The prevalence of childhood obesity has doubled in the last 20 years, with African-African (AA) adolescents being almost twice as likely to be affected as Caucasians. Obesity is a risk factor for a myriad of chronic diseases, including cardiovascular disease (CVD), with an estimated $92.6 billion dollars spent nationally on obesity. The disease burden engendered by obesity disproportionately affects minorities. Its harmful sequelae are not limited to adulthood, with some overweight youth exhibiting cardiovascular (CVR) factors and type 2 diabetes (T2DM). Our preliminary data suggest that severity of overweight increases CVR factors and risk of glucose intolerance in AA adolescents; however, not all overweight AA adolescents exhibit CVR factors or glucose intolerance, suggesting that additional factors mediate the consequences of obesity. This cross-sectional, exploratory study assesses five interrelated factors (overweight severity and distribution, insulin resistance, cardiorespiratory fitness, diet, and family history) to determine predictors of cardiovascular risk and glucose intolerance in overweight AA adolescents. We will incorporate emerging CVR factors [Creative protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), fibrinogen, and homocysteine level, lipoprotein a, and lipoprotein size], as well as established CVR factors [standard lipid profile, diabetes status determined during oral glucose tolerance test (OGTT), resting blood pressure, and smoking status] to develop a CVR profile of 100 overweight AA adolescents. The predictive value of self-reported measures of physical activity vs. cardiorespiratory fitness and fasting vs. dynamic OGTT-derived indices of insulin resistance will also be examined. The association of independent variables with measures of glucose metabolism and the CVR profile will be examined using Kendall's Tau. Prediction models, adjusted for gender and Tanner stage, will be developed from the list of independent variables for glucose intolerance and the CVR profile. This study will elucidate predictors of CVR and glucose intolerance in overweight AA adolescents, aid clinicians in transforming research findings into clinical guidelines for assessment of overweight AA youth, and provide further direction for development of interventions to mitigate the complications of obesity. Future studies will incorporate genotyping as well as predictors identified in the current study to predict risk in a multiethnic population, and include longitudinal follow-up of participants to track changes in CVR. Our long-term goal is to develop targeted interventions based on variables identified in this exploratory study tomitigate the consequences of obesity and prevents development of CVD and T2DM in youth.

R15NR008862

2005-09-09

2009-08-31