Hudson, Lee Duncan; (2018) Cardiovascular risk and stress in adolescents with obesity. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Cardiovascular risk prediction is problematic in adolescents with obesity. Pulse wave velocity (PWV) can contemporaneously capture arterial stiffening in obesity. Stress has been implicated in the aetiology of obesity and cardiovascular risk. This thesis examines these relationships within a community sample of obese adolescents recruited to an obesity intervention (the HELP trial). // Methods: Two systematic reviews were performed for: i) associations between PWV and obesity; ii) associations between stress, obesity and metabolic risk. In the HELP trial PWV, adiposity measures, blood pressure, cardiovascular blood testing, stress measures (salivary cortisol, A-FILE questionnaire) were measured longitudinally. Baseline and longitudinal analyses investigated associations between adiposity, blood pressure, and blood markers with stress and PWV. // Results: Systematic reviews found: i)moderate evidence for increased arterial stiffening in obese children, especially in central arteries; ii)mixed findings for associations between stress, obesity and cardiovascular risk. 174 adolescents were recruited to the HELP study. Baseline findings: i)PWV was associated with adiposity; ii)PWV was not associated with BP or blood tests; iii) severe obesity groups had greater average PWV however overlap between groups was large; iv)stress measures were not associated with adiposity, blood pressure or blood tests; v)stress exposure was associated with risk of binge eating. Longitudinal findings: i)PWV in the group did not change; ii)multi-level models showed no association between stress measures, adiposity or blood pressure over time; iii)blood pressure and adiposity were associated over time. // Conclusions: Greater adiposity was associated with greater arterial stiffness. Partitioning by obesity severity was unreliable. Lack of associations between BP, blood testing and arterial stiffness questions their reliability for predicting cardiovascular risk in obese adolescents. Increases in adiposity and blood pressure were linked. The thesis did not demonstrate associations between stress and adiposity, blood pressure or PWV. Reducing BMI in adolescents with obesity may be an effective way to reduce cardiovascular risk.

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