Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Body fat evolution as predictor of retinal microvasculature in children

Abstract

Objectives:

Microvascular changes may represent an underlying mechanism through which overweight contributes to cardiovascular disease development. Therefore, the aim of this study was to investigate whether changes in children’s body fat over time are associated with the retinal microvasculature, a marker of cardiovascular aging.

Methods:

In a longitudinal design, 171 healthy Flemish children (53.8% boys) were followed-up for 7 years (2008–2015), aged 2.7–8.1 years at baseline.Z-scores of body mass index (zBMI; 4.1% overweight), waist circumference (zWC) and fat mass index (zFMI by BODPOD) were obtained using standardized protocols during each visit. Retinal arteriolar (central retinal arteriolar equivalent (CRAE)) and venular equivalents (central retinal venular equivalent (CRVE)) were measured from digital retinal photographs (2015) using IVAN software. Cross-sectional and longitudinal associations between changes in body fat and retinal microvasculature were explored using multivariable regression analysis, while controlling for age, sex, mean arterial pressure, alternate retinal caliber, physical activity, diet and birth weight.

Results:

In cross-sectional analysis, children with high zFMI had a higher CRVE, but only in boys (β=0.25, P=0.02). In addition, boys with high zFMI had also a lower CRAE to CRVE ratio (β=−0.26, P=0.03). No associations were seen with the CRAE, or between zBMI or zWC and the retinal microvasculature. Only changes in zFMI over time were found to be positively associated with the CRVE in boys (β=0.38, P=0.01).

Conclusions:

Our analysis over a 7-year period shows that changes in body fat during childhood are already associated with the CRVE (especially in boys).

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. World Health Organization. Obesity and Overweight. Fact sheet No. 311, 2015.http://www.who.int/mediacentre/factsheets/fs311/en (accessed 9 March 2016).

  2. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–781.

    Article  Google Scholar 

  3. Poirier P, Giles TD, Bray GA, Hong YL, Stern JS, Pi-Sunyer FX et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss - an update of the 1997 American Heart Association Scientific Statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113: 898–918.

    Article  Google Scholar 

  4. Bridger T . Childhood obesity and cardiovascular disease. Paediatr Child Health 2009; 14: 177–182.

    Article  Google Scholar 

  5. Freedman DS, Mei ZG, Srinivasan SR, Berenson GS, Dietz WH . Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007; 150: 12–17.

    Article  Google Scholar 

  6. Berenson GS, Srinivasan SR, Bao WH, Newman WP, Tracy RE, Wattigney WA . Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998; 338: 1650–1656.

    Article  CAS  Google Scholar 

  7. Sun C, Wang JJ, Mackey DA, Wong TY . Retinal vascular caliber: systemic, environmental, and genetic associations. Surv Ophthalmol 2009; 54: 74–95.

    Article  Google Scholar 

  8. McClintic BR, McClintic JI, Bisognano JD, Block RC . The relationship between retinal microvascular abnormalities and coronary heart disease: a review. Am J Med 2010; 123: 374e1–7.

    Article  Google Scholar 

  9. Boillot A, Zoungas S, Mitchell P, Klein R, Klein B, Ikram MK et al. Obesity and the microvasculature: a systematic review and meta-analysis. Plos One 2013; 8: e52708.

    Article  CAS  Google Scholar 

  10. Siegrist M, Hanssen H, Neidig M, Fuchs M, Lechner F, Stetten M et al. Association of leptin and insulin with childhood obesity and retinal vessel diameters. Int J Obes (Lond) 2014; 38: 1241–1247.

    Article  CAS  Google Scholar 

  11. Taylor B, Rochtchina E, Wang JJ, Wong TY, Heikal S, Saw SM et al. Body mass index and its effects on retinal vessel diameter in 6-year-old children. Int J Obesity 2007; 31: 1527–1533.

    Article  CAS  Google Scholar 

  12. Cheung N, Saw SM, Islam FMA, Rogers SL, Shankar A, de Haseth K et al. BMI and retinal vascular caliber in children. Obesity (Silver Spring) 2007; 15: 209–215.

    Article  Google Scholar 

  13. Gishti O, Jaddoe VWV, Hofman A, Wong TY, Ikram MK, Gaillard R . Body fat distribution, metabolic and inflammatory markers and retinal microvasculature in school-age children. The Generation R Study. Int J Obes (Lond) 2015; 39: 1482–1487.

    Article  CAS  Google Scholar 

  14. Xiao W, Gong WF, Chen QY, Ding XH, Chang B, He MG . Association between body composition and retinal vascular caliber in children and adolescents. Invest Ophth Vis Sci 2015; 56: 705–710.

    Google Scholar 

  15. Hanssen H, Siegrist M, Neidig M, Renner A, Birzele P, Siclovan A et al. Retinal vessel diameter, obesity and metabolic risk factors in school children (JuvenTUM 3). Atherosclerosis 2012; 221: 242–248.

    Article  CAS  Google Scholar 

  16. Kurniawan ED, Cheung CY, Tay WT, Mitchell P, Saw SM, Wong TY et al. The relationship between changes in body mass index and retinal vascular caliber in children. J Pediatr 2014; 165: 1166–1171.

    Article  Google Scholar 

  17. Rochtchina E, Wang JJ, Taylor B, Wong TY, Mitchell P . Ethnic variability in retinal vessel caliber: a potential source of measurement error from ocular pigmentation?—the Sydney Childhood Eye Study. Invest Ophthalmol Vis Sci 2008; 49: 1362–1366.

    Article  Google Scholar 

  18. Ahrens W, Bammann K, Siani A, Buchecker K, De Henauw S, Iacoviello L et al. The IDEFICS cohort: design, characteristics and participation in the baseline survey. Int J Obes (Lond) 2011; 35 (Suppl 1): S3–S15.

    Article  Google Scholar 

  19. Michels N, Vanaelst B, Vyncke K, Sioen I, Huybrechts I, De Vriendt T et al. Children's body composition and stress - the ChiBS study: aims, design, methods, population and participation characteristics. Arch Public Health 2012; 70: 17.

    Article  Google Scholar 

  20. Cole TJ, Lobstein T . Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 2012; 7: 284–294.

    Article  CAS  Google Scholar 

  21. Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit JM . Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr 2005; 164: 216–222.

    Article  Google Scholar 

  22. Fields DA, Hull HR, Cheline AJ, Yao M, Higgins PB . Child-specific thoracic gas volume prediction equations for air-displacement plethysmography. Obes Res 2004; 12: 1797–1804.

    Article  Google Scholar 

  23. Wells JCK, Williams JE, Chomtho S, Darch T, Grijalva-Eternod C, Kennedy K et al. Pediatric reference data for lean tissue properties: density and hydration from age 5 to 20 y. Am J Clin Nutr 2010; 91: 610–618.

    Article  CAS  Google Scholar 

  24. Wells JC, Williams JE, Chomtho S, Darch T, Grijalva-Eternod C, Kennedy K et al. Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am J Clin Nutr 2012; 96: 1316–1326.

    Article  CAS  Google Scholar 

  25. Hubbard LD, Brothers RJ, King WN, Clegg LX, Klein R, Cooper LS et al. Atherosclerosis risk communities. Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the atherosclerosis risk in communities study. Ophthalmology 1999; 106: 2269–2280.

    Article  CAS  Google Scholar 

  26. Knudtson MD, Lee KE, Hubbard LD, Wong TY, Klein R, Klein BEK . Revised formulas for summarizing retinal vessel diameters. Curr Eye Res 2003; 27: 143–149.

    Article  Google Scholar 

  27. Lanfer A, Knof K, Barba G, Veidebaum T, Papoutsou S, de Henauw S et al. Taste preferences in association with dietary habits and weight status in European children: results from the IDEFICS study. Int J Obes (Lond) 2012; 36: 27–34.

    Article  CAS  Google Scholar 

  28. Liew G, Sharrett AR, Kronmal R, Klein R, Wong TY, Mitchell P et al. Measurement of retinal vascular caliber: issues and alternatives to using the arteriole to venule ratio. Invest Ophthalmol Vis Sci 2007; 48: 52–57.

    Article  Google Scholar 

  29. Loomba-Albrecht LA, Styne DM . Effect of puberty on body composition. Curr Opin Endocrinol Diabetes Obes 2009; 16: 10–15.

    Article  CAS  Google Scholar 

  30. Knowlton AA, Lee AR . Estrogen and the cardiovascular system. Pharmacol Ther 2012; 135: 54–70.

    Article  CAS  Google Scholar 

  31. Oren S, Grossman E, Frohlich ED . Arterial and venous compliance in obese and nonobese subjects. Am J Cardiol 1996; 77: 665–667.

    Article  CAS  Google Scholar 

  32. Lyon CJ, Law RE, Hsueh WA . Minireview: adiposity, inflammation, and atherogenesis. Endocrinology 2003; 144: 2195–2200.

    Article  CAS  Google Scholar 

  33. Wisse BE . The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol 2004; 15: 2792–2800.

    Article  CAS  Google Scholar 

  34. Liew G, Wang JJ, Mitchell P, Wong TY . Retinal vascular imaging: a new tool in microvascular disease research. Circ Cardiovasc Imaging 2008; 1: 156–161.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all children and their parents for their voluntary participation. This study was supported by the Research Foundation—Flanders, Belgium (project number G073315N). The funder had no role in the design, data collection, management, analyses, interpretation and writing and reviewing the article or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C J C Van Aart.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on International Journal of Obesity website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van Aart, C., Michels, N., Sioen, I. et al. Body fat evolution as predictor of retinal microvasculature in children. Int J Obes 41, 527–532 (2017). https://doi.org/10.1038/ijo.2016.226

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2016.226

Search

Quick links