Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2334-2340 (doi:10.1542/peds.2006-0302)
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ARTICLE

Intima-Media Thickness in Obese Children Before and After Weight Loss

Rainer Wunsch, MDa, Gideon de Sousa, MDb, André Michael Toschke, MPH, MScc and Thomas Reinehr, MDb

b Departments of Pediatrics
a Pediatric Radiology, University of Witten/Herdecke, Germany
c Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig Maximilians University of Munich, Munich, Germany

OBJECTIVE. Obesity in childhood is related to increased intima-media thickness, a noninvasive marker for early atherosclerotic changes. The objective of this study was to analyze the changes of intima-media thickness in obese children with weight loss.

METHODS. We analyzed the changes of intima-media thickness and, as markers of cardiovascular risk factor profile, systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, glucose, insulin, and insulin resistance index (homeostasis model analysis) in 56 prepubertal obese children (median: 9 years old) before and after a 1-year outpatient intervention program. The control group consisted of 10 nonobese children of the same age and gender. We determined the carotid intima-media thickness by B-mode ultrasound with a 14-MHz linear transducer. Substantial weight loss was defined by a reduction of overweight of at least 0.5 standard deviation scores in BMI.

RESULTS. Obese children demonstrated a significantly thicker intima-media compared with the control group. Furthermore, blood pressure, triglycerides, insulin, and insulin resistance index were significantly higher in obese children, whereas high-density lipoprotein cholesterol was significantly lower. In the 24 obese children with substantial weight loss, intima-media thickness, blood pressure, triglycerides, insulin, and insulin resistance index decreased significantly, whereas high-density lipoprotein cholesterol increased significantly. In the 32 obese children without substantial weight loss, there were no significant changes apart from an increase of insulin and insulin resistance index.

CONCLUSIONS. Because obese children demonstrated a thicker intima-media, vascular changes seemed to occur already in childhood obesity. Paralleling the improvement of the cardiovascular risk factor profile, intima-media thickness decreased in obese children with substantial weight loss, suggesting the reversibility of early atherosclerotic changes.

Key Words: obesity • carotid arteries • ultrasound • weight loss • children

Abbreviations: HDL—high-density lipoprotein • IMT—intima-media thickness • SDS-BMI—SD score of BMI • SBP—systolic blood pressure • DBP—diastolic blood pressure • HOMA—homeostasis model analysis • CI—confidence interval

Accepted Aug 29, 2006.




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