Review article
Obesity and postprandial lipemia in adolescents: Risk factors for cardiovascular diseaseObesidad y lipemia postprandial en adolescentes: factores de riesgo de enfermedad cardiovascular

https://doi.org/10.1016/j.endonu.2011.08.004Get rights and content

Abstract

In the last 50 years, obesity has become a global epidemic and is one of the main public health problems in many parts of the world. Adolescence is a critical period regarding weight control. The factors determining obesity include a complex group of interrelated biological, behavioral and environmental factors which reinforce each other. In children and adolescents, obesity is associated with premature cardiovascular diseases, diabetes mellitus type 2, acanthosis nigricans, respiratory and skeletal muscle problems, as well as psychological problems. The clinical manifestations of cardiovascular disease begin in middle age. Nevertheless, studies indicate that the atherosclerotic process begins to develop during childhood. Postprandial hyperlipemia is a physiological process that occurs several times a day after the complete absorption of a diet including lipids and has been suggested as a risk factor for coronary heart disease (CHD). New study areas include the effects of different fatty acids, lipid sources (endogenous and exogenous), and the effect ingesting alcoholic beverages during meals. Given the evidence that postprandial lipidemia is an independent risk factor for CHD, it is vital to establish normative values for children and adolescents such that more effective and efficient preventive and therapeutic measures can be adopted.

Resumen

En los últimos cincuenta años, la obesidad se ha transformado en una epidemia global y figura en la lista de los principales problemas de salud pública en varios países del mundo. La adolescencia representa un periodo crítico para el control del peso. Los factores determinantes de la obesidad incluyen un complejo conjunto de factores biológicos, comportamentales y ambientales que se interrelacionan y se potencializan mutuamente. En niños y adolescentes, la obesidad se asocia a la aparición precoz de enfermedades cardiovasculares, diabetes mellitus tipo 2, acanthosis nigricans, complicaciones respiratórias y músculo-esqueléticas, además de problemas psicológicos. Las manifestaciones clínicas de las enfermedades cardiovasculares comienzan a partir de la mediana edad. Sin embargo, estudios indican que el proceso aterosclerótico empieza en la infancia. La hiperlipemia postprandial es un proceso fisiológico que ocurre varias veces al día después de la absorción completa de una dieta con lípidos y es sugerido cómo factor de riesgo para enfermedad arterial coronaria. Nuevas áreas de estudio incluyen los efectos de los diferentes ácidos grasos, las fuentes de los lípidos (endógenos y exógenos) y el efecto de la bebida alcohólica durante la alimentación. Con la evidencia de que la lipemia postprandial es un factor de riesgo independiente para enfermedad arterial coronaria, es de fundamental importancia el establecimiento de valores normativos en niños y adolescentes, pues, de esa forma, medidas preventivas y terapéuticas más efectivas y eficaces podrán ser adoptadas.

Introduction

The World Health Organization defines obesity as a disease in which the excess of body fat causes serious health problems to the individual.1

In the last fifty years, obesity has become a global epidemic and it is in the list of the main problems of public health in many parts of the world. It is estimated that there is 1.6 billion of individuals with current excess of body weight and, at least, out of these, four hundred million of them are obese. Until 2015, approximately 2.3 billion people will show overweight and more than seven hundred million people will be obese.1

Adolescence represents a critical period for the control of weight. In this stage of growth, the individual acquires approximately twenty-five percent of the final stature and fifty percent of body weight. Besides, the risk of an adolescent who is overweight to be obese in adulthood as well, is of approximately 80%.2 During adolescence, besides the physiological transformations, the individual passes through important psychosocial changes that contribute to the vulnerability of this population group.

The increase of overweight and obesity in even more precocious ages has arisen important issues related with the harms and grievance to health provoked by the excess of weight, such as hypertension, cardiopathies, diabetes and hyperlipemia among other pathologies.3

In this review of literature the main risk factors for cardiovascular diseases in adolescents, the alterations in the lipoproteic metabolism and the role of post-prandial lipemia will be analyzed.

Section snippets

Epidemiology of overweight and obesity in children and adolescents

The prevalence of obesity in youths has been dramatically increasing in the three last decades, not only in developed countries but also in developing ones.3

Obesity represents, in the United States, the most prevalent disease among children and adolescents that affects one in each seven Americans.4

A multicenter study held by Wang et al.5 in countries in different phases of social and economic development observed an important increment of obesity: in the United States, from 15.4 to 25.6%;

Risk factors for cardiovascular diseases

Obesity that starts before adulthood seems to have an important connection with diverse factors: genetics, life style, food habits, practice of physical activity, among others.

Longitudinal studies have identified that obesity in childhood and adolescence, particularly during the second decade in life, is an important predictor of obesity in adulthood, especially in children with severe obesity whose parents are obese.12 Deshmukh-Taskar et al.13 analyzed data on weight and height of children

Obesity and its consequences

Obesity is one of the main factors that contribute for the arising of cardiovascular diseases in adolescence,28 beyond type 2 diabetes mellitus, acanthosis nigricans, respiratory and skeletal muscle dysfunctions and psychological problems.29

The Bogalusa Heart Study,29, 30 held with 9.167 individuals with ages varying from 5 to 17 years old, between 1973 and 1994, aimed to evaluate risk factors for cardiovascular diseases in the first decades of life. It was found that, among obese children and

Atherosclerosis in adolescents

The clinical manifestations of cardiovascular diseases start from middle age onwards. However, a recent study indicates that the atherosclerotic process starts in childhood.37 Fatty streaks – that are precursors of atherosclerotic plaques – appear in the inside layer of the aorta at three years of age and in the coronary layers during adolescence.37

Cresanta et al.38 cite the report from Monckberg, in which it is described how atheromatosis of the inside layer of the aorta was found in children

Postprandial lipoproteic metabolism

The term postprandial lipemia refers to a series of metabolic events that are related to the increase in lipoproteins (LP) concentrations that are rich in triglycerides (TG)–chylomicron and their remainders, very low density protein (VLDL) and their remainders, after the ingestion of fat.44

Under normal conditions, the plasmatic levels of postprandial triglycerides and the conversion of the particles of very low density protein (VLDL) in LDL cholesterol is controlled by a dynamic metabolic

Post-prandial lipemia, inflammation and atherogenic state

Post-prandial lipemia has been suggested as a risk factor for coronary heart disease.44 Post-prandial hyperlipemia is a physiological process that occurs many times a day after the complete absorption of a diet that contains lipids. The absorbed lipids are incorporated in chylomicron for the distribution of triglycerides (TG) in the adipose tissue (storing) or muscular cells. In some circumstances the process of triglycerides removal is not efficient which results in an excess of triglycerides

Postprandial lipemia in children and adolescents

Data on postprandial lipemia in children and adolescents are scarce. Couch et al.74 evaluated the postprandial TG response to a fat load in children and their mothers from families with or without history of premature coronary heart disease (Columbia University Biomarkers Study). They found that a profile of low HDL-C and high TG levels is associated with impaired postprandial TG response in children (the highest TG values postprandially were 200 mg/dl at 3 h) after post-prandial lipemia. Moreno

Final considerations

Postprandial lipemia can be considered a useful tool in the evaluation of the risk for coronary heart disease in adolescents. The establishment of normative values for postprandial lipemia in children and adolescents may allow the adoption of preventive and/or therapeutic measures. So, we suggest that cohort studies are implemented in adolescents, in order to evaluate the real role of the lipidic changes in fasting, and in the postprandial state and its impact on the atherosclerotic process.

Conflict of interest

The authors declare no conflict of interests.

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