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Submitted on April 21, 2006
Accepted on August 2, 2006
Department of Endocrinology and Diabetes, Medical Imaging, Public Health Research Unit and Department of Paediatrics. University of Adelaide, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia; Department of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, P.O. Box 7343, Wellington South, Wellington, New Zealand
* To whom correspondence should be addressed. 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: To evaluate endothelial and smooth muscle function and their determinants using flow-mediated dilatation (FMD) and glyceryl trinitrate-mediated dilatation (GTN) in obese, non-obese and type 1 diabetes (T1DM) children.
Design: Cross sectional study.
Subjects: 270 children (140 males, mean age 13.7 [2.8] years) including 58 obese, 53 non-obese and 159 T1DM children.
Measurements: Vascular function (FMD and GTN), body mass index (BMI) z-score, blood pressure, glucose, HbA1c, lipids, folate, homocysteine and high sensitive C-reactive protein.
Results: FMD and GTN were significantly lower in obese and T1DM compared with non-obese 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 non-diabetic subjects (n = 111) both FMD and GTN were significantly and independently related to BMI z-score (r= -0.28, P = 0.003, 
= -0.36, P < 0.001) and weight z-score (= -0.31, P = 0.002; r= -0.52, P < 0.001). FMD related independently to total cholesterol (= -0.22, P = 0.02). GTN related independently to vessel diameter (= -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 non-obese and obese children. Glucose relates to smooth muscle function in non-obese non-diabetic children. This suggests a continuum effect of BMI and glucose within the normal range on vascular function in childhood.
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