Review articleObesity and postprandial lipemia in adolescents: Risk factors for cardiovascular diseaseObesidad y lipemia postprandial en adolescentes: factores de riesgo de enfermedad cardiovascular
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.
References (76)
- et al.
Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia
Am J Clin Nutr
(2002) - et al.
Fetal nutrition and cardiovascular disease in adult life
Lancet
(1993) Body fat distribution, insulin resistance, and metabolic diseases
Nutrition
(1997)- et al.
Atherosclerosis: a nutritional disease of childhood
Am J Cardiol
(1998) - et al.
Prevalence of carbohydrate metabolism disturbances in a population of children and adolescents with severe obesity
Endocrinol Nutr
(2010) - et al.
Do obese children become obese adults? A review of the literature
Prev Med
(1993) - et al.
Prevention of atherosclerosis in childhood
Pediatr Clin North Am
(1986) - et al.
Reducing saturated fat intake is associated with increased levels of LDL receptors on mononuclear cells in healthy men and women
J Lipid Res
(1997) Lipoprotein physiology
Endocrinol Metab Clin North Am
(1998)- et al.
Postprandial dyslipidemia: an atherogenic disorder common in patients with diabetes mellitus
Am J Cardiol
(2001)
Postprandial lipemia—effect of lipid-lowering drugs
Atheroscler Suppl
Postprandial hyperlipidemia: another correlate of the “hypertriglyceridemic waist” phenotype in men
Atherosclerosis
A longitudinal study of the biological variability of plasma lipoproteins in healthy young adults
Atherosclerosis
The relationships between post-prandial lipaemia, endothelial function and oxidative stress in healthy individuals and patients with type 2 diabetes
Atherosclerosis
The metabolic syndrome in relation to complement component 3 and postprandial lipemia in patients from an outpatient lipid clinic and healthy volunteers
Atherosclerosis
Emulsified lipids increase endotoxemia: possible role in early postprandial low-grade inflammation
J Nutr Biochem
Fasting and postprandial markers of inflammation in lean and overweight children
Am J Clin Nutr
Predictors of postprandial triacylglycerol response in children: the Columbia University Biomarkers Study
Am J Clin Nutr
Postprandial triglyceride levels in familial combined hyperlipidemia. The role of apolipoprotein E and lipoprotein lipase polymorphisms
J Nutr Biochem
Obesity and Overweight
Tracking of body mass index in children in relation to overweight in adulthood
Am J Clin Nutr
Prevalence of risk factors for metabolic syndrome in adolescents: National Health and Nutrition Examination Survey (NHANES), 2001–2006
Arch Pediatr Adolesc Med
Prevalence of overweight and obesity in the United States, 1999–2004
JAMA
Temporal trends in overweight and obesity in Canada, 1981–1996
Int J Obes Relat Metab Disord
Trends in overweight and obesity prevalence in Chilean children: comparison of three definitions
Eur J Clin Nutr
Overweight and obesity in preschool children from developing countries
Int J Obes Relat Metab Disord
Prevalence and trends of overweight among preschool children in developing countries
Am J Clin Nutr
Nutritional status, dietary habitus, physical activity and self-perceived body image of pre-adolescents in Catalonia, Sicily, 2002
Bollettino Epidemiologico Nazionale
Epidemiología de la obesidad infantil y juvenil en España
Resultados del estudio enKid (1998–2000)
Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study
Pediatrics
Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study
Eur J Clin Nutr
Risk factors of obesity among Brazilian adolescents: a case–control study
Public Health Nutr
Early growth and death from cardiovascular disease in women
BMJ
The nutrition transition and obesity in the developing world
J Nutr
Fatores Ambientais e Antropométricos Associados à Hipertensão Arterial Infantil
Arq Bras Endocrinol Metab
Hábitos alimentares na adolescência
Pediatr Mod
Dietary habits and nutritional status in adolescents over Europe. An overview of current studies in the Nordic countries
Eur J Clin Nutr
What are the key food groups to target for preventing obesity and improving nutrition in schools?
Eur J Clin Nutr
Cited by (14)
Parental separation in childhood and self-reported psychological health: A population-based study
2016, Psychiatry ResearchCitation Excerpt :This life course research has been inspired by Barker who postulated that growth inhibition during the third trimester in utero constitutes a crucial “critical period”, i.e. a defined crucial time period early in life when risk exposure will lead to disease later in life, for the development of the metabolic syndrome and cardiovascular diseases in adult life (Barker, 1995, 1998). The critical period hypothesis has also been investigated regarding other disease mechanisms than the Barker hypothesis (Sahade et al., 2011) including hypotheses derived from life course epidemiology in psychiatry (Lindström et al., 2014). A topic of high importance in psychiatric life course epidemiology concerns the association between the experience of parental separation/divorce in childhood and psychological health in adulthood.
The Influence of Secular Trends in Body Height and Weight on the Prevalence of Overweight and Obesity among Chinese Children and Adolescents
2016, Biomedical and Environmental SciencesEpigenome-wide association study of triglyceride postprandial responses to a high-fat dietary challenge
2016, Journal of Lipid ResearchCitation Excerpt :We identified four correlated CpG sites at CPT1A that strongly associated with AUC (supplemental Table S3), and decreased methylation of the same four sites has been associated with increased fasting plasma TG (22). Moreover, obese subjects show increased PPL responses to a high-fat meal (9, 39, 40). As the methylation of CPT1A contributes to increased risk of obesity in several populations (35), it is not surprising that CPT1A methylation is highly correlated with PPL responses, likely linked to risk of CVD.
Economic stress in childhood and adulthood, and poor psychological health: Three life course hypotheses
2014, Psychiatry ResearchCitation Excerpt :Barker (1995,1998) suggested that the last trimester of life in utero was a “critical period” which if exposed to growth retardation would eventually result in a number of increased risk factors and diseases related to the metabolic syndrome. The critical period hypothesis has later been empirically investigated with regard to a variety of diseases other than the metabolic syndrome and its clinical consequences (Sahade et al., 2011). The literature concerning childhood experiences of psychological and psychosocial adversities and their effects on depression, anxiety and other mental disorders in adulthood suggest that childhood may be regarded as a “critical period” also for these conditions.
Modified lipoproteins as biomarkers of cardiovascular risk in diabetes mellitus
2013, Endocrinologia y Nutricion