Adipositas im Kindes- und Jugendalter – Kardiovaskuläre Implikationen für die Zukunft

Zusammenfassung

Adipositas und assoziierte kardiovaskuläre Risikofaktoren, wie arterielle Hypertonie, Dyslipidämie, Hyperinsulinämie und gestörte Glukosetoleranz, entstehen häufig bereits in der Kindheit und legen somit den Grundstein für Herz-Kreislauf-Erkrankungen im Erwachsenenalter. Gleichwohl lassen sich Folgeschäden wie endotheliale Dysfunktion, Arteriosklerose und kardiales Remodeling bereits in dieser frühen Lebensphase nachweisen. Die Risikofaktoren zeigen eine hohe Stabilität bis in das Erwachsenenalter hinein und führen in ihrer langfristigen Akkumulation zur Ausprägung kardiovaskulärer Ereignisse. Auch wenn eine Gewichtsreduktion nur in seltenen Fällen gelingt, sollte eine konsequente Therapie der Adipositas und ihrer Komorbiditäten frühzeitig versucht werden, da eine Remission während der Kindheit das Risiko für kardiovaskuläre Folgen im Erwachsenenalter auf ein Niveau senkt, welches vergleichbar mit dem der schlanken Normalbevölkerung ist.

Abstract

The origin of cardiovascular diseases reaches back until childhood, when obesity and its associated cardiovascular risk factors, like arterial hypertension, dyslipidemia, hyperinsulinemia and impaired glucose tolerance, often start to develop. Furthermore, first signs of end organ damage, such as endothelial dysfunction, atherosclerosis and cardiac remodeling, can be detected already during childhood as well. Long-term accumulation of associated risk factors which generally exhibit a strong longitudinal stability, finally will lead to cardiovascular events in adulthood. The cardiovascular risk can be reduced to the level of the healthy normal-weight population, if consequent and early treatment of obesity and its comorbidities succeeds still during childhood.

Schlüsselwörter

Kindliche Adipositas - Hypertonie - Kardiovaskuläre Erkrankungen - kardiovaskuläre Risikofaktoren

Key words

childhood obesity - hypertension - cardiovascular disease - cardiovascular risk

Publication History

Article published online:
12 March 2021

• Literatur

• 1 Statistisches Bundesamt.destatis.de. URL:https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Todesursachen/_inhalt. html; Stand: 08.12.2020.
• 2 Bentham J, Di Cesare M, Bilano V. et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017; 390: 2627-2642. DOI: 10.1016/S0140-6736(17)32129-3.
• 3 Schienkiewitz A, Damerow S, Schaffrath Rosario A. et al. Body mass index among children and adolescents: Prevalences and distribution considering underweight and extreme obesity: Results of KiGGS Wave 2 and trends. Bundesgesundheitsblatt Gesundheitsforsch Gesundheitsschutz 2019; 62: 1225-1234. DOI: 10.1007/s00103-019-03015-8.
• 4 Gausche R, Beger C, Körner A. et al. Latest news about overweight and obesity in childhood and adolescence. Kinder Und Jugendmedizin 2019; 19: 24-28
• 5 Wühl E. Hypertension in Childhood Obesity. Acta Paediatr 2018; 0-2. DOI: 10.1111/apa.14551.
• 6 Bussler S, Penke M, Flemming G. et al. Novel Insights in the metabolic syndrome in childhood and adolescence. Horm Res Paediatr 2017; 88: 181-193. DOI: 10.1159/000479510.
• 7 Reinehr T, De Sousa G, Toschke AM. et al. Comparison of metabolic syndrome prevalence using eight different definitions: A critical approach. Arch Dis Child 2007; 92: 1067-1072. DOI: 10.1136/adc.2006.104588.
• 8 Friedemann C, Heneghan C, Mahtani K. et al. Cardiovascular disease risk in healthy children and its association with body mass index: Systematic review and meta-analysis. BMJ 2012; 345. DOI: 10.1136/bmj.e4759.
• 9 Garrison RJ, Kannel WB, Stokes J. et al. Incidence and precursors of hypertension in young adults: The Framingham offspring study. Prev Med (Baltim) 1987; 16: 235-251. DOI: 10.1016/0091-7435(87)90087-9.
• 10 Van Emmerik NMA, Renders CM, Van De Veer M. et al. High cardiovascular risk in severely obese young children and adolescents. Arch Dis Child 2012; 97: 818-821. DOI: 10.1136/archdischild-2012-301877.
• 11 Flechtner-Mors M, Neuhauser H, Reinehr T. et al. Blood pressure in 57,915 pediatric patients who are overweight or obese based on five reference systems. Am J Cardiol 2015; 115: 1587-1594. DOI: 10.1016/j.amjcard.2015.02.063.
• 12 Wirix AJG, Nauta J, Groothoff JW. et al. Is the prevalence of hypertension in overweight children overestimated?. Arch Dis Child 2016; 101: 998-1003. DOI: 10.1136/archdischild-2015-309969.
• 13 Leyvraz M, Wahlen R, Bloetzer C. et al. Persistence of elevated blood pressure during childhood and adolescence. J Hypertens 2018; 1. DOI: 10.1097/HJH.0000000000001699.
• 14 Mattace-Raso FUS, Van Der Cammen TJM, Hofman A. et al. Arterial stiffness and risk of coronary heart disease and stroke: The Rotterdam Study. Circ 2006; 113: 657-663. DOI: 10.1161/CIRCULATIONAHA.105.555235.
• 15 Cote AT, Harris KC, Panagiotopoulos C. et al. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 2013; 62: 1309-1319. DOI: 10.1016/j.jacc.2013.07.042.
• 16 Dangardt F, Osika W, Volkmann R. et al. Obese children show increased intimal wall thickness and decreased pulse wave velocity. Clin Physiol Funct Imaging 2008; 28: 287-293. DOI: 10.1111/j.1475-097X.2008.00806.x.
• 17 Dangardt F, Chen Y, Berggren K. et al. Increased rate of arterial stiffening with obesity in adolescents: a five-year follow-up study. PLoS One 2013; 8. DOI: 10.1371/journal.pone.0057454.
• 18 Cote AT, Phillips AA, Harris KC. et al. Obesity and arterial stiffness in children: Systematic review and meta-analysis. Arterioscler Thromb Vasc Biol 2015; 35: 1038-1044. DOI: 10.1161/ATVBAHA.114.305062.
• 19 Berenson GS, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998; 157: 947-948. DOI: 10.1056/nejm199810083391514.
• 20 Le J, Zhang D, Menees S. et al. Vascular age is advanced in children with atherosclerosis-promoting risk factors. Circ Cardiovasc Imaging 2010; 3: 8-14. DOI: 10.1161/CIRCIMAGING.109.880070.
• 21 De Jonge LL, Van Osch-Gevers L, Willemsen SP. et al. Growth, obesity, and cardiac structures in early childhood: The generation r study. Hypertens 2011; 57: 934-940. DOI: 10.1161/HYPERTENSIONAHA.110.163303.
• 22 Mangner N, Scheuermann K, Winzer E. et al. Childhood obesity: Impact on cardiac geometry and function. JACC Cardiovasc Imaging 2014; 7: 1198-1205. DOI: 10.1016/j.jcmg.2014.08.006.
• 23 Brady TM. The role of obesity in the development of left ventricular hypertrophy among children and adolescents. Curr Hypertens Rep 2016; 18: 1-12. DOI: 10.1007/s11906-015-0608-3.The.
• 24 Hanevold C, Waller J, Daniels S. et al. the effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: A collaborative study of the international pediatric hypertension association. Pediatr 2004; 113: 328-333. DOI: 10.1542/peds.113.2.328.
• 25 McNiece KL, Portman RJ. Left ventricular hypertrophy in hypertensive adolescents analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertens 2007; 50: 392-395. DOI: 10.1161/HYPERTENSIONAHA.107.092197.Left.
• 26 Sorof JM, Alexandrov AV, Cardwell G. et al. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatr 2003; 111: 61-66
• 27 Urbina EM, Dolan LM. Cardiac and Vascular Consequences of Pre-Hypertension in Youth. J Clin Hypertens 2011; 13: 332-342. DOI: 10.1111/j.1751-7176.2011.00471.x.Cardiac.
• 28 Stabouli S, Kotsis V, Rizos Z. et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol 2009; 24: 1545-1551. DOI: 10.1007/s00467-009-1165-2.
• 29 Lauer MS, Anderson KM, Kannel WB. et al. the impact of obesity on left ventricular mass and geometry: the framingham heart study. JAMA J Am Med Assoc 1991; 266: 231-236. DOI: 10.1001/jama.1991.03470020057032.
• 30 Dušan P, Tamara I, Goran V. et al. Left ventricular mass and diastolic function in obese children and adolescents. Pediatr Nephrol 2015; 30: 645-652. DOI: 10.1007/s00467-014-2992-3.
• 31 Abdullah A, Stoelwinder J, Shortreed S. et al. The duration of obesity and the risk of type 2 diabetes. Public Health Nutr 2011; 14: 119-126. DOI: 10.1017/S1368980010001813.
• 32 Umer A, Kelley GA, Cottrell LE. et al. Childhood obesity and adult cardiovascular disease risk factors: A systematic review with meta-analysis. BMC Public Health 2017; 17: 1-24. DOI: 10.1186/s12889-017-4691-z.
• 33 Sivanandam S, Sinaiko AR, Jacobs DR. et al. Relation of increase in adiposity to increase in left ventricular mass from childhood to young adulthood. Am J Cardiol 2006; 98: 411-415. DOI: 10.1016/j.amjcard.2006.02.044.
• 34 Li X, Li S, Ulusoy E. et al. Childhood adiposity as a predictor of cardiac mass in adulthood: The Bogalusa Heart Study. Circ 2004; 110: 3488-3492. DOI: 10.1161/01.CIR.0000149713.48317.27.
• 35 Mahoney LT, Burns TL, Stanford W. et al. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: The Muscatine study. J Am Coll Cardiol 1996; 27: 277-284. DOI: 10.1016/0735-1097(95)00461-0.
• 36 Geserick M, Keller E, Pfäffle R. et al. Acceleration of BMI in early childhood and risk of sustained obesity. N Engl J Med 2018; 379: 1303-1312. DOI: 10.1056/NEJMoa1803527.
• 37 Whitaker RC, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337: 869-873. DOI: 10.1056/nejm199709253371301.
• 38 Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: A systematic review and meta-regression analysis. Circ 2008; 117: 3171-3180. DOI: 10.1161/CIRCULATIONAHA.107.730366.Tracking.
• 39 Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: The Princeton lipid research clinics follow-up study. Pediatr 2007; 120: 340-345. DOI: 10.1542/peds.2006-1699.
• 40 Twig G, Yaniv G, Levine H. et al. body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med 2016; 374: 2430-2440. DOI: 10.1056/nejmoa1503840.
• 41 Franks PW, Hanson RL, Knowler WC. et al. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010; 362: 609-619
• 42 Reinehr T, Lass N, Toschke C. et al. Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children?. J Clin Endocrinol Metab 2016; 101: 3171-3179. DOI: 10.1210/jc.2016-1885.
• 43 Erbs S, Broniecki H, Scheuermann K. et al. Impact of Weight Reduction During Adolescence on Parameters of Cardiac Geometry and Function in Obese Children. JACC Cardiovasc Imaging 2018 DOI: 10.1016/j.jcmg.2018.05.023
• 44 Inge TH, Courcoulas AP, Jenkins TM. et al. Five-year outcomes of gastric bypass in adolescents as compared with adults. N Engl J Med 2019; 380: 2136-2145. DOI: 10.1056/NEJMoa1813909.
• 45 Ippisch HM, Inge TH, Daniels SR. et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol 2008; 51: 1342-1348. DOI: 10.1016/j.jacc.2007.12.029.
• 46 Juonala M, Magnussen CG, Berenson GS. et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365: 1876-1885. DOI: 10.1056/NEJMoa1010112.
• 47 Weihrauch-Blüher S, Schwarz P, Klusmann JH. Childhood obesity: Increased risk for cardiometabolic disease and cancer in adulthood. Metab 2019; 92: 147-152. DOI: 10.1016/j.metabol.2018.12.001.