Intima-Media Thickness in Obese Children Before and After Weight Loss

OBJECTIVE: Obesity in childhood is related to increased intima-media thickness, a noninvasive marker for early atherosclerotic changes. The objective of this study was to analyze the changes of intima-media thickness in obese children with weight loss. METHODS: We analyzed the changes of intima-media thickness and, as markers of cardiovascular risk factor profile, systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, glucose, insulin, and insulin resistance index (homeostasis model analysis) in 56 prepubertal obese children (median: 9 years old) before and after a 1-year outpatient intervention program. The control group consisted of 10 nonobese children of the same age and gender. We determined the carotid intima-media thickness by B-mode ultrasound with a 14-MHz linear transducer. Substantial weight loss was defined by a reduction of overweight of at least 0.5 standard deviation scores in BMI. RESULTS: Obese children demonstrated a significantly thicker intima-media compared with the control group. Furthermore, blood pressure, triglycerides, insulin, and insulin resistance index were significantly higher in obese children, whereas high-density lipoprotein cholesterol was significantly lower. In the 24 obese children with substantial weight loss, intima-media thickness, blood pressure, triglycerides, insulin, and insulin resistance index decreased significantly, whereas high-density lipoprotein cholesterol increased significantly. In the 32 obese children without substantial weight loss, there were no significant changes apart from an increase of insulin and insulin resistance index. CONCLUSIONS: Because obese children demonstrated a thicker intima-media, vascular changes seemed to occur already in childhood obesity. Paralleling the improvement of the cardiovascular risk factor profile, intima-media thickness decreased in obese children with substantial weight loss, suggesting the reversibility of early atherosclerotic changes.