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http://hdl.handle.net/11375/21484
Title: | Investigating the relationship between dysglycemia and measures of carotid intima-media thickness in children and youth enrolled in weight management |
Other Titles: | Dysglycemia and carotid intima-media thickness in children and youth with obesity |
Authors: | Li, Jenifer |
Advisor: | Morrison, Katherine |
Department: | Medical Sciences |
Publication Date: | 2017 |
Abstract: | INTRODUCTION: The prevalence of obesity in Canadian adults is high and is mirrored in the pediatric population. The collective increase of childhood obesity over the last three decades has been associated with a corresponding rise in the deterioration in cardiometabolic health. Abnormally high measures of blood glucose are indicative of impaired glucose metabolism that is related to the development of adverse adult conditions such as type 2 diabetes mellitus (T2DM) and/or cardiovascular disease (CVD). Prediabetes is a transient state of abnormally elevated blood glucose levels that, in adults, has comparable cardiovascular risk to diagnosed diabetes. Previous studies have demonstrated that children with prediabetes can progress to T2DM over a short period of time. Given that up to 21% of children with obesity have abnormal glucose parameters, it is critical to manage risk at early stages of life in this population in order to prevent adverse adult outcomes. PURPOSE: The purpose of this study was to evaluate if there is a contributing role of prediabetes on vascular structure, assessed via carotid intima-media thickness (cIMT), in children and youth with obesity. Given the high prevalence of adverse health indicators, we aimed to characterize the relationships between these clinical measures and early structural changes associated with atherosclerosis progression. As protocols used to measure cIMT in pediatric studies vary, an additional aim of this project was to assess comparability of cIMT protocols reported in the literature. HYPOTHESIS: It is hypothesized that children with obesity and prediabetes will have greater mean cIMT compared to normal glycemic controls and that mean cIMT will be significantly different across varying cIMT methodologies. METHODS: We recruited 165 participants (ages 5-17y) into this cross-sectional study, a sub-study of the CANadian Pediatric Weight Management Registry (CANPWR). This study assessed cIMT via B-mode ultrasonography in children and youth at time of entry into a weight management program. Clinical measures were obtained via prospective clinical chart review and were evaluated to identify potential relationships between modifiable and non-modifiable cardiovascular health indicators and measures of cIMT, using univariable and multivariable regression analyses. To compare methodologies, we assessed differences of mean cIMT (mm) using an intra-class correlation and a Bland-Altman plot. RESULTS: Fasting plasma glucose was related to mean cIMT (mm) in univariable analyses (p=0.047), but no measure of glycemia was independently correlated to arterial thickness. Segment-specific thickening contributed to significant differences in mean cIMT (mm) between methodologies that included all arterial segments (far and near wall of the common carotid artery, carotid bulb, and internal carotid artery; 12-segment) compared to those limited to the far wall of the common carotid artery (2-segment) (p<0.001). Intra-class correlation between these cIMT methodologies indicated moderate resemblance (ICC: 0.65, 95%CI: 0.55 to 0.73), however, a significant difference between means (mean difference: 0.012mm, 95%CI: -0.016 to -0.009, p<0.001) and a positive proportional bias (r=0.19, 95%CI: 0.06 to 0.31, p=0.003) were present. Furthermore, correlates of mean cIMT were inconsistent between varying methodologies commonly used to assess cIMT in children. CONCLUSIONS: In this study, dysglycemia did not predict on arterial thickness in children and youth with obesity. By comparing determinants and absolute differences between measures of cIMT, this study emphasizes the heterogeneity between the two methodologies and suggests that they should not be used interchangeably. |
URI: | http://hdl.handle.net/11375/21484 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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Li_Jenifer_FinalSubmissionApril2017_MSc.pdf | 2.67 MB | Adobe PDF | View/Open |
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