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Departments of Endocrinology and Diabetes (A.S.P., K.M., J.C.) and Pediatrics (J.C.), Medical Imaging (R.G., L.P.), and Public Health Research Unit (C.H.), University of Adelaide, Women’s and Children’s Hospital, North Adelaide, South Australia 5006, Australia; and Department of Pediatrics and Child Health (E.W.), Wellington School of Medicine and Health Sciences, Wellington South, Wellington, New Zealand
Address all correspondence and requests for reprints to: Alexia Sophie Peña, Department of Endocrinology, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia. E-mail: alexia.pena{at}adelaide.edu.au.
Context: Endothelial and smooth muscle dysfunction are critical precursors of atherosclerosis. These can be detected in children at risk of cardiovascular disease.
Objective: The objective of this study is to evaluate endothelial and smooth muscle function and their determinants using flow-mediated dilatation (FMD) and glyceryl trinitrate-mediated dilatation (GTN) in obese, nonobese, and type 1 diabetes mellitus (T1DM) children.
Design: This is a cross-sectional study.
Subjects: The study subjects were 270 children [140 males, mean age 13.7 (2.8) yr] including 58 obese, 53 nonobese, and 159 T1DM children.
Measurements: Vascular function (FMD and GTN), body mass index (BMI) z-score, blood pressure, glucose, glycosylated hemoglobin, lipids, folate, homocysteine, and high sensitive C-reactive protein were measured.
Results: FMD and GTN were significantly lower in obese and T1DM compared with nonobese subjects (P < 0.001, P < 0.001). FMD and GTN were similarly reduced in obese and T1DM subjects (P = 0.22, P = 0.28). In all nondiabetic subjects (n = 111), both FMD and GTN were significantly and independently related to BMI z-score (r = –0.28, P = 0.003, ß = –0.36, P < 0.001) and weight z-score (ß = –0.31, P = 0.002; r = –0.52, P < 0.001). FMD related independently to total cholesterol (ß = –0.22, P = 0.02). GTN related independently to vessel diameter (ß = –0.49, P < 0.001). GTN related to glucose within the normal range (r = –0.34, P = 0.001).
Conclusions: Children with obesity and T1DM have a similar degree of vascular dysfunction. BMI and weight adjusted for age and sex relate to endothelial and smooth muscle function in nonobese and obese children. Glucose relates to smooth muscle function in nonobese nondiabetic children. This suggests a continuum effect of BMI and glucose within the normal range on vascular function in childhood.
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