Thursday, July 10, 2003

This presentation is part of : Children with Chronic Illness

Central Obesity, the Metabolic Syndrome and Plasminogen Activator Inhibitor-1 in Youth

Susan J. Appel, RN, PhD, ACNP, FNP, CS, Assistant Professor1, Joanne S. Harrell, RN, PhD, FAAN, professor2, and Jianhua Hu, PhD-c, Doctoral Candidate2. (1) School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA, (2) School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Learning Objective #1: Describe the presentation of the metabolic syndrome in these youth
Learning Objective #2: Outline the potential predictors for early development of cardiovascular risk factors in youth

Objective: To determine the relationship of central obesity with the Metabolic Syndrome (MS) (hyperinsulinemia, hypertension, hypertriglyceridemia, and low HDL-C), and plasma levels of Plasminogen Activator Inhibitor-1 (PAI-1) in youth age 18-22.

Design: Cross-sectional descriptive study.

Population: 85 subjects who had participated in the Cardiovascular Health in Children study, 53 females and 32 males, mean age 19.6.

Concept: Central obesity is the cornerstone of the MS that may lead to type 2 diabetes (T2D) and cardiovascular disease (CVD). PAI-1 is associated with vascular injury and is a new candidate as a risk factor for CVD, and as a component of the MS however, little is known regarding this syndrome during youth.

Methods: Subjects fasted for 12-hours, waist circumference (as measure of central obesity), BP were obtained along with labs.

Findings: Over half of the subjects had one or more components of the MS (58.2%). Central obesity was present in 14.1%, and in more females (X2 = 5.11; p = 0.021). Waist circumference was significantly correlated with BP, insulin, PAI-1 and low HDL-C. More subjects with central obesity had hyperinsulinemia (25%, X2 = 12.26; p = 0.009) and hypertension (41.7%, X2 = 10.23; p = 0.007). Multiple regression determined the most efficient model for predicting waist circumference. Predictors were diastolic BP, insulin and HDL-C, (R2 = 0.572). An additional predictor of central obesity was family history of T2D. In a separate regression, PAI-1 was predicted by waist circumference (R2 = 0.276).

Conclusion: Screening for central obesity, MS and PAI-1 levels should be considered before adulthood and especially in those with first-degree relatives with T2D.

Implications: Measurement of waist circumference as a screening for central obesity should be performed during routine well exams and youth with central obesity should be further screened for MS.

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Sigma Theta Tau International
10-12 July 2003