title: Impaired flow-mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: the impact of cardiovascular risk factors.
abstract: OBJECTIVE
  Childhood obesity contributes to the development of adult obesity and subsequent cardiovascular disease. The present study aimed to assess vascular status (flow-mediated vasodilation [FMD], intima-media thickness [IMT]) and to analyze plasma surrogate endothelial markers (von Willebrand factor [vWf], E-selectin, and thrombomodulin) in obese children as compared with controls. Associations between early morphologic and functional vascular changes, surrogate soluble markers of early atherosclerosis, and the cardiovascular risk profile were determined.
  
  
  METHODS
  We examined 32 obese children versus 20 control subjects. All of the children underwent identical screening, comprehensive risk factor assessment, and measurements of E-selectin, vWf, thrombomodulin, FMD, and IMT.
  
  
  RESULTS
  Compared with controls, obese children demonstrated significantly impaired FMD and increased IMT. Concentrations of soluble E-selectin and thrombomodulin were significantly elevated in obese children, whereas vWf showed no significant differences between obese children and controls. FMD, IMT, E-selectin, and thrombomodulin were significantly associated with various risk factors, including the extent of obesity, arterial hypertension, fibrinogen, C-reactive protein, and low physical fitness.
  
  
  CONCLUSIONS
  The present study documented increased IMT, impaired endothelial function, and elevated plasma markers of endothelial activation and injury in obese children. Morbid obesity, arterial hypertension, subclinical inflammation, and low physical fitness formed a risk profile associated with the risk of early atherosclerosis in these children. Sonographic assessment of vascular status and the estimation of soluble endothelial plasma markers, combined with comprehensive risk factor screening, may form a rationale to identify high-risk children susceptible to early atherosclerotic disease and to monitor vascular changes during follow-up studies and therapeutic measures.
authors.affiliation: Division of Pediatric Cardiology, Childrens Hospital, University of Rostock, Rostock, Germany. andreas-alexander.meyer@medizin.uni-rostock.de
authors.forename: Andreas Alexander
authors.initials: AA
authors.lastname: Meyer
authors.forename: Günther
authors.initials: G
authors.lastname: Kundt
authors.forename: Michael
authors.initials: M
authors.lastname: Steiner
authors.forename: Peter
authors.initials: P
authors.lastname: Schuff-Werner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kienast
mesh_terms: D000293:Adolescent; D050197:Atherosclerosis / Q000175:diagnosis / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D002339:Carotid Arteries / Q000473:pathology*; D002648:Child; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000378:metabolism*; D006801:Humans; D009765:Obesity / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D017534:Radial Artery; D012307:Risk Factors; D018180:Thrombomodulin / Q000032:analysis; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*; D014664:Vasodilation; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D019040:E-Selectin; D018180:Thrombomodulin; D014841:von Willebrand Factor