Article

Reduction of Risk for Cardiovascular Disease in Children and Adolescents

Department of Pediatrics, University of Colorado School of Medicine, The Children's Hospital, Aurora, CO 80045, USA.
Circulation (Impact Factor: 14.43). 10/2011; 124(15):1673-86. DOI: 10.1161/CIRCULATIONAHA.110.016170
Source: PubMed

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    • "Elevated levels of blood lipids are well-documented risk factors for cardiovascular disease. Cardiovascular disease remains the leading cause of death in the adult population, and it has been shown that the atherosclerotic process begins in childhood [58,59]. In children, investigators found that the extent to which the intimal surface was covered with atherosclerotic lesions was significantly associated with elevation of concentrations of total cholesterol, LDL, TG, and lower concentration of HDL. "
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    ABSTRACT: The liver is a major metabolic organ, essentially controlling glucose and fat metabolism. Because lipids are water-insoluble, they need to be transported in the circulation in association with proteins in the form of lipoproteins. These lipoproteins play a key role in the absorption and transport of dietary lipids by the small intestine, in the transport of lipids from the liver to peripheral tissues, and in the transport of lipids from peripheral tissues to the liver and intestine. Upon feeding, energy is provided by glycolysis and the unused glucose is stored as glycogen in the liver. Excess glucose is used to synthesize fatty acids through de novo lipogenesis. Fatty acids are incorporated into triacylglycerol, phospholipids, or cholesterol esters in hepatocytes. These complex lipids are stored in lipid droplets or secreted into the circulation as very low-density lipoprotein particles. Upon fasting, after consumption of stored glycogen, the liver secretes glucose through gluconeogenesis. Fasting also promotes lipolysis in adipose tissue, resulting in release of free fatty acids which are metabolized in hepatic mitochondria though beta-oxidation for energy production, while excess fatty acids are stored by the liver leading to hepatic steatosis. Disturbances in lipid metabolism, as in alcoholic and non-alcoholic steatohepatitis, obesity and diabetes, will affect liver performance and function. Likewise, disturbed liver functions by acute or chronic liver disease, as in viral hepatitis, will affect lipid homeostasis. This may carry an increased risk of atherosclerosis and ischemic heart disease which may endanger life. Dietary restriction or fasting was found to have a positive impact on restoring lipid homeostasis leading to improved quality of life.
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    • "A number of inflammatory factors including adipokines or adipocytokines, secreted in response to increasing adipose tissue, are known to play an important role in the atherosclerotic process and the development of diabetes and hypertension. They can also predict future cardiovascular events (Daniels et al., 2011). Elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6) together with hypoadiponectinemia are present in obese children (Cook et al., 2000; Valle et al., 2005) and may demonstrate a plausible mechanism linking increased adiposity to the development of insulin resistance (IR), type 2 diabetes and cardiometabolic disorders . "
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    ABSTRACT: This study examined the independent relationships between cardiorespiratory and muscular fitness with cardiometabolic risk in adolescents. Subjects were 192 adolescents (118 boys), aged 15-17.5 years. The 2 m multi-stage fitness test assessed cardiorespiratory fitness and the counter movement jump assessed muscular fitness. Additional measures included interleukin-6, C-reactive protein, adiponectin, fibrinogen and plasminogen activator inhibitor-1. Regression analysis revealed that cardiorespiratory fitness was negatively related to cardiometabolic risk (β = -0.014, p < 0.001). With additional adjustment for muscular fitness the relationship remained significant (β = -0.015, p < 0.001). Muscular fitness was negatively related to cardiometabolic risk (β = -0.021, p < 0.001) and remained significant after adjustment for cardiorespiratory fitness. Participants in the least-fit quartile for both cardiorespiratory and muscular fitness had significantly poorer cardiometabolic risk scores than those in the other quartiles. Findings revealed that muscular and cardiorespiratory fitness are significantly associated with cardiometabolic risk independently of one another.
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    • "Autopsy studies have shown that early coronary atherosclerosis o f t e n b eg i n s i n c h i l d h o o d a n d a d o l e s c e n c e . F u r t h e r, hypercholesterolaemia in adolescents correlated positively with changes in vasculature predictive of later CVD[9]. There is a tendency to persistence in ranks (tracking) for total serum and β-lipoprotein cholesterol with age[10]. "
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    ABSTRACT: To study the differences between the lipid profiles of the subjects whose parents are having known non-modifiable risk factors such as obesity, hypertension (HTN), myocardial infarction and diabetes, and compare them with the lipid profiles of the subjects whose parents are not having those risk factors.
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