European Journal of Pediatrics

, Volume 173, Issue 3, pp 345–352 | Cite as

Body composition phenotypes and carotid intima-media thickness in 11–13-year-old children

  • Xavier Melo
  • Helena Santa-Clara
  • Nuno M. Pimenta
  • Margarida Carrolo
  • Sandra S. Martins
  • Cláudia S. Minderico
  • Bo Fernhall
  • Luís B. Sardinha
Original Article


Early detection of impairment in vascular structure is an important clinical pursuit. However, it is unknown which measure of body composition best predicts vascular wall changes. We assess the differences in body composition among intima-media thickness (IMT) tertiles and determined which measures of body composition are associated with IMT in 385 children aged 11–13 years (196 girls). In this cross-sectional study, body mass index (BMI), waist circumference (WC), body fat mass (BFM), and trunk fat mass (TFM) from dual-energy radiographic absorptiometry and IMT through high-resolution ultrasonography were collected. Differences in body composition measures among IMT tertiles [low IMT (LIMT), ≤0.46 mm; middle IMT, 0.46–0.53 mm; higher IMT (HIMT), ≥0.53 mm] were assessed with ANOVA/ANCOVA after categorization. Regression analysis was used to assess the relationships between body composition and IMT. The groups were similar for sex, age, and maturity (p > 0.05). As compared with LIMT group, subjects with HIMT had higher mean values of BMI, BFM, TFM, and WC (p < 0.05). Significant differences were found for WC even when controlling for BMI (p < 0.05). Combining all subjects, IMT was significantly correlated to BMI, BFM, TFM, and WC (p < 0.05). In multiple regression, WC was the only predictor of IMT (β = 0.22, p < 0.001). Conclusion: Differences exist in body composition variables among IMT tertiles. In the overall model, WC was the only obesity-related predictor of increased IMT in 11–13-year-old children.


Body composition phenotypes Carotid artery Children Waist circumference Intima-media thickness 



Body fat mass by DXA


Body mass index


Common carotid artery




Diastolic blood pressure


Higher intima-media thickness


Intima-media thickness


Lower intima-media thickness


Maturity offset


Middle intima-media thickness


Peak height velocity


Systolic blood pressure


Trunk fat mass by DXA


Waist circumference


Waist to hip ratio



The first author of this paper is supported by a research grant from the Foundation for Science and Technology (FCT), Ministry of Education and Science of Portugal (grant SFRH/ BD/ 70515/ 2010).

Conflict of interest

The authors have no competing interests.


  1. 1.
    Alpsoy S, Akyuz A, Akkoyun DC, Nalbantoglu B, Topcu B, Tulubas F, Demirkol M, Donma MM (2013) Is overweight a risk of early atherosclerosis in childhood? Angiology. doi: 10.1177/0003319713476134 Google Scholar
  2. 2.
    Andersen LB, Sardinha LB, Froberg K, Riddoch CJ, Page AS, Anderssen SA (2008) Fitness, fatness and clustering of cardiovascular risk factors in children from Denmark Estonia and Portugal: the European youth heart study. Int J Pediatr Obes 3(Suppl 1):58–66. doi: 10.1080/17477160801896366 PubMedCrossRefGoogle Scholar
  3. 3.
    Bays HE (2012) Adiposopathy, diabetes mellitus, and primary prevention of atherosclerotic coronary artery disease: treating “sick fat” through improving fat function with antidiabetes therapies. Am J Cardiol 110(9 Suppl):4B–12B. doi: 10.1016/j.amjcard.2012.08.029 PubMedCrossRefGoogle Scholar
  4. 4.
    Bigaard J, Tjønneland A, Thomsen BL, Overvad K, Heitmann BL, Sørensen TI (2003) Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obes Res 11(7):895–903. doi: 10.1038/oby.2003.123 PubMedCrossRefGoogle Scholar
  5. 5.
    Cole TJ, Lobstein T (2012) Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 7(4):284–294. doi: 10.1111/j.2047-6310.2012.00064.x PubMedCrossRefGoogle Scholar
  6. 6.
    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(23):2815–2819PubMedCrossRefGoogle Scholar
  7. 7.
    de Groot E, Hovingh GK, Wiegman A, Duriez P, Smit AJ, Fruchart JC, Kastelein JJ (2004) Measurement of arterial wall thickness as a surrogate marker for atherosclerosis. Circulation 109(23 Suppl 1):III33–38. doi: 10.1161/ PubMedGoogle Scholar
  8. 8.
    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(12):2923–2928PubMedCrossRefGoogle Scholar
  9. 9.
    Elkiran O, Yilmaz E, Koc M, Kamanli A, Ustundag B, Ilhan N (2011) The association between intima media thickness, central obesity and diastolic blood pressure in obese and owerweight children: a cross-sectional school-based study. Int J Cardiol. doi: 10.1016/j.ijcard.2011.09.080 PubMedGoogle Scholar
  10. 10.
    Fang J, Zhang JP, Luo CX, Yu XM, Lv LQ (2010) Carotid intima-media thickness in childhood and adolescent obesity relations to abdominal obesity, high triglyceride level and insulin resistance. Int J Med Sci 7(5):278–283PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Ferreira I, Twisk JW, van Mechelen W, Kemper HC, Seidell JC, Stehouwer CD (2004) Current and adolescent body fatness and fat distribution: relationships with carotid intima-media thickness and large artery stiffness at the age of 36 years. J Hypertens 22(1):145–155PubMedCrossRefGoogle Scholar
  12. 12.
    Geerts CC, Evelein AM, Bots ML, van der Ent CK, Grobbee DE, Uiterwaal CS (2012) Body fat distribution and early arterial changes in healthy 5-year-old children. Ann Med 44(4):350–359. doi: 10.3109/07853890.2011.558520 PubMedCrossRefGoogle Scholar
  13. 13.
    Giannini C, de Giorgis T, Scarinci A, Ciampani M, Marcovecchio ML, Chiarelli F, Mohn A (2008) Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children. Atherosclerosis 197(1):448–456. doi: 10.1016/j.atherosclerosis.2007.06.023 PubMedCrossRefGoogle Scholar
  14. 14.
    Harrington J, Peña AS, Gent R, Hirte C, Couper J (2010) Aortic intima media thickness is an early marker of atherosclerosis in children with type 1 diabetes mellitus. J Pediatr 156(2):237–241. doi: 10.1016/j.jpeds.2009.08.036 PubMedCrossRefGoogle Scholar
  15. 15.
    Hoeks AP, Willekes C, Boutouyrie P, Brands PJ, Willigers JM, Reneman RS (1997) Automated detection of local artery wall thickness based on M-line signal processing. Ultrasound Med Biol 23(7):1017–1023PubMedCrossRefGoogle Scholar
  16. 16.
    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(4):528–531. doi: 10.1016/j.amjcard.2005.08.072 PubMedCrossRefGoogle Scholar
  17. 17.
    Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Ronnemaa T, Hartiala JJ, Celermajer DS, Raitakari OT (2001) Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 104(24):2943–2947PubMedCrossRefGoogle Scholar
  18. 18.
    Jourdan C, Wuhl E, Litwin M, Fahr K, Trelewicz J, Jobs K, Schenk JP, Grenda R, Mehls O, Troger J, Schaefer F (2005) Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 23(9):1707–1715PubMedCrossRefGoogle Scholar
  19. 19.
    Karpoff L, Vinet A, Schuster I, Oudot C, Goret L, Dauzat M, Obert P, Perez-Martin A (2009) Abnormal vascular reactivity at rest and exercise in obese boys. Eur J Clin Invest 39(2):94–102. doi: 10.1111/j.1365-2362.2008.02068.x PubMedCrossRefGoogle Scholar
  20. 20.
    Koeijvoets KC, Rodenburg J, Hutten BA, Wiegman A, Kastelein JJ, Sijbrands EJ (2005) Low-density lipoprotein receptor genotype and response to pravastatin in children with familial hypercholesterolemia: substudy of an intima-media thickness trial. Circulation 112(20):3168–3173. doi: 10.1161/CIRCULATIONAHA.105.565507 PubMedCrossRefGoogle Scholar
  21. 21.
    Lamotte C, Iliescu C, Libersa C, Gottrand F (2010) Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies. Eur J Pediatr. doi: 10.1007/s00431-010-1328-y PubMedGoogle Scholar
  22. 22.
    Lande MB, Carson NL, Roy J, Meagher CC (2006) Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension 48(1):40–44. doi: 10.1161/01.HYP.0000227029.10536.e8 PubMedCrossRefGoogle Scholar
  23. 23.
    Lobstein T, Baur L, Uauy R (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5(Suppl 1):4–104. doi: 10.1111/j.1467-789X.2004.00133.x PubMedCrossRefGoogle Scholar
  24. 24.
    Meinders JM, Kornet L, Hoeks AP (2003) Assessment of spatial inhomogeneities in intima media thickness along an arterial segment using its dynamic behavior. Am J Physiol Heart Circ Physiol 285(1):H384–391. doi: 10.1152/ajpheart.00729.2002 PubMedGoogle Scholar
  25. 25.
    Meyer AA, Kundt G, Steiner M, Schuff-Werner P, Kienast W (2006) Impaired flow-mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: the impact of cardiovascular risk factors. Pediatrics 117(5):1560–1567. doi: 10.1542/peds.2005-2140 PubMedCrossRefGoogle Scholar
  26. 26.
    Mirwald RL, Baxter-Jones AD, Bailey DA, Beunen GP (2002) An assessment of maturity from anthropometric measurements. Med Sci Sports Exerc 34(4):689–694PubMedCrossRefGoogle Scholar
  27. 27.
    Morrison KM, Dyal L, Conner W, Helden E, Newkirk L, Yusuf S, Lonn E (2010) Cardiovascular risk factors and non-invasive assessment of subclinical atherosclerosis in youth. Atherosclerosis 208(2):501–505. doi: 10.1016/j.atherosclerosis.2009.07.034 PubMedCrossRefGoogle Scholar
  28. 28.
    Pacifico L, Cantisani V, Ricci P, Osborn JF, Schiavo E, Anania C, Ferrara E, Dvisic G, Chiesa C (2008) Nonalcoholic fatty liver disease and carotid atherosclerosis in children. Pediatr Res 63(4):423–427. doi: 10.1203/PDR.0b013e318165b8e7 PubMedCrossRefGoogle Scholar
  29. 29.
    Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ (1994) Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 73(7):460–468PubMedCrossRefGoogle Scholar
  30. 30.
    Puato M, Palatini P, Zanardo M, Dorigatti F, Tirrito C, Rattazzi M, Pauletto P (2008) Increase in carotid intima-media thickness in grade I hypertensive subjects: white-coat versus sustained hypertension. Hypertension 51(5):1300–1305. doi: 10.1161/HYPERTENSIONAHA.107.106773 PubMedCrossRefGoogle Scholar
  31. 31.
    Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, Jarvisalo MJ, Uhari M, Jokinen E, Ronnemaa T, Akerblom HK, Viikari JS (2003) Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 290(17):2277–2283. doi: 10.1001/jama.290.17.2277 PubMedCrossRefGoogle Scholar
  32. 32.
    Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M (2006) Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study. Am J Clin Nutr 84(2):299–303PubMedGoogle Scholar
  33. 33.
    Sardinha LB, Santos R, Vale S, Silva MJ E, Raimundo AM, Moreira H, Baptista F, Mota J (2012) Waist circumference percentiles for Portuguese children and adolescents aged 10 to 18 years. Eur J Pediatr 171(3):499–505. doi: 10.1007/s00431-011-1595-2 PubMedCrossRefGoogle Scholar
  34. 34.
    Sardinha LB, Santos R, Vale S, Silva AM, Ferreira JP, Raimundo AM, Moreira H, Baptista F, Mota J (2011) Prevalence of overweight and obesity among Portuguese youth: a study in a representative sample of 10-18-year-old children and adolescents. Int J Pediatr Obes 6(2–2):e124–128. doi: 10.3109/17477166.2010.490263 PubMedCrossRefGoogle Scholar
  35. 35.
    Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, Georgiou C, Kafatos A (2000) Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 24(11):1453–1458PubMedCrossRefGoogle Scholar
  36. 36.
    Sorof JM, Alexandrov AV, Cardwell G, Portman RJ (2003) Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics 111(1):61–66PubMedCrossRefGoogle Scholar
  37. 37.
    Sorof JM, Alexandrov AV, Garami Z, Turner JL, Grafe RE, Lai D, Portman RJ (2003) Carotid ultrasonography for detection of vascular abnormalities in hypertensive children. Pediatr Nephrol 18(10):1020–1024. doi: 10.1007/s00467-003-1187-0 PubMedCrossRefGoogle Scholar
  38. 38.
    Stensland-Bugge E, Bønaa KH, Joakimsen O (2001) Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromsø study. Atherosclerosis 154(2):437–448PubMedCrossRefGoogle Scholar
  39. 39.
    Sun Q, van Dam RM, Spiegelman D, Heymsfield SB, Willett WC, Hu FB (2010) Comparison of dual-energy X-ray absorptiometric and anthropometric measures of adiposity in relation to adiposity-related biologic factors. Am J Epidemiol 172(12):1442–1454. doi: 10.1093/aje/kwq306 PubMedCrossRefGoogle Scholar
  40. 40.
    Tounian P, Aggoun Y, Dubern 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(9291):1400–1404. doi: 10.1016/S0140-6736(01)06525-4 PubMedCrossRefGoogle Scholar
  41. 41.
    Wiegman A, de Groot E, Hutten BA, Rodenburg J, Gort J, Bakker HD, Sijbrands EJ, Kastelein JJ (2004) Arterial intima-media thickness in children heterozygous for familial hypercholesterolaemia. Lancet 363(9406):369–370. doi: 10.1016/S0140-6736(04)15467-6 PubMedCrossRefGoogle Scholar
  42. 42.
    Wojcicki JM, Heyman MB (2010) Let's Move–childhood obesity prevention from pregnancy and infancy onward. N Engl J Med 362(16):1457–1459. doi: 10.1056/NEJMp1001857 PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    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(16):1981–1986. doi: 10.1161/01.CIR.0000126599.47470.BE PubMedCrossRefGoogle Scholar
  44. 44.
    Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, Lam CW, Metreweli C, Celermajer DS (2004) Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening. Int J Obes Relat Metab Disord 28(7):852–857. doi: 10.1038/sj.ijo.0802539 PubMedCrossRefGoogle Scholar
  45. 45.
    Zhu W, Huang X, He J, Li M, Neubauer H (2005) Arterial intima-media thickening and endothelial dysfunction in obese Chinese children. Eur J Pediatr 164(6):337–344. doi: 10.1007/s00431-005-1642-y PubMedCrossRefGoogle Scholar
  46. 46.
    Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S, Group IC (2007) The metabolic syndrome in children and adolescents—an IDF consensus report. Pediatr Diabetes 8(5):299–306. doi: 10.1111/j.1399-5448.2007.00271.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Xavier Melo
    • 1
  • Helena Santa-Clara
    • 1
  • Nuno M. Pimenta
    • 1
    • 2
  • Margarida Carrolo
    • 1
  • Sandra S. Martins
    • 3
  • Cláudia S. Minderico
    • 1
  • Bo Fernhall
    • 4
  • Luís B. Sardinha
    • 1
  1. 1.Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human KineticsUniversity of LisbonLisbonPortugal
  2. 2.Polytechnic Institute of Santarem, Health and FitnessSport Sciences School of Rio MaiorRio MaiorPortugal
  3. 3.Faculty of Physical Education and SportsLusofona UniversityLisbonPortugal
  4. 4.College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoUSA

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