1. Comparison of some cardiometabolic risk factors in peri-urban adolescent school learners in mthatha, South Africa. Presented by BN Nkeh-Chungag

2. Cardiometabolic risk factors in adolescents There is no universal consensus on the definition of cardiometabolic risk factors in children The International Diabetes Federation attempted to standardize the definition of these risk factors however the National Cholesterol Education Program and Adult Treatment Panel III (NCEP-ATP III) covers children better Hypertension is an important risk factor which tends to be neglected in children and adolescents Described by African Union as Africa’s second challenge only after AIDS

3. Prevalence of hypertension in adolescents Hypertension. 2013; 62: 247-254 Children whose BMI or WC were in the top 25% for their age group were about twice as likely to have elevated blood pressure as children with measurements in the bottom 25%. African-American children had a 28% higher risk of elevated blood pressure than Caucasians

4. Were low HT rates due to low prevalence or poor diagnostic methods? The use of percentiles for age, sex and height has been a challenge However there is a trend for higher HT prevalence rates in South African children Hypertension in South African adolescents http://www.hypertension.org.za/monthly-theme/hypertension-in-adolescents-the-race-against-time http://www.health24.com/Diet-and-nutrition/Weight-loss/Obesity-are-our-children-doomed-20130725

5. South African Demographic and Health Survey 2004. www.gov.za/documents/download.php?f=90139

6. Prevalence of hypertension in rural South African children – 2005 Ellisras study. Monyeki et al, 2005. International Journal of Epidemiology. 2006;35:114–120

7. Prevalence of hypertension in rural South African children/adolescents – 2012 Limpopo locations. Moselakgomo et al 2012, Rev Paul Pediatr. 30:562-9

8. In the current study we investigated the risk factors for cardiometabolic diseases in a peri-urban adolescent population.

9. CohortFemalesMales N410283127 Age15±0.0715±0.0815.3±0.1 Weight64±0.865±0.962.4±1.4 Height161±0.4159±0.4166.2±0.8 * BMI25±0.326±0.4 * 22.5±0.5 WC77±0.679±0.7 * 73.8±1 HC98±0.7101±10.8 * 91±1 Demographic and general information on participants

10. MalesFemales TotalLeanOW/OBTotalLeanOW/OB N1279730283137146 MSBP121.9±1120±1.3 125.6±1.7 * 118±0.6114.6±1.1120.3±0.9 * MDBP72±0.771.3±174.7±1.3 * 72±1.470.9±0.872.9±0.5 * Note: Total = all males or females, lean= BMI<85 th percentile for age and gender; - overweigh/obese (OW/OB)= BMI ≥85 th percentile, BMI- Body mass index, * p<0.05. Blood pressure by gender and body size

11. Prevalence of hypertension in adolescents HypertensionPre-hypertensionNormotensive Whole cohort (n=391)83 (21.2%)48 (12.3%)260 (66.5%) Males (n=118)26 (22.0%)16 (13.6%)76 (64.4%) Females (n=273)57 (20.9%)32 (11.7%)184 (73.4%) Lean (BMI<85 th %) (n=224)37 (16.5%)25 (11.1%)162 (72.3%) Overweight (BMI≥85 th <95 th %) (n=84 )25 (29.8%)13 (15.5%)46 (54.7%) Obese (BMI≥95 th %) (n=78)13 (16.7%)16 (20.5%)49 (62.8%)

12. FemaleMaleP-value BMI25.7±0.322.6±0.40.001 SBP118.5±0.7122.1±10.003 DBP71.9±0.571.8±0.80.82 Triglycerides0.77±0.020.8±0.030.48 HDL1.56±0.021.34±0.030.001 Glucose4.6±0.040.47±0.060.13 Risk factors for metabolic syndrome

13. Number of risk factors for metabolic syndrome Lean ParticipantsObese participant Three or more risk factors 1043 Two risk factors3259 One risk factor7547 No risk factor1010 Risk factors or metabolic syndrome in lean vs obese Metabolic syndrome was defined by the NCEP with modification, Silveira et al, 2013

14. CohortFemalesMales Number (n/%)370257 (69.5%)113 (30.5%) Overweight/Obese112 (30.3%)9428 Metabolic Syndrome53 (14.3%)33 (12.8%)#20 (17.7%)# Two risk factors926924 One risk factor1228636 No risk factor1036834 Prevalence of the metabolic syndrome Metabolic syndrome was defined by the NCEP with modification, Silveira et al, 2013

15. Hs-CRP and Adiponectin levels Cohort Participant with metabolic syndrome Without metabolic syndrome P-value HS-CRP2.02 ±0.411.72±0.170.51 Adiponectin14.33±2.516.83±0.90.36 Participant with metabolic syndrome FemalesMalesP-value Hs-CRP1.67±0.312.68±1.70.30 Adiponectin14.5±2.313.5±10.80.81

16. Influence of BMI on CVD markers BMI > 5 th < 85 th %BMI > 85 th %p-value hs-CRP (mg/l) 1.44±0.162.42±0.3 0.002** Adiponectin ( µ g/ml) 17.4±1.8 14.7±1.2 0.16 Influence of WC on CVD markers WC ≤ 80 cmWC > 80 cmp-value hs-CRP (mg/l) 1.4±0.22.8±0.4 0.0001 Adiponectin ( µ g/ml)17.2±1.114.9±1.30.2* Body size effect on CVD markers

17. LeanOverweight/ Obese P-value TCh/HDL2.67±0.052.95±0.070.001 LDL/HDL1.65±0.131.71±0.560.71 TRIG/HDL0.53±0.190.58±0.030.08 Atherosclerosis indices

18. TChol/HDLLDL/HDLTGL/HDL MDBPR0.0380.0390.087 95% CI-0.202 - 0.274-0.201-0.275-0.154 - 0.319 p-value0.7510.7410.467 MSBPR0.2320.2480.167 95% CI-0.066 - 0.4460.0106-0.4590.074 - 0.390 p-value0.049 *0.036*0.160 hs-CRPR0.2660.2770.039 95% CI0.030 - 0.4830.041-0.483-0.201- 0.275 p-value0.023*0.019*0.74 Pearson correlations between various atherosclerosis indices with BP and Hs-CRP TChol/HDLLDL/HDLTGL/HDL MDBPR0.0380.0390.087 95% CI-0.202 - 0.274-0.201-0.275-0.154 - 0.319 p-value0.7510.7410.467 MSBPR0.2320.2480.167 95% CI-0.066 - 0.4460.0106-0.4590.074 - 0.390 p-value0.049 *0.036*0.160 hs-CRPR0.2660.2770.039 95% CI0.030 - 0.4830.041-0.483-0.201- 0.275 p-value0.023*0.019*0.74

19. Conclusion Cardiometabolic risk factors were greater in overweight/obese adolescents Cardiometabolic risks were greater in males than in females Hs-CRP was significiantly increased in adolescents with higher BMI Adiponectin levels were significantly decreased in overweight /obese adolescents