Endothelial Function in Obese Adolescents

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2013 by Montefiore Medical Center
Sponsor:
Information provided by (Responsible Party):
Montefiore Medical Center
ClinicalTrials.gov Identifier:
NCT01879033
First received: June 5, 2013
Last updated: June 12, 2013
Last verified: June 2013

June 5, 2013
June 12, 2013
March 2011
June 2013   (final data collection date for primary outcome measure)
RH-Pat score [ Time Frame: 2 weeks after Screening Visit ] [ Designated as safety issue: No ]
After Screening visit, the subjects were assessed for endothelial function using Rh-PAT.
Same as current
Complete list of historical versions of study NCT01879033 on ClinicalTrials.gov Archive Site
  • insulin and glucose levels [ Time Frame: 2 weeks after Screening Visit ] [ Designated as safety issue: No ]
    Subjects were assesses for their insulin and glucose levels on Visit 1. Lean subjects only had their fasting levels of glucose and insulin, while obese had 2 hour Oral glucose tolerance test.
  • Lipid Profile [ Time Frame: 2 weeks after Screening visit ] [ Designated as safety issue: No ]
    Subjects were assessed for their fasting cholesterol, Low density lipoprotein (LDL), High density lipoprotein (HDL) and Triglyceride levels during the visit 1.
  • Adipocytokine levels [ Time Frame: 2 weeks after Screening Visit ] [ Designated as safety issue: No ]
    Subjects were assessed for their levels of adipocytokines which include Leptin, Adiponectin, Tumor Necrosis Factor (TNF)- alfa, Interleukin (IL)-6 during the Visit 1.
Same as current
Not Provided
Not Provided
 
Endothelial Function in Obese Adolescents
Effect Of Obesity And Hyperglycemia on Endothelial Function in Inner City Bronx Adolescents

Childhood obesity is perhaps the most significant public health problem in the most developed countries and is rapidly becoming so in developing countries. National Health and Nutrition Examination Survey data shows a 3-fold increase in the prevalence of obesity in childhood, over past few decades. Furthermore, childhood obesity has markedly contributed to the prevalence of the metabolic syndrome and type 2 diabetes in U.S. children. Alarmingly, there is increasing evidence that atherosclerosis develops silently during childhood in obese children. In the Bogalusa Heart Study, pediatric autopsy studies showed a clear relationship between the number and severity of risk factors, principally obesity, with atherosclerosis in both the aorta and coronary arteries. Increased intimal medial thickness (IMT) was not present among obese adults who had been normal weight as children, emphasizing the cumulative effects of childhood obesity persisting into adulthood. Thus, the need for primary prevention of cardiovascular disease beginning in childhood is strongly suggested.

Following informed consent, a detailed history and physical examination will be performed including supine blood pressure taken twice after a 20 minute period of rest, height (using Harpenden stadiometer) to the nearest 0.1 cm and weight will be measured to the nearest 0.1 kg with a balance scale, pubertal staging using the method of Marshall and Tanner, waist measurement obtained at the minimal circumference of the abdomen, hip measurements with a plastic tape while the subject is standing and recorded at the widest diameter over the greater trochanters. BMI (kg/m2) and waist to hip ratio will be calculated. Screening labs in all recruited subjects: A fasting laboratory evaluation will include chemistry panel (basic metabolic, liver function tests), Complete Blood Count (CBC), lipid profile, urinalysis and HbA1c. All obese recruited subjects after a 12 hour fast will undergo an OGTT using a glucose load of 1.75 g/kg body weight with a maximum of 75 g. Blood samples will be collected for insulin, glucose, leptin, adiponectin, High sensitive C-reactive protein (hsCRP) and Free Fatty Acids (FFA). Serum and urine will be stored at -70 (degree Centigrade)C for measuring markers of oxidative stress and adipocytokines (including Tumor Necrosis Factor (TNF)-α, Plasminogen Acivator Inhibitor (PAI)-1) for future studies depending on the funding availability.

Subjects who fulfill the study criteria would be admitted to Clinical Research Center to evaluate endothelial function by RH-PAT.

RH-PAT for endothelial function Reactive hyperemia peripheral arterial tonometry (RH-PAT) is a noninvasive technique used to assess peripheral microvascular endothelial function by measuring changes in digital pulse volume during reactive hyperemia (Bonetti, Kuvin). Pulse volume is measured by a finger plethysmographic device that allows isolated detection of pulsatile arterial volume changes, which are sensed by a pressure transducer and transferred to a computer where the signal is amplified, displayed and stored (EndoPAT, Itamar Medical). Studies are performed with the patient at rest, in a comfortable, thermo neutral environment. Fingertip probes are placed on the index finger of both hands and 5 minutes of baseline recording are obtained. Blood flow is then occluded in one arm for 5 minutes, using a standard blood pressure cuff. Recording continues in both fingers during occlusion and for 5 minutes after release of the cuff. The RH-PAT index is calculated as the ratio of the average pulse amplitude in the post-hyperemic phase divided by the average baseline amplitude, with normalization to the signal in the control arm to compensate for any systemic changes.

Interventional
Not Provided
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Diagnostic
  • Insulin Resistance
  • Glucose Intolerance
  • Obesity
  • Atherosclerosis
  • Device: Reactive hyperemia peripheral artery tonometry (Rh-PAT)
    Pulse volume is measured by a finger plethysmographic device which are sensed by a pressure transducer and transferred to a computer where the signal is amplified, displayed and stored (EndoPAT, Itamar Medical). Fingertip probes are placed on the index finger of both hands and 5 minutes of baseline recording are obtained. Blood flow is then occluded in one arm for 5 minutes, using a standard blood pressure cuff. Recording continues in both fingers during occlusion and for 5 minutes after release of the cuff. The RH-PAT index is calculated as the ratio of the average pulse amplitude in the post-hyperemic phase divided by the average baseline amplitude, with normalization to the signal in the control arm to compensate for any systemic changes.
    Other Name: Endopat
  • Other: Blood levels for glucose, insulin, lipids and adipocytokines
    A fasting laboratory evaluation will include chemistry panel (basic metabolic, liver function tests), CBC, lipid profile, urinalysis and HbA1c. All obese recruited subjects after a 12 hour fast will undergo an OGTT using a glucose load of 1.75 g/kg body weight with a maximum of 75 g. Blood samples will be collected for insulin, glucose, leptin, adiponectin, hsCRP and FFA. Serum and urine will be stored at -70 degrees Centigrade for measuring markers of oxidative stress and adipocytokines (including TNF-α, PAI-1)
  • Active Comparator: Obese adolescents
    Those with BMI more than or equal to 95th percentile. This group was further divided into two subgroups on the basis of Oral Glucose Tolerance Test (OGTT) into normal and impaired glucose tolerance groups. Reactive hyperemia peripheral artery tonometry (Rh-PAT)score and blood levels for glucose, insulin, lipids and adipocytokines will be measured in the study.
    Interventions:
    • Device: Reactive hyperemia peripheral artery tonometry (Rh-PAT)
    • Other: Blood levels for glucose, insulin, lipids and adipocytokines
  • Placebo Comparator: Lean adolescents
    BMI between 5th-85th percentile.Reactive hyperemia peripheral artery tonometry (Rh-PAT)score and blood levels of glucose, insulin, lipids and adipocytokines will be measured in the study.
    Interventions:
    • Device: Reactive hyperemia peripheral artery tonometry (Rh-PAT)
    • Other: Blood levels for glucose, insulin, lipids and adipocytokines
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
60
January 2014
June 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Children in the age range of 12-18 years
  • For the lean group, age and sex matched subjects with BMI between 5th-85th percentiles
  • Obese group defined as BMI ≥95th percentile. These will further be subgrouped into those with normal and those with abnormal glucose tolerance normal glucose tolerance (NGT) defined as fasting glucose level<100mg/dl and a 2 hour postprandial glucose level<140mg/d and abnormal OGTT defined as fasting level ≥100mg/dl and/or 2hr ≥140 using a glucose load of 1.75 g/kg body weight (max 75 g).Hence, we will

Exclusion Criteria:

-

Both
12 Years to 18 Years
Yes
Contact: Chhavi Agarwal, MD 718-920-5612 cagarwal@montefiore.org
United States
 
NCT01879033
09-07-219E
No
Montefiore Medical Center
Montefiore Medical Center
Not Provided
Not Provided
Montefiore Medical Center
June 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP