Background: Cardiovascular risk is reported in disabled children and epicardial fat (EF) is considered an independent predictor of cardiovascular disease (CVD). No data on the EF thickness (EFT) evaluation in disabled children have been published. Objective: We investigated EFT in neurologically impaired (NI) children; its relationship with their metabolic profile was also considered. Methods: Clinical data, body composition estimation, biochemical profile, and ultrasound-measured EFT were performed in 32 disabled patients (12.4 ± 6.3 years). Pathological parameters were defined using the following criteria: waist circumference >95th percentile, waist to height ratio (WHtR) >0.5, total cholesterol and triglycerides (TG) values >95th percentile, high density lipoprotein cholesterol <5th percentile, fasting blood glucose >100 mg/dL, homeostasis model assessment for insulin resistance (HOMA) >97.5th percentile, and EFT >3.6 mm. Results: EFT values in NI children were higher compared with control group values (p = 0.02). EFT correlated with gender (p < 0.001), age (p = 0.02), pubertal stage (p = 0.04), as well as WHtR (p = 0.03). A correlation between EFT and leptin was also noted (p = 0.04). EFT levels significantly correlated with pathological TG (p = 0.01) and HOMA-IR (p = 0.04). Conclusions: Higher EFT was observed in NI children compared with controls. EFT values correlated with clinical, metabolic, and endocrinological parameters. Ultrasound-measured EFT could be used to promptly detect subclinical CVD and to prevent adverse outcomes in disabled children.

1.
Erickson SR, Spoutz P, Dorsch M, Bleske B: Cardiovascular risk and treatment for adults with intellectual or developmental disabilities. Int J Cardiol 2016; 221: 371–375.
2.
Hollar D: Cross-sectional patterns of allostatic load among persons with varying disabilities, NHANES: 2001–2010. Disabil Health J 2013; 6: 177–187.
3.
Hosking FJ, Carey IM, Shah SM, Harris T, DeWilde S, Beighton C, Cook DG: Mortality among adults with intellectual disability in England: comparisons with the general population. Am J Public Health 2016; 106: 1483–1490.
4.
Iacobellis G: Epicardial adipose tissue in endocrine and metabolic diseases. Endocrine 2014; 46: 8–15.
5.
Iacobellis G: Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol 2015; 11: 363–371.
6.
Cena H, Fonte ML, Casali PM, Maffoni S, Roggi C, Biino G: Epicardial fat thickness: threshold values and lifestyle association in male adolescents. Pediatr Obes 2015; 10: 105–111.
7.
Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, Leonetti F: Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304–310.
8.
Iacobellis G: Epicardial fat: a new cardiovascular therapeutic target. Curr Opin Pharmacol 2016; 27: 13–18.
9.
Stevenson RD: Use of segmental measures to estimate stature in children with cerebral palsy. Arch Pediatr Adolesc Med 1995; 149: 658–662.
10.
McCarthy HD, Jarrett KV, Crawley HF: The development of waist circumference percentiles in British children aged 5.0–16.9 y. Eur J Clin Nutr 2001; 55: 902–907.
11.
Maffeis C, Banzato C, Talamini G; Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology: Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr 2008; 152: 207–213.
12.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.
13.
Balcazar H, Haas J: Classification schemes of small-for-gestational age and type of intrauterine growth retardation and its implications to early neonatal mortality. Early Hum Dev 1990; 24: 219–230.
14.
Rieken R, van Goudoever JB, Schierbeek H, Willemsen SP, Calis EA, Tibboel D, Evenhuis HM, Penning C: Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability. Am J Clin Nutr 2011; 94: 759–766.
15.
Third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in adults (adult treatment panel III). Bethesda, National Heart, Lung, and Blood Institute, 2001.
16.
D’Annunzio G, Vanelli M, Pistorio A, Minuto N, Bergamino L, Lafusco D, Lorini R; Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetes. Insulin resistance and secretion indexes in healthy Italian children and adolescents: a multicentre study. Acta Biomedica 2009; 80: 21–28.
17.
Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A, Di Mario U, Leonetti F: Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003; 88: 5163–5168.
18.
Iacobellis G, Willens HJ, Barbaro G, Sharma AM: Threshold values of high-risk echocardiographic epicardial fat thickness. Obesity (Silver Spring) 2008; 16: 887–892.
19.
Iacobellis G, Bianco AC: Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011; 22: 450–457.
20.
Pierdomenico SD, Pierdomenico AM, Cuccurullo F, Iacobellis G: Meta-analysis of the relation of echocardiographic epicardial adipose tissue thickness and the metabolic syndrome. Am J Cardiol 2013; 111: 73–78.
21.
Room B, Timmermans O, Roodbol P: The prevalence and risk factors of the metabolic syndrome in inpatients with intellectual disability. J Intellect Disabil Res 2016; 60: 594–605.
22.
Martínez-Zaragoza F, Campillo-Martínez JM, Ato-García M: Effects on physical health of a multicomponent programme for overweight and obesity for adults with intellectual disabilities. J Appl Res Intellect Disabil 2016; 29: 250–265.
23.
Sin NL: The protective role of positive well-being in cardiovascular disease: review of current evidence, mechanisms, and clinical implications. Curr Cardiol Rep 2016; 18: 106.
24.
Juster RP, McEwen BS, Lupien SJ: Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 2010; 35: 2–16.
25.
Han TS, Lean ME: A clinical perspective of obesity, metabolic syndrome and cardiovascular disease. JRSM Cardiovasc Dis 2016; 5: 2048004016633371.
26.
Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall&apos;Oglio L, Fidler Mis N, Hojsak I, Orel R, Papadopoulou A, Schaeppi M, Thapar N, Wilschanski M, Sullivan P, trand F: ESPGHAN- guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 2017.
27.
Thibault R, Pichard C: The evaluation of body composition: a useful tool for clinical practice. Ann Nutr Metab 2012; 60: 6–16.
28.
Hara M, Saitou E, Iwata F, Okada T, Harada K: Waist-to-height ratio is the best predictor of car- diovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb 2002; 9: 127–132.
29.
Kahn HS, Imperatore G, Cheng YJ: A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr 2005; 146: 482–488.
30.
Sardinha LB, Santos D, Silva AM, Grøntved A, Andersen LB, Ekelund U: A comparison between BMI, waist circumference, and waist-to-height ratio for identifying cardio-metabolic risk in children and adolescents. PLoS One 2016; 11:e0149351.
31.
Bertaso AG, Bertol D, Duncan BB, Foppa M: Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol 2013; 101:e18–e28.
32.
Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al: Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors,and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 2008; 117: 605–613.
33.
Geer EB, Shen W: Gender differences in insulin resistance, body composition, and energy balance. Gend Med 2009; 6(suppl 1):60–75.
34.
Mastrangelo A, Martos-Moreno GÁ, García A, Barrios V, Rupérez FJ, Chowen JA, Barbas C, Argente J: Insulin resistance in prepubertal obese children correlates with sex-dependent early onset metabolomic alterations. Int J Obes (Lond) 2016; 40: 1494–1502.
35.
Ginsberg HN, Huang LS: The insulin resistance syndrome: impact on lipoprotein metabolism and atherothrombosis. J Cardiovasc Risk 2000; 7: 325–331.
36.
Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, Miraglia del Giudice E, Pacifico L, Pellegrin MC, Tomat M, Baroni MG; CARdiometabolic Risk Factors in Overweight and Obese Children in ITALY (CARITALY) Study Group: Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis 2015; 25: 489–494.
37.
Fasshauer M, Blüher M: Adipokines in health and disease. Trends Pharmacol Sci 2015; 36: 461–470.
38.
Iacobellis G, Diaz S, Mendez A, Goldberg R: Increased epicardial fat and plasma leptin in type 1 diabetes independently of obesity. Nutr Metab Cardiovasc Dis 2014; 24: 725–729.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.