л., Гринева Е.Н. Взаимосвязь уровня витамина D, содержания адипоцитокинов и метаболических нарушений у детей с ожирением. Трансляционная медицина. 2013;3(20):37-46 [Nikitina IL, Todieva AM, Karonova TL, Grineva EN. Vzaimosviaz' urovnia vitamina D, soderzhaniia adipotsitokinov i metabolicheskikh narushenii u detei s ozhireniem. Transliatsionnaia meditsina. 2013;3(20):37-46 (in Russian)].
  11. Зазерская И.Е., Дорофейков В.В., Хазова Е.Л. Витамин D и репродуктивное здоровье женщины. СПб.: Эко-Вектор, 2017 [Zazerskaia IE, Dorofeikov VV, Khazova EL. Vitamin D i reproduktivnoe zdorov'e zhenshchiny. Saint Petersburg: Eko-Vektor, 2017 (in Russian)].
  12. Никитина И.Л., Тодиева А.М., Каронова Т.Л., Буданова М.В. Ожирение у детей и подростков: особенности фенотипа, ассоциации с компонентами метаболического синдрома. Вопросы детской диетологии. 2012;10(5):23-30 [Nikitina IL, Todieva AM, Karonova TL, Budanova MV. Ozhirenie u detei i podrostkov: osobennosti fenotipa, assotsiatsii s komponentami metabolicheskogo sindroma. Voprosy detskoi dietologii. 2012;10(5):23-30 (in Russian)].
  13. Никитина И.Л., Каронова Т.Л., Гринева Е.Н. Дефицит витамина D и здоровье. Артериальная гипертензия. 2010;16(3):277-81 [Nikitina IL, Karonova TL, Grineva EN. Defitsit vitamina D i zdorov'e. Arterial'naia gipertenziia. 2010;16(3):277-81 (in Russian)].
  14. Holic MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30. doi: 10.1210/jc.2011-0385
  15. August GP, Caprio S, Fennoy I, et al. Prevention and Treatment of pediatric obesity: an endocrine society clinical practice guidline based on expert opinion. J Clin Endocrinol Metab. 2008;93(12):4576-99. doi: 10.1210/jc.2007-2458
  16. Cole TJ, Freeman JV, Preece MA. Body Mass Index reference curves for the UK, 1990. Arch Dis Child. 1995;73(1):17-24. doi: 10.1136/adc.73.1.25
  17. Deanfield JE, Halcox JP, Rabelink TJ. Endothelial Function and Dysfunction Testing and Clinical Relevance. Circulation. 2007;115:1285-95.
  18. Singhal A. Endothelial dysfunction: role in obesity-related disorders and the early origins of CVD. Proc Nutr Soc. 2005;64(1):15-22.
  19. Kassi E, Adamopoulos C, Basdra EK, Papavassiliou AG. Role of vitamin D in atherosclerosis. Circulation. 2013;128(23):2517-31.
  20. Carvalho LS, Sposito AC. Vitamin D for the prevention of cardiovascular disease: Are we ready for that? Atherosclerosis. 2015;241(2):729-40.
  21. Михно В.А., Никитина И.Л. Дисфункция эндотелия как фактор риска сахарного диабета и сердечно-сосудистой патологии. Забайкальский медицинский вестник. 2009;1:53-64 [Mikhno VA, Nikitina IL. Disfunktsiia endoteliia kak faktor riska sakharnogo diabeta i serdechno-sosudistoi patologii. Zabaikal'skii meditsinskii vestnik. 2009;1:53-64 (in Russian)].
  22. Singhal A, Farooqi IS, Cole TJ, et al. Influence of leptin onarterial distensibility; a novel link between obesity and cardiovascular Disease. Circulation. 2002;106(15):1919-24. doi: 10.1161/01.cir.0000033219.24717.52
  23. Kumada M, Kihara S, Sumitsuji S, et al. Association of hypoadiponectinemia with coronary artery disease in men. Arterioscler Thromb Vasc Biol. 2003;23(1):85-9. doi: 10.1161/01.atv.0000048856.22331.50
  24. Gannagé-Yared MH, Chedid R, Khalifie S. Vitamin D in relation to metabolic risk factors, insulin sensitivity and adiponectin in a young Middle-Eastern population. Eur J Endocrinol. 2009;160:965-71.
  25. Bonetti PO, Pumper GM, Higano ST, et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol. 2004;44(11):2137-41. doi: 10.1016/j.jacc.2004.08.062
  26. Müller U, Matsuo Y, Lauber M, et al. Correlation between endothelial function measured by finger plethysmography in children and HDL-mediated eNOS activation – a preliminary study. Metabolism. 2013;62(5):634-7.
  27. Selamet Tierney ES, Newburger JW, Gauvreau K, et al. Endothelial Pulse Amplitude Testing: Feasibility and Reproducibility in Adolescents. J Pediatr. 2009;154(6):901-5. doi: 10.1016/j.jpeds.2008.12.028
  28. Bhangoo A, Sinha S, Rosenbaum M, et al. Endothelial Function as Measured by Peripheral Arterial Tonometry Increases during Pubertal Advancement. Horm Res Paediatr. 2011;76(4):226-33.
  29. Kelly AS, Marlatt KL, Steinberger J, Dengel DR. Younger Age is Associated with Lower Reactive Hyperemic Index but not Lower Flow-Mediated Dilation among Children and Adolescents. Atherosclerosis. 2014;234(2):410-4. doi: 10.1016/j.atherosclerosis.2014.03.031
  30. Kheirandish-Gozal L, Etzioni T, Bhattacharjee R, et al. Obstructive sleep apnea in children is associated with severity-dependent deterioration in overnight endothelial function. Sleep Med. 2013;14(6):526-31. doi: 10.1016/j.sleep.2013.02.010
  31. Mahmud FH, Hill DJ, Cuerden MS, Clarson CL. Impaired vascular function in obese adolescents with insulin resistance. J Pediatr. 2009;155(5):678-82.
  32. Javed A, Kullo IJ, Balagopal PB, Kumar S. Effect of vitamin D3 treatment on endothelial function in obese adolescents. Pediatr Obes. 2016;11(4):279-84. doi: 10.1111/ijpo.12059
  33. Hudgins LC, Annavajjhala V, Kovanlikaya A, et al. Paradoxical Relationship Between Reactive Hyperemia Index and Age in Children with Lipid Disorders. Journal of Clinical Lipidology. 2012. doi: 10.1016/j.jacl.2012.04.043


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies