Evidence for contemporary arterial stiffening in obese children and adolescents using pulse wave velocity: A systematic review and meta-analysis

Abstract

Introduction: Pulse wave velocity (PWV) and augmentation index (AI) may provide information on future cardiovascular risk. Reports are conflicting on whether obese children show evidence of raised PWV and AI.

Methods: Systematic review and meta-analysis of published studies using EMBASE, Web-of-Science and PUBMED databases for studies reporting PWV and AI in obese versus non-obese controls(<age 18 years). Studies were pooled in meta-analyses to generate weighted mean differences (WMD) using random effects methodology. Analyses were repeated by method, quality grade and anatomical region.

Results: 383 studies were found in initial searches and 81 were assessed in detail; 14 studies (6677 total participants, 1120 obese and 5557 non-obese) were suitable for meta-analysis for PWV, and 5 studies (728 participants obese and 317 non-obese) for AI. Across all studies, obese children had higher PWV than non-obese children (WMD 0.45(95% confidence interval 0.10 to 0.81 ms(-)(1))). This difference was not significant when only studies with low/medium risk of bias were included. Obese subjects had higher PWV measured directly at the carotid (WMD 0.51 (0.35-0.67 ms(-)(1))) and aorta (WMD 1.33 (0.36-2.31)). No significant differences were found for AI. Heterogeneity was high in all analyses(I(2) > 90% in PWV and AI meta-analyses).

Conclusion: There is moderate evidence that obese children have increased arterial stiffening, especially in central arteries. This supports concerns about future CVD risk in obese children. Developing effective obesity interventions must remain a health priority.

Keywords: Adolescent; Arterial stiffness; Augmentation index; Cardiovascular disease; Children; Obesity; Pulse wave velocity.