1. Hypertension and overweight to obese BMI in children were associated with changes in retinal microvasculature.
Evidence Rating Level: 2 (Good)
Hypertension and obesity, two of the most important risk for cardiovascular diseases, are growing increasingly prevalent in childhood due to a shift in health behaviours towards a sedentary lifestyle, poor dietary patterns, and increased screen time. Less is known about the impact of blood pressure and/or weight, specifically fat distribution, on retinal microvasculature at a younger age. In this ongoing population-based cohort study, as a subset of the Hong Kong Children Eye Study, 1006 children aged 6 to 8 years underwent full ophthalmic and physical examinations as well as standardized interviews. Retinal photographs visualized retinal vessel calibers, and sitting blood pressure, BMI, and weight-to-height ratio (WHtR) were measured. Compared to overweight and normal weight children, obese children had the smallest arteriolar fractal dimensions (1.211 vs 1.234 and 1.240, p-trend=0.004). Hypertensive systolic blood pressure was significantly associated with the narrowest central retinal arteriolar equivalents (CRAE) over elevated or normotensive systolic blood pressure (162.4 vs 164.6 and 167.1um, p-trend <0.001). Moreover, children with hypertension who were either overweight or obese had the narrowest CRAE(p-trend <0.001) and smallest arteriolar Df value, or the simplest vascular network (p-trend=0.007). While weight-to-height ratio was not associated with retinal vascular parameters, both overweight to obese BMI and hypertensive blood pressure were independent and synergestic factors in changing retinal microvasculature in children. Although longitudinal studies would be necessary to study how these microvasculature changes may predict cardiovascular events, these results support the implementation of initiatives to lower childhood cardiovascular risk in schools and communities.
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