Comparison of some cardiometabolic risk factors in peri-urban adolescent school

learners in mthatha, South Africa.

Presented by

BN Nkeh-Chungag

Cardiometabolic risk factors in adolescents

• There is no universal consensus on the definition of cardiometabolic risk factors in children• The International Diabetes Federation attempted to standardize the definition

of these risk factors however the National Cholesterol Education Program and Adult Treatment Panel III (NCEP-ATP III) covers children better• Hypertension is an important risk factor which tends to be neglected in

children and adolescents• Described by African Union as Africa’s second challenge only after AIDS

Prevalence of hypertension in adolescents

Hypertension. 2013; 62: 247-254

• Children whose BMI or WC were in the top 25% for their age group were about twice as likely to have elevated blood pressure as children with measurements in the bottom 25%.• African-American children had a 28% higher risk of elevated

blood pressure than Caucasians

• Were low HT rates due to low prevalence or poor diagnostic methods?

• The use of percentiles for age, sex and height has been a challenge• However there is a trend for higher HT prevalence rates in South

African children

Hypertension in South African adolescents

http://www.hypertension.org.za/monthly-theme/hypertension-in-adolescents-the-race-against-time

http://www.health24.com/Diet-and-nutrition/Weight-loss/Obesity-are-our-children-doomed-20130725

South African Demographic and Health Survey 2004.

www.gov.za/documents/download.php?f=90139

Prevalence of hypertension in rural South African children – 2005

Ellisras study. Monyeki et al, 2005. International Journal of Epidemiology. 2006;35:114–120

Prevalence of hypertension in rural South African children/adolescents – 2012

Limpopo locations. Moselakgomo et al 2012, Rev Paul Pediatr. 30:562-9

• In the current study we investigated the risk factors for cardiometabolic diseases in a peri-urban adolescent population.

Cohort Females Males

N 410 283 127

Age 15±0.07 15±0.08 15.3±0.1

Weight 64±0.8 65±0.9 62.4±1.4

Height 161±0.4 159±0.4 166.2±0.8*

BMI 25±0.3 26±0.4* 22.5±0.5

WC 77±0.6 79±0.7* 73.8±1

HC 98±0.7 101±10.8* 91±1

Demographic and general information on participants

Males Females

Total Lean OW/OB Total Lean OW/OB

N 127 97 30 283 137 146

MSBP 121.9±1 120±1.3 125.6±1.7* 118±0.6 114.6±1.1 120.3±0.9*

MDBP 72±0.7 71.3±1 74.7±1.3* 72±1.4 70.9±0.8 72.9±0.5*

Note: Total = all males or females, lean= BMI<85th percentile for age and gender; - overweigh/obese (OW/OB)= BMI ≥85th

percentile, BMI- Body mass index, *p<0.05.

Blood pressure by gender and body size

Prevalence of hypertension in adolescents

Hypertension Pre-hypertension Normotensive

Whole cohort (n=391) 83 (21.2%) 48 (12.3%) 260 (66.5%)

Males (n=118) 26 (22.0%) 16 (13.6%) 76 (64.4%)

Females (n=273) 57 (20.9%) 32 (11.7%) 184 (73.4%)

Lean (BMI<85th %) (n=224) 37 (16.5%) 25 (11.1%) 162 (72.3%)

Overweight (BMI≥85th <95th %) (n=84 ) 25 (29.8%) 13 (15.5%) 46 (54.7%)

Obese (BMI≥95th %) (n=78) 13 (16.7%) 16 (20.5%) 49 (62.8%)

Female Male P-valueBMI 25.7±0.3 22.6±0.4 0.001SBP 118.5±0.7 122.1±1 0.003DBP 71.9±0.5 71.8±0.8 0.82Triglycerides 0.77±0.02 0.8±0.03 0.48HDL 1.56±0.02 1.34±0.03 0.001Glucose 4.6±0.04 0.47±0.06 0.13

Risk factors for metabolic syndrome

Number of risk factors for metabolic syndrome

Lean Participants Obese participant

Three or morerisk factors

10 43

Two risk factors 32 59

One risk factor 75 47

No risk factor 101 0

Risk factors or metabolic syndrome in lean vs obese

Metabolic syndrome was defined by the NCEP with modification, Silveira et al, 2013

Cohort Females MalesNumber (n/%) 370 257 (69.5%) 113 (30.5%)Overweight/Obese 112 (30.3%) 94 28 Metabolic Syndrome 53 (14.3%) 33 (12.8%)# 20 (17.7%)#Two risk factors 92 69 24One risk factor 122 86 36No risk factor 103 68 34

Prevalence of the metabolic syndrome

Metabolic syndrome was defined by the NCEP with modification, Silveira et al, 2013

Hs-CRP and Adiponectin levels Cohort

Participant with metabolic syndrome

Without metabolic syndrome

P-value

HS-CRP 2.02 ±0.41 1.72±0.17 0.51Adiponectin 14.33±2.5 16.83±0.9 0.36

Participant with metabolic syndromeFemales Males P-value

Hs-CRP 1.67±0.31 2.68±1.7 0.30Adiponectin 14.5±2.3 13.5±10.8 0.81

Influence of BMI on CVD markersBMI > 5th < 85th % BMI > 85th % p-value

hs-CRP (mg/l) 1.44±0.16 2.42±0.3 0.002**Adiponectin (µg/ml) 17.4±1.8 14.7±1.2 0.16

Influence of WC on CVD markersWC ≤ 80 cm WC > 80 cm p-value

hs-CRP (mg/l) 1.4±0.2 2.8±0.4 0.0001Adiponectin (µg/ml) 17.2±1.1 14.9±1.3 0.2*

Body size effect on CVD markers

Lean Overweight/Obese

P-value

TCh/HDL 2.67±0.05 2.95±0.07 0.001LDL/HDL 1.65±0.13 1.71±0.56 0.71 TRIG/HDL 0.53±0.19 0.58±0.03 0.08

Atherosclerosis indices

TChol/HDL LDL/HDL TGL/HDL

MDBP R 0.038 0.039 0.087

95% CI -0.202 -

0.274

-0.201-0.275 -0.154 -

0.319

p-value 0.751 0.741 0.467

MSBP R 0.232 0.248 0.167

95% CI -0.066 -

0.446

0.0106-0.459 0.074 - 0.390

p-value 0.049 * 0.036* 0.160

hs-CRP R 0.266 0.277 0.039

95% CI 0.030 - 0.483 0.041-0.483 -0.201- 0.275

p-value 0.023* 0.019* 0.74

Pearson correlations between various atherosclerosis indices with BP and Hs-CRP

TChol/HDL LDL/HDL TGL/HDL

MDBP R 0.038 0.039 0.087

95% CI -0.202 - 0.274 -0.201-0.275 -0.154 - 0.319

p-value 0.751 0.741 0.467

MSBP R 0.232 0.248 0.167

95% CI -0.066 - 0.446 0.0106-0.459 0.074 - 0.390

p-value 0.049 * 0.036* 0.160

hs-CRP R 0.266 0.277 0.039

95% CI 0.030 - 0.483 0.041-0.483 -0.201- 0.275

p-value 0.023* 0.019* 0.74

Conclusion• Cardiometabolic risk factors were greater in overweight/obese adolescents• Cardiometabolic risks were greater in males than in females• Hs-CRP was significiantly increased in adolescents with higher BMI• Adiponectin levels were significantly decreased in

overweight /obese adolescents

Thank you