RELATION BETWEEN OBESITY AND BLOOD PRESSURE IN CHILDREN: POSSIBLE ROLE OF POLYUNSATURATED FATTY ACIDS AND THEIR METABOLITES VIA CYTOCHROME P450

We investigated the role of erythrocyte membrane fatty acids and their metabolites via CYP450 on blood pressure and metabolic status in 3 observetional studies conducted in childre

Snoring in a cohort of obese children: association with palate position and nocturnal desaturations

Purpose of the study: Frequency of habitual snoring is significantly higher in obese than in normal-weight subjects. Obesity and adeno-tonsillar size are risk factors of snoring. Other factors, such as fat distribution and upper airway collapsibility, could explain the relationship between obesity, snoring and obtructive sleep apneas. The aim of the study was to investigate clinical and instrumental significance of snoring in exogenous obese children referred to our department.Methodology: This preliminary study takes part of a larger prospective respiratory sleep study. In 36 consecutive obese children (18 males), bodymass index (BMI), BMI Z score and neck circumference were calculated according to age and sex. Nasal patency, tonsil size, palate position scoring were also recorded. An overnight polygraphy was performed using a portable ambulatory device. Statistical analysis was done using SPSS® Statistics 19.0 software for Windows®.Main findings: Snoring, objectively measured by polygraphy, was associated with palate position and with oxygen desaturation index (ODI). The correlation between snoring and ODI completely disappeared when adjusting for palate position scoring.Key conclusions: Low palate position can be identified as an adjunctive, although not unique, factor that can contribute to making snoring and increased desaturation events possibly related to increased risk of upper airway collapsibility during sleep in obese childre

Positive effects of tomato paste on vascular function after a fat meal in male healthy subjects

Tomato consumption has been recently associated with a reduced incidence of cardiovascular disease (CVD). The aim of this study was to test whether a seven-day period of tomato paste pur\ue8e (tomato paste, TP) supplementation could improve some haemodynamic parameters in healthy volunteers before and after a standardized fat meal (FM)

Fatty Acid Profile and Desaturase Activities in 7–10-Year-Old Children Attending Primary School in Verona South District: Association between Palmitoleic Acid, SCD-16, Indices of Adiposity, and Blood Pressure

In previous studies, dietary and circulating fatty acids (FA) and desaturases activity (delta-5 desaturase [D5D], delta-6 desaturase [D6D], and stearoyl-CoA desaturase [SCD-16]) involved in their metabolism were associated with metabolic and cardiovascular disorders. The aim of the study was to assess the association between different FAs and desaturases activity (estimated as product:precursor ratios) with individual cardiovascular risk factors (in particular, anthropometric measurements and blood pressure [BP]) in children. The FA profile was determined on a whole-blood drop in 243 children (age: 8.6 ± 0.72 years) participating in a school-based cross-sectional study. Docosahexaenoic acid (DHA) inversely correlated with indices of adiposity, glucose, and triglycerides. Palmitoleic acid and SCD-16 were directly associated with markers of adiposity and BP, even after adjustment for main confounders. D6D correlated directly with the waist/height ratio. Children with excess weight (>85th percentile; that is overweight plus obese ones) showed higher palmitic acid, palmitoleic acid, and higher SCD-16 activity as compared to normal-weight children. Most of the associations were confirmed in the excess-weight group. Omega-3 FAs, particularly DHA, but not omega-6 FA, showed a potentially beneficial association with metabolic parameters, whereas palmitoleic acid and SCD-16 showed a potentially harmful association with indices of adiposity and BP, especially in obese children

Omega-3 fatty acids and cytochrome P450-derived eicosanoids in cardiovascular diseases: Which actions and interactions modulate hemodynamics?

Increasing interest is focused on omega-3 fatty acids (FA) because of their potential beneficial effects, particularly in cardiovascular disease prevention. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), two major omega-3 FA, are mainly consumed through diet, particularly from fish and seafood intake, whereas alpha-linolenic acid (ALA) is present in high amounts in leafy green vegetables, nuts and seeds. The hypothesis of a cardiovascular protective action of omega-3 FA derives mainly from observational studies, whereas the evidence from interventional studies is not always consistent. Nonetheless, clinical trials and meta-analyses indicate a positive action, at minimum on blood pressure (BP). Omega-3 FA may act through different biological pathways; however, in our review, we seek to revisit, most notably, the role of their metabolites via cytochrome P450 (CYP450) in hemodynamic modulation. We emphasize that the effect of omega-3 FA may depend on their balance with other dietary compounds, particularly omega-6 FA, which compete for the same pathways, thus modulating the production of metabolites. Furthermore, the biological activity of omega-3 FA might be better explained by the complex balance and interactions between a variety of nutrients and polymorphisms of genes implicated in specific metabolic pathways

Eicosanoids via CYP450 and cardiovascular disease: Hints from genetic and nutrition studies

Metabolites of arachidonic acid via CYP450 such as epoxyeicosatrienoic acids (EETs) and 20-hydroxyeicosatetraenoic acid (20-HETE), have vasoactive and natriuretic properties and have been implicated in BP homeostasis and the incidence of cardio- and cerebrovascular diseases in animal studies. In humans, genetic studies considering genes implicated in arachidonic acids metabolism (CYP4F2, CYP4A11, CYP2J2, CYP2C8, CYP2C9, CYP2A1/2, EPHX2) can offer a hint to understand their role, if any, in hypertension development and its deleterious cardiovascular effects. Candidate genes studies and successive meta-analyses have shown that specific single nucleotide polymorphisms (SNPs), often functional, and haplotypes in these genes were associated with one or more cardiovascular endpoints. Nevertheless, genome wide association studies (GWAS) have never detected any SNPs nearby these genes (the only exception being the CYP2A1/2 locus) as associated with either BP, hypertension, coronary artery disease or stroke questioning their real importance for cardiovascular health in humans. Nutrition studies exploring the effects of specific foods on the formation of these compounds or others through the same pathway can offer new insights on this field

Home blood pressure measurements: Advantages and disadvantages compared to office and ambulatory monitoring

Home blood pressure monitoring (HBPM) is an easy and standardized tool to measure blood pressure (BP) at home, which is recommended by several national and international guidelines to obtain reliable BP values. It is a useful and dependable measure of BP, which can add information to the more common and standardized methods, such as office (OBPM) and ambulatory blood pressure measurement (ABPM), and sometimes substitute for them. Along with ABPM, HBPM detects out-of-office BP levels, helping to identify the white-coat effect and masked hypertension. Moreover, the large number of BP measurements obtained with HBPM has been demonstrated to be associated with future cardiovascular events and to provide information on day-to-day variability; this is a new aspect, the clinical significance of which is still under evaluation. By giving patients a more active role in the management of their chronic disease, HBPM can improve treatment adherence. The present review focuses on all these aspects and describes the pros and cons of HBPM use compared to OBPM and ABPM. In conclusion, although some aspects need to be clarified, the scientific evidence collected so far should encourage the more widespread use of HBPM in clinical practice

Cardiorespiratory interaction with continuous positive airway pressure

The treatment of choice for obstructive sleep apnoea (OSA) is continuous positive airway pressure therapy (CPAP). Since its introduction in clinical practice, CPAP has been used in various clinical conditions with variable and heterogeneous outcomes. In addition to the well-known effects on the upper airway CPAP impacts on intrathoracic pressures, haemodynamics and blood pressure (BP) control. However, short- and long-term effects of CPAP therapy depend on multiple variables which include symptoms, underlying condition, pressure used, treatment acceptance, compliance and usage. CPAP can alter long-term cardiovascular risk in patients with cardiorespiratory conditions. Furthermore, the effect of CPAP on the awake patient differs from the effect on the patients while asleep, and this might contribute to discomfort and removal of the use interface. The purpose of this review is to highlight the physiological impact of CPAP on the cardiorespiratory system, including short-term benefits and long-term outcomes

Beneficial effects of \u3c9-3 PUFA in children on cardiovascular risk factors during childhood and adolescence

Omega-3 polyunsatured fatty acids (\u3c9-3 PUFA) are essential nutrients mainly derived from fish and seafood but present also in vegetables such as nuts and seed-oils. Some epidemiological and clinical studies indicate a protection of \u3c9-3 FA against cardiovascular disease and a favourable effect on cardiovascular risk factors control in adults. The evidences of their effects in children and adolescents are scanty but a possible beneficial role, especially for insulin sensitivity and blood pressure control, has been proposed. In this review we want to focus especially on the evidences, which could justify the assumption of \u3c9-3 in children and adolescents, and to underline the aspects which need further investigation. Mechanisms through which \u3c9-3 FA act are manifolds and still a matter of investigation: beside their interaction with ion channel and their influence on plasma membrane fluidity, probably the main effect is acting as competitor for cytochrome P-450 (CYP) with respect to \u3c9-6 FA. Thus, they can modulate the biosynthesis of eicosanoids and other lipid mediators, which likely exert a protective action. Another suggestive hypothesis is that their beneficial effect is not dependent only on the intake of \u3c9-3 FA, but also on the complex interaction between different nutrients including \u3c9-3 and other FAs with polymorphisms in genes involved in \u3c9-3 FA modulation. This complex interaction has seldom been explored in children and adolescents. Further studies are needed to investigate all these points in order to find a better collocation of \u3c9-3 FA on the available armamentarium for preventive, possibly individualized, medicine

NASAL OBSTRUCTION AND SLEEP DISORDERED BREATHING DURING CLINICAL PRACTICE IN CHILDREN

One component of the pathophysiology of OSAS that is among the least understood and studied is the role of the nose. Daytime nasal obstruction was reported as an independent risk factor for OSAS. The patency of the nose can influence the patency of the pharynx. Finally, the nasal obstruction test may be a useful, time sparring ambulatory assessment that can predict SDB severity in childre