June 18, 2015
2 min read

Obesity tied to congenital adrenal hyperplasia in teens increases CVD risk

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Adolescents and young adults with congenital adrenal hyperplasia are more likely to have increased amounts of abdominal fat tissue, putting them at greater risk for metabolic syndrome and cardiovascular disease, according to research in The Journal of Clinical Endocrinology & Metabolism.

In a cross-sectional study of adolescents with congenital adrenal hyperplasia (CAH) and healthy, matched controls with obesity, researchers found that adolescents with CAH also are more likely to have a higher proportion of proinflammatory visceral adipose tissue than subcutaneous tissue.

“We see an increased prevalence of obesity in adolescents with CAH, even above the alarmingly high rates already seen in children,” Mimi S. Kim, MD, MSc, co-director of the Congenital Adrenal Hyperplasia Clinic at Children’s Hospital Los Angeles, said in a press release. “We also see that these young patients have a more unfavorable abdominal fat distribution, which could actively promote [CVD].”

Kim and colleagues analyzed data from 28 adolescents and young adults with CAH (mean age, 16 years; mean BMI, 27.8 kg/m²; 15 female; 19 Hispanic), matched for age, sex, ethnicity and BMI to 28 controls (mean age, 17 years; mean BMI, 27.2 kg/m²; 15 female; 19 Hispanic) with obesity who were otherwise healthy. Researchers used CT imaging to quantify visceral and subcutaneous adipose tissue in the abdominal area and measured lipid profiles, insulin sensitivity and blood pressure. Researchers used paired-sample t tests and Wilcoxon signed rank tests to determine whether there was a statistically significant difference between participants with CAH and matched controls.

Researchers found that adolescents and young adults with CAH had increased abdominal adiposity compared with controls, for both visceral abdominal tissue (43.8 ± 45.5 cm² vs. controls, 26.4 ± 29.6 cm²;  P < .001) and subcutaneous abdominal tissue (288.1 ± 206.5 cm² vs. controls, 226.3 ± 157.5 cm²;  P < .01). The visceral to subcutaneous abdominal tissue ratio was significantly higher in participants with CAH vs. controls (0.154 ± 0.067 vs. 0.118 ± 0.064; P < .05).

“Of note, 50% of the CAH cohort had elevated leptin levels, which were significantly higher in obese compared with nonobese subjects and correlated strongly with measures of obesity,” the researchers wrote.

Researchers also found a link between the amount of abdominal adipose tissue and inflammatory markers in the CAH arm. Both visceral and subcutaneous abdominal tissue was correlated with high levels of adipokine, plasminogen activator inhibitor-1 and high-sensitivity C-reactive protein, which are risk factors for CVD in adults.

Researchers said clinicians should evaluate adolescents with CAH for abdominal obesity by measuring weight-to-height ratio, which correlates with visceral adipose tissue.

“We can then target these at-risk individuals for preventive weight loss and therapeutics to decrease long-term adverse outcomes in CAH,” the researchers wrote. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.