Heart and Vessels

, 24:419 | Cite as

Comparison of two diets of varying glycemic index on carotid subclinical atherosclerosis in obese children

  • Arcangelo Iannuzzi
  • Maria Rosaria Licenziati
  • Maria Vacca
  • Donata De Marco
  • Giorgio Cinquegrana
  • Marco Laccetti
  • Alessandro Bresciani
  • Giuseppe Covetti
  • Gabriella Iannuzzo
  • Paolo Rubba
  • Mario Parillo
Original Article

Abstract

Childhood obesity is associated with an increased carotid intima-media thickness (IMT) and stiffness. Increased carotid wall thickening and rigidity are considered markers of subclinical atherosclerosis. The aim of the present study was to test the effect of two hypocaloric diets of varying glycemic index on weight loss and markers of subclinical atherosclerosis in obese children. Seventy consecutive obese children attending the Outpatient Weight Clinic of the Department of Pediatrics were invited to participate in an intensive dietary protocol. Twenty-six accepted and were randomly assigned to two different groups: the first group followed a hypocaloric low-glycemic index diet and the second a hypocaloric high-glycemic index diet. Anthropometric measures and biochemical tests were performed in all children. Quantitative B-mode ultrasound scans were used to measure intima-media thickness (IMT) and diameters of the common carotid artery. Considering both groups together, at 6 months, body mass index decreased from 28.3 ± 3.1 to 25.8 ± 3.3 kg/m2, systolic blood pressure from 119 ± 12 to 110 ± 11 mmHg (P< 0.001), diastolic blood pressure from 78 ± 8 to 74 ± 7 mmHg (P< 0.001), IMT from 0.48 ± 0.05 to 0.43 ± 0.07 mm (P< 0.001), stiffness from 3.57 ± 1.04 to 2.98 ± 0.94 mm (P = 0.002), and high-sensitivity C-reactive protein from 1.5 ± 0.9 (values log transformed) to 0.4 ± 1.1 (P < 0.001). No differences were detectable in fasting serum triglycerides, total cholesterol, and high-density lipoprotein cholesterol. Insulin resistance (calculated by the HOmeostatic Model Assessment index [HOMA] score) significantly reduced only in the low-glycemic-index diet group (P < 0.04). In conclusion, this study confirms a benefit of hypocaloric diets on carotid IMT and stiffness in obese children and demonstrates, for the first time, an amelioration of insulin sensitivity in obese children after a low-glycemic index diet. These results justify the advice to obese children to follow a low-glycemic index diet in order to improve their cardiometabolic profile.

Key words

Children Obesity Diet Glycemic index Vascular Ultrasound Carotid Intima-media thickness Stiffness 

References

  1. 1.
    Lobstein T, Frelut ML (2003) Prevalence of overweight among children in Europe. Obes Rev 4:195–200CrossRefPubMedGoogle Scholar
  2. 2.
    De Michele M, Panico S, Iannuzzi A, Celentano E, Ciardullo AV, Galasso R, Sacchetti L, Zarrilli F, Bond MG, Rubba P (2002) Association of obesity and central fat distribution with carotid artery wall thickening in middle-aged women. Stroke 33:2923–2938CrossRefPubMedGoogle Scholar
  3. 3.
    Mizia-Stec K, Gasior Z, Zahorska-Markiewicz B, Holecki M, Haberka M, Mizia M, Gomułka S, Zak-Gołab A, Gościńska A (2008) The indexes of arterial structure and function in women with simple obesity: a preliminary study. Heart Vessels 23: 224–229CrossRefPubMedGoogle Scholar
  4. 4.
    Iannuzzi A, Licenziati MR, Acampora C, Salvatore V, Auriemma L, Romano ML, Panico S, Rubba P, Trevisan M (2004) Increased carotid intima media-thickness and stiffness in obese children. Diabetes Care 27:2506–2508CrossRefPubMedGoogle Scholar
  5. 5.
    Tounian P, Aggoun Y, Dubem B, Varille V, Guy-Grand B, Sidi D, Girardet JP, Bonnet D (2001) Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 358:1400–1404CrossRefPubMedGoogle Scholar
  6. 6.
    Iannuzzi A, Licenziati MR, Acampora C, Renis M, Agrusta M, Romano L, Valerio G, Panico S, Trevisan M (2006) Carotid artery stiffness in obese children with the metabolic syndrome. Am J Cardiol 97:528–531CrossRefPubMedGoogle Scholar
  7. 7.
    Iannuzzi A, Licenziati MR, Acampora C, De Michele M, Iannuzzo G, Chiariello G, Covetti G, Bresciani A, Romano L, Panico S, Rubba P (2008) Carotid artery wall hypertrophy in children with metabolic syndrome. J Hum Hypertens 22:83–88CrossRefPubMedGoogle Scholar
  8. 8.
    Hayman LL, Meininger JC, Daniels SR, McCrindle BW, Helden L, Ross J, Dennison BA, Steinberger J, Williams CL (2007) Primary prevention of cardiovascular disease in nursing practice: focus on children and youth: a scientific statement from the American Heart Association Committee on Atherosclerosis, Hypertension, and Obesity in Youth of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116:344–357CrossRefPubMedGoogle Scholar
  9. 9.
    Dickinson S, Brand-Miller J (2005) Glycemic index, postprandial glycemia and cardiovascular disease. Curr Opin Lipidol 16:69–75CrossRefPubMedGoogle Scholar
  10. 10.
    Parillo M, Riccardi G (1995) Dietary carbohydrates and glucose metabolism in diabetic patients. Diabetes Metab 21:391–401Google Scholar
  11. 11.
    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC growth charts for the United States: methods and development. Vital and health statistics. Series 11. National Health Survey. pp 1–190Google Scholar
  12. 12.
    Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA (2005) Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 116:e125–e144CrossRefPubMedGoogle Scholar
  13. 13.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treaker DF, Turner RC (1985) Homeostasis model assessment: insulinresistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419CrossRefPubMedGoogle Scholar
  14. 14.
    Hirai T, Sasayama S, Kawasaki T, Yagi S (1989) Stiffness of systemic arteries in patients with myocardial infarction: a noninvasive method to predict severity of coronary atherosclerosis. Circulation 80:78–86PubMedGoogle Scholar
  15. 15.
    Davis PH, Dawson JD, Riley WA, Lauer RM (2001) Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine Study. Circulation 104:2815–2819CrossRefPubMedGoogle Scholar
  16. 16.
    Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM, Berenson GS (2003) Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA 290:2271–2276CrossRefPubMedGoogle Scholar
  17. 17.
    Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitnen T, Maki-Torkko N, Jarvisalo MJ, Uhari M, Jokinen E, Ronnemaa T, Akerblom HK, Viikari JS (2003) Cardiovascular risk factors in childhood and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 290: 2277–2283CrossRefPubMedGoogle Scholar
  18. 18.
    Knoflach M, Kiechl S, Kind M, Said M, Sief R, Gisinger M, van der Zee R, Gaston H, Jarosch E, Willeit J, Wick G (2003) Cardiovascular risk factors and atherosclerosis in young males: ARMY study (Atherosclerosis Risk-Factors in Male Youngsters). Circulation 108:1064–1069CrossRefPubMedGoogle Scholar
  19. 19.
    Sanchez A, Barth JD, Zhang L (2000) The carotid artery wall thickness in teenagers is related to their diet and the typical risk factors of heart disease among adults. Atherosclerosis 152: 265–266CrossRefPubMedGoogle Scholar
  20. 20.
    Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, Lam CW, Metreweli C, Celermajer DS (2004) Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation 109:1981–1986CrossRefPubMedGoogle Scholar
  21. 21.
    Wunsch R, de Sousa G, Toschke AM, Reinehr T (2006) Intimamedia thickness in obese children before and after weight loss. Pediatrics 118:2334–2340CrossRefPubMedGoogle Scholar
  22. 22.
    Iannuzzi A, Licenziati MR, Acampora C, Salvatore V, De Marco D, Mayer MC, De Michele M, Russo V (2004) Preclinical changes in the mechanical properties of abdominal aorta in obese children. Metabolism 53:1243–1246CrossRefPubMedGoogle Scholar
  23. 23.
    Barinas-Mitchell E, Kuller LH, Sutton-Tyrrell K, Hegazi R, Harper P, Mancino J, Kelley DE (2006) Effect of weight loss and nutritional intervention on arterial stiffness in type 2 diabetes. Diabetes Care 29:2218–2222CrossRefPubMedGoogle Scholar
  24. 24.
    Wildman R, Farhat G, Patel A, Mackey R, Brockwell S, Thompson T, Sutton-Tyrrell K (2005) Weight change is associated with change in arterial stiffness among healthy young adults. Hypertension 45:187–192CrossRefPubMedGoogle Scholar
  25. 25.
    Yasmin, McEniery CM, Wallace S, Mackenzie IS, Cockcroft JR, Wilkinson IB (2004) C-reactive protein is associated with arterial stiffness in apparently healthy individuals. Arterioscler Thromb Vasc Biol 24:969–974CrossRefPubMedGoogle Scholar
  26. 26.
    Diamant M, Lamb HJ, van de Ree MA, Endert EL, Groeneveld Y, Bots ML, Kostense PJ, Radder JK (2005) The association between abdominal visceral fat and carotid stiffness is mediated by circulating inflammatory markers in uncomplicated type 2 diabetes. J Clin Endocrinol Metab 90:1495–1501CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2009

Authors and Affiliations

  • Arcangelo Iannuzzi
    • 1
  • Maria Rosaria Licenziati
    • 2
  • Maria Vacca
    • 2
  • Donata De Marco
    • 2
  • Giorgio Cinquegrana
    • 3
  • Marco Laccetti
    • 1
  • Alessandro Bresciani
    • 1
  • Giuseppe Covetti
    • 1
  • Gabriella Iannuzzo
    • 4
  • Paolo Rubba
    • 4
  • Mario Parillo
    • 5
  1. 1.Department of Internal MedicineA. Cardarelli HospitalNaplesItaly
  2. 2.Department of PediatricsA. Cardarelli HospitalNaplesItaly
  3. 3.Emergency DepartmentA. Cardarelli HospitalNaplesItaly
  4. 4.Department of Clinical and Experimental MedicineFederico II UniversityNaplesItaly
  5. 5.Department of Internal MedicineSt. Anna and St. Sebastian HospitalCasertaItaly

Personalised recommendations