Document Type : original article


1 Pediatric Department, Faculty of Medicine, Helwan University, Egypt.

2 Radiodiagnosis Department, Faculty of Medicine, Helwan University, Egypt.

3 Clinical Pathology Department, Faculty of Medicine, Helwan University, Egypt

4 Pediatric Department, Faculty of Medicine, Helwan University, Egypt


Our study aimed to assess Carotid artery Intima-Media Thickness (CIMT) in a group of children with overweight/obesity as a good predictor for atherosclerosis.
We included 39 prepubertal children with Body Mass Indexes (BMI) above 85% for age and sex; 23% overweight, and 77% obese. Twenty matched non-obese healthy children were enrolled to compare CIMT results. About 44% of the cases had abnormal blood pressure, ~39% had dyslipidemia, and ~74% had an unhealthy metabolic state.
We observed higher CIMT in cases than controls, with no significant difference between overweight and obese status (at a confidence interval of 95% and P < 0.05). CIMT was positively associated with the BMI of the whole study group, and with HC and triglyceride in the children with obesity. CIMT was significantly higher among children with overweight/obesity than in average weight children, regardless of their metabolic status or blood pressure stage.


  1. WHO. Fact Sheet on Obesity and Overweight. World Health Organization Media Center, Geneva, Switzerland. At: Last update 16 February 2018. Accessed 7-8-2019.
  2. Samy MA, Khairy SA, Ibrahim SA, Matter MK, Hassan HK. Management of Overweight and Obesity in Egyptian School Children -An Intervention Study. J Am Sci. 2012; 8 (12): 120-8.
  3. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015; 4(2):187-92.
  4. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Stephen R Daniels. American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013; 128(15):1689-712. doi: 10.1161 /CIR. 0b013e3182a5cfb3. PMID: 24016455.
  5. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, Järvisalo MJ, Uhari M, Jokinen E, Rönnemaa T, Akerblom HK, Viikari J. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003; 290(17):2277-83. doi: 10.1001 /jama.290. 17.2277. PMID: 14600186.
  6. Lewis KA, Brown SA. Searching for evidence of an anti-inflammatory diet in children: A systematic review of randomized controlled trials for pediatric obesity interventions with a focus on Leptin, Ghrelin, and Adiponectin. Biol Res Nurs. 2017; 19:511-30.
  7. Dalla Pozza R, Ehringer-Schetitska D, Fritsch P, Jokinen E, Petropoulos A, Oberhoffer R; Association for European Pediatric Cardiology Working Group Cardiovascular Prevention. Intima media thickness measurement in children: a statement from the Association for European Pediatric Cardiology (AEPC) working group on cardiovascular prevention endorsed by the Association for European pediatric cardiology. Atherosclerosis 2015; 238:380-7.
  8. Farello G, Antenucci A, Stagi S, Mazzocchetti C, Ciocca F, Verrotti A. Metabolically healthy and metabolically unhealthy obese children both have increased carotid intima-media thickness: a case control study. BMC Cardiovasc Disord. 2018; 18(1):140. doi: 10.1186/s12872-018-0874-5. PMID: 29973145; PMCID: PMC6032770.
  9. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat 2002; 11(246). Available at:
  10. Tanner JM: Growth at adolescence, ed 2, Oxford, England, 1962, Blackwell Scientific.
  11. Canadian Pediatric endocrine group (CPEG), the official Canadian association for pediatric endocrinology 2018. Z-score calculators (CDC anthropometric Z-scores 0-20y, NHANES III Waist Z 5-19y) & AAP 2017 pediatric blood pressure percentiles. At: Accessed at 31-12-2020.
  12. International Society for the Advancement of anthropometry (ISAK). International Standards for Anthropometric Assessment, National Library of Australia, 2001; 131.
  13. Gahagan S. Overweight and Obesity. Chapter 60. In: Kliegman RM, St. Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Nelson Textbook of Pediatrics. 21th edition, ISBN: 978-0-323-52950-1. Copyright © 2020 Elsevier Inc. 1600 John F. Kennedy Blvd. Ste. 1600, Philadelphia, PA 19103-2899. The online version e-pub, 2019.
  14. McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5. ±16.9 y; Eur J Clin Nutr. 2001; 55:902–7.
  15. Damanhoury S, Newton AS, Rashid M, Hartling L, Byrne JLS, Ball GDC. Defining metabolically healthy obesity in children: a scoping review. Obes Rev. 2018; 19:1476-91. doi: 10.1111/obr.12721.
  16. Önal ZE, Soydan L, Öztürk HE, Sağ Ç, Gürbüz T, Nuhoğlu Ç. Carotid intima media thickness in obese children: is there an association with hyperlipidemia? J Pediatr Endocrinol Metab. 2016; 29(2):157-62. doi: 10.1515/jpem-2015-0221. PMID: 26540218.
  17. Al-Shorman A, Al-Domi H, Al-Atoum M. The associations of body composition and anthropometric measures with carotid intima-media thickness in obese and non-obese schoolchildren: A possible predictor for cardiovascular diseases. Vascular. 2018; 26(3):285-90. doi: 10.1177/ 1708538117735457. PMID: 28959914.
  18. Sönmez HE, Canpolat N, Ağbaş A, Taşdemir M, Ekmekçi ÖB, Alikaşifoğlu M, Sever L, Çalışkan S The Relationship between the Waist Circumference and Increased Carotid Intima Thickness in Obese Children. Child Obes. 2019; 15(7):468-75. doi: 10.1089/chi.2019.0022. PMID: 31246513.
  19. Zhao M, Lopez-Bermejo A, Caserta CA, Medeiros CCM, Kollias A, Bassols J, et al ; International Childhood Vascular Structure Evaluation Consortium. Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in Children and Adolescents: International Childhood Vascular Structure Evaluation Consortium. Diabetes Care. 2019; 42(1):119-25. doi: 10.2337/dc18-1536. PMID: 30420475.
  20. Weberruß H, Pirzer R, Böhm B, Dalla Pozza R, Netz H, Oberhoffer R. Intima-media thickness and arterial function in obese and non-obese children. BMC Obes. 2016; 3:2. doi: 10.1186/s40608-016-0081-9. PMID: 26798485; PMCID: PMC4706715.
  21. Al-Domi H, Al-Shorman A. Increased waist circumference is associated with subclinical atherosclerosis in schoolchildren. Diabetes Metab Syndr. 2019; 13(1):264-9. doi: 10.1016/ j.dsx.2018.09.004. PMID: 30641709.
  22. Day TG, Park M, Kinra S. The association between blood pressure and carotid intima-media thickness in children: a systematic review. Cardiol Young. 2017; 27(7):1295-305. doi: 10.1017/ S1047951117000105. PMID: 28376933.
  23. Sontichai W, Dejkhamron P, Pothacharoen P, Kongtaweelert P, Unachak K, Ukarapol N. Subtle inflammation: a possible mechanism of future cardiovascular risk in obese children. Korean J Pediatr. 2017; 60(11):359-64. doi: 10.3345/kjp.2017.60.11.359. PMID: 29234359; PMCID: PMC5725341.
  24. Elshorbagy HH, Fouda ER, Kamal NM, Bassiouny MM, Fathi WM. Evaluation of Epicardial Fat and Carotid Intima-Media Thickness in Obese Children. Iran J Pediatr. 2016; 26(1):e2968. doi: 10.5812/ijp.2968. PMID: 26848373; PMCID: PMC4733289.
  25. Reinehr T, Wunsch R, Pütter C, Scherag A. Relationship between carotid intima-media thickness and metabolic syndrome in adolescents. J Pediatr. 2013; 163(2):327-32. doi: 10.1016/j.jpeds.2013.01.032. PMID: 23485031.
  26. Sénéchal M, Wicklow B, Wittmeier K, Hay J, MacIntosh AC, Eskicioglu P, Venugopal N, McGavock JM. Cardiorespiratory fitness and adiposity in metabolically healthy overweight and obese youth. Pediatrics. 2013; 132:e85–92. doi: 10.1542/peds.2013-0296.
  27. Prince RL, Kuk JL, Ambler KA, Dhaliwal J, Ball GD. Predictors of metabolically healthy obesity in children. Diabetes Care. 2014; 37:1462–8. doi: 10.2337/dc13-1697.
  28. Vukovic R, Milenkovic T, Mitrovic K, Todorovic S, Plavsic L, Vukovic A, Zdravkovic D. Preserved insulin sensitivity predicts metabolically healthy obese phenotype in children and adolescents. Eur J Pediatr. 2015; 174(12):1649-55. doi: 10.1007/s00431-015-2587-4.
  29. Bervoets L, Massa G. Classification and clinical characterization of metabolically "healthy" obese children and adolescents. J Pediatr Endocrinol Metab. 2016; 29(5):553-60.
  30. Margolis-Gil M, Yackobovitz-Gavan M, Phillip M, Shalitin S. Which predictors differentiate between obese children and adolescents with cardiometabolic complications and those with metabolically healthy obesity? Pediatr Diabetes. 2018; 19(7):1147-55. doi: 10.1111/pedi.12694. PMID: 29802767.
  31. Reinehr T, Wolters B, Knop C, Lass N, Holl RW. Strong effect of pubertal status on metabolic health in obese children: a longitudinal study. J Clin Endocrinol Metab. 2015; 100(1):301-8. doi: 10.1210/jc.2014-2674.
  32. Vukovic R, Dos Santos TJ, Ybarra M, Atar M. Children with Metabolically Healthy Obesity: A Review. Front Endocrinol (Lausanne). 2019; 10:865. doi: 10.3389/fendo.2019.00865. PMID: 31920976; PMCID: PMC6914809.
  33. Bluher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood - does weight status alone matter?Metabolism. 2014; 63:1084–92. doi: 10.1016/j.metabol.2014.06.009.
  34. Nasreddine L, Tamim H, Mailhac A, AlBuhairan FS. Prevalence and predictors of metabolically healthy obesity in adolescents: findings from the national “Jeeluna” study in Saudi-Arabia. BMC Pediatr. 2018; 18:281. doi: 10.1186/s12887-018-1247-z.
  35. Rocha E, Vogel M, Stanik J, Pietzner D, Willenberg A, Korner A, et al. Serum uric acid levels as an indicator for metabolically unhealthy obesity in children and adolescents. Horm Res Paediatr. 2018; 90:19-27. doi: 10.1159/000490113.
  36. Chen F, Liu J, Yan Y, Mi J. China Child and Adolescent Cardiovascular Health (CCACH) Study Group. Adolescent cardiovascular health study group. Abnormal metabolic phenotypes among urban chinese children: epidemiology and the impact of DXA-measured body composition. Obesity. 2019; 27:837-44. doi: 10.1002/oby.22426.