Sex-Related Differences in Cardiovascular Risk in Adolescents with Overweight or Obesity

⁵ Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy

⁶ Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy

⁷ Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples “Federico II”, 80131 Napoli, Italy

⁸ Pediatric Department, “V. Buzzi" Children's Hospital, 20154 Milano, Italy

⁹ Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy

¹⁰ Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, 33100 Udine, Italy

¹¹ Pediatric Unit, IRCCS Azienda Ospedaliero-universitaria di Bologna, 40138 Bologna, Italy

¹² Department of Cardiology, “S. Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy

¹³ Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy

¹⁴ Department of Medical, Movement and Wellbeing Sciences, University of Napoli “Parthenope”, 80133 Napoli, Italy

^*Correspondence: giuliana.valerio@uniparthenope.it (Giuliana Valerio)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2024, 25(4), 141; https://doi.org/10.31083/j.rcm2504141

Submitted: 29 November 2023 | Revised: 11 February 2024 | Accepted: 20 February 2024 | Published: 9 April 2024

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Pediatric obesity is closely associated with cardiometabolic comorbidities, but the role of sex in this relationship is less investigated. We aimed to evaluate sex-related differences on cardiometabolic risk factors and preclinical signs of target organ damage in adolescents with overweight/obesity (OW/OB). Methods: The main cross-sectional study included 988 adolescents (510 boys and 478 girls) with OW/OB aged 10–18 years. In all youths clinical and biochemical variables were evaluated and an abdominal echography was performed. Echocardiographic data for the assessment of left ventricular mass (LVM) and relative wall thickness (RWT) were available in an independent sample of 142 youths (67 boys and 75 girls), while echographic data of carotid intima media thickness (cIMT) were available in 107 youths (59 boys and 48 girls). Results: The three samples did not differ for age, body mass index, and sex distribution. In the main sample, boys showed higher waist-to-height ratio (WHtR) values (p $<$ 0.0001) and fasting glucose levels (p = 0.002) than girls. Lower levels of estimates glomerular filtration rate (eGFR) were found in girls vs boys (p $<$ 0.0001). No sex-related differences for prediabetes and hyperlipidemia were observed. A higher prevalence of WHtR $\geq$ 0.60 (57.3% vs 49.6%, p = 0.016) and fatty liver disease (FLD) (54.5% vs 38.3%, p $<$ 0.0001) as well as a trend for high prevalence of hypertension (40.4 vs 34.7%, p = 0.06) were observed in boys vs girls. More, a higher prevalence of mild reduced eGFR (MReGFR) ( $<$ 90 mL/min/1.73 m ${}^{2}$ ) was observed in girls vs boys (14.6% vs 9.6 %, p $<$ 0.0001). In the sample with echocardiographic evaluation, boys showed higher levels of LVM (p = 0.046), and RWT (p = 0.003) than girls. Again, in the sample with carotid echography, boys showed higher levels of cIMT as compared to girls (p = 0.011). Conclusions: Adolescent boys with OW/OB showed higher risk of abdominal adiposity, FLD, and increased cardiac and vascular impairment than girls, whereas the latter had a higher risk of MReGFR. Risk stratification by sex for cardiometabolic risk factors or preclinical signs of target organ damage should be considered in youths with OW/OB.

Keywords

adolescents

cardiometabolic risk

carotid intima media thickness

estimated glomerular filtration rate

fatty liver disease

left ventricular mass

sex

visceral adiposity

Figures

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174