Correlation of habitual physical activity levels with flow-mediated dilation of the brachial artery in 5–10 year old children


      Endothelial dysfunction is an early key event of atherogenesis. Both fitness level and exercise intervention have been shown to positively influence endothelial function. In a cross-sectional study of 47 children, the relationship between habitual physical activity and flow-mediated dilation (FMD) of the brachial artery was explored. Habitual physical activity levels (PALs) were assessed using a validated stable isotope technique, and FMD of the brachial artery was measured via high-resolution ultrasound. The results showed that habitual physical activity significantly correlated with FMD (r=0.39, P=0.007), and remained the most influential variable on dilation in multivariate analysis. Although both fitness level and exercise intervention have previously been shown to positively influence FMD, this is the first time that a relationship with normal PALs has been investigated, especially, at such a young age. These data support the concept that physical activity exerts its protective effect on cardiovascular health via the endothelium and add further emphasis to the importance of physical activity in childhood.


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        • Stary H.C.
        Evolution and progression of atherosclerotic lesions on coronary arteries in children and young adults.
        Arteriosclerosis. 1989; 99: 19-32
        • Berenson G.S.
        • Srinivasan S.R.
        • Bao W.
        • Newman W.P.
        • Tracey R.E.
        • Wattigney W.A.
        Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults.
        N Engl J Med. 1998; 338: 1650-1656
        • Celermajer D.S.
        • Sorenson K.E.
        • Gooch V.M.
        • et al.
        Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis.
        Lancet. 1992; 340: 1111-1115
        • Sorenson K.E.
        • Celermajer D.S.
        • Spiegelhalter D.J.
        • et al.
        Non-invasive measurement of human endothelium dependent arterial responses: accuracy and reproducibility.
        Br Heart J. 1995; 74: 247-253
        • Anderson T.J.
        • Uehata A.
        • Gerhard M.D.
        • et al.
        Close relation of endothelial function in the human coronary and peripheral circulation.
        J Am Coll Cardiol. 1995; 26: 1235-1241
        • Takase B.
        • Uehata A.
        • Akima T.
        • et al.
        Endothelium-dependent flow mediated vasodilation in coronary and brachial arteries in suspected coronary artery disease.
        Am J Cardiol. 1998; 82: 1535-1539
      1. Murakami T, Arai Y. Relationship between non-invasively evaluated endothelial dysfunction and future cardiovascular events. ACC Conference 2001: Session 1263.

        • Zhang X.
        • Zhao S.
        • Li X.
        • Gao M.
        • Zhou Q.
        Endothelium-dependent and independent functions are impaired in patients with coronary heart disease.
        Atherosclerosis. 2000; 149: 19-24
        • Mietus-Snyder M.
        • Malloy M.J.
        Endothelial dysfunction occurs in children with two genetic hyperlipidaemias: improvement with antioxidant vitamin therapy.
        J Pediatr. 1998; 1998: 35-40
        • Clarkson P.
        • Celermajer D.S.
        • Donald A.E.
        Impaired vascular reactivity in insulin-dependent diabetes mellitus is related to disease duration and low density lipoprotein cholesterol levels.
        J Am Coll Cardiol. 1996; 28: 573-579
        • Goodfellow J.
        • Bellamy M.
        • Ramsey M.W.
        • Jones C.J.H.
        • Lewis M.J.
        Dietary supplementation with marine omega-3 fatty acids improve systemic large artery endothelial function in subjects with hypercholesterolaemia.
        J Am Coll Cardiol. 2000; 35: 265-270
        • Iayama K.
        • Nagano M.
        • Yo Y.
        Impaired endothelial function with essential hypertension assessed by ultrasonography.
        Am Heart J. 1996; 132: 779-782
        • Poredos P.
        • Orehek M.
        • Tratnik E.
        Smoking is associated with dose-related increase in intima-media thickness and endothelial dysfunction.
        Angiology. 1999; 50: 201-207
        • Jensen-Urstad K.
        • Johansson J.
        • Jensen-Urstad M.
        Vascular function correlates with risk factors for cardiovascular disease in a healthy population of 35 year old subjects.
        J Intern Med. 1997; 241: 507-513
        • Berlin J.A.
        • Colditz G.A.
        A meta-analysis of physical activity in the prevention of coronary heart disease.
        Am J Epidemiol. 1990; 132: 612-628
        • Clarkson P.
        • Montgomery H.E.
        • Mullen M.J.
        • et al.
        Exercise training enhances endothelial function in young men.
        J Am Coll Cardiol. 1999; 33: 1379-1385
        • Kingwell B.A.
        • Sherrard B.
        • Jennings G.L.
        • Dart A.M.
        Four weeks of cycle training increases basal production of nitric oxide from the fore-arm.
        Am J Physiol. 1997; 272: H1070-H1077
        • Lavrencic A.
        • Salobir B.G.
        • Keber I.
        Physical training improves flow mediated dilation in patients with the polymetabolic syndrome.
        Arterioscler Thromb Vasc Biol. 2000; 20: 551-555
      2. Chan SY, Brozic A, Kingsbury KJ, et al. Quantitative relationship between cardiovascular fitness and endothelial function. J Am Coll Cardiol ACC 2000 Conference 2000:272A.

        • Jensen-Urstad K.
        • Bouvier F.
        • Jensen-Urstad M.
        Preserved vascular reactivity in elderly male athletes.
        Scand J Med Sci Sports. 1999; 9: 88-91
        • Davies P.S.W.
        Total energy expenditure in young children.
        Am J Hum Biol. 1996; 8: 183-188
        • Salbe A.
        • Fontvieille A.M.
        • Harper I.
        • Ravussin E.
        Low levels of physical activity in 5 year old children.
        J Pediatr. 1997; 131: 423-429
        • Black A.E.
        • Coward W.A.
        • Cole T.J.
        • Prentice A.M.
        Human energy expenditure in affluent societies: an analysis of 574 doubly labelled water measurements.
        Eur J Clin Nutr. 1996; 50: 72-92
        • Davies P.S.W.
        • Gregory J.
        • White A.
        Physical activity and body fatness in pre-school children.
        Int J Obes. 1994; 19: 6-10
        • Schofield W.N.
        Predicting basal metabolic rate, new standards and review of previous work.
        Hum Nutr Clin Nutr. 1985; 39C: S5-41
        • Fomon S.J.
        • Haschke F.
        • Ziegler E.E.
        • Nelson S.E.
        Body composition of reference children from birth to age 10 years.
        Am J Clin Nutr. 1982; 35: 1169-1175
      3. NHMRC. Recommended dietary intakes for use in Australia. NHMRC. Australian Publishing Service. Canberra, 1992.

        • Torun B.
        • Davies P.S.W.
        • Livingstone M.B.E.
        • Paolisso M.
        • Sackett R.
        • Spurr G.B.
        Energy requirements and dietary recommendations for children and adolescents 1 to 18 years old.
        Eur J Clin Nutr. 1996; 50: S37-81
      4. FAO/WHO/UNU. Energy and protein requirement. Report of joint FAO/WHO/UNU Expert Consultants. WHO technical report. Series no. 724. Geneva, 1985.

        • Sorenson K.E.
        • Celermajer D.S.
        • Georgakpopoulos D.
        • Hatcher G.
        • Betteridge D.J.
        • Deanfield J.E.
        Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein (a) level.
        J Clin Invest. 1994; 93: 50-55
        • Delp M.D.
        • McAllister R.M.
        • Laughlin M.H.
        Exercise training alters endothelium dependent vasoreactivity of rat abdominal aorta.
        J Appl Physiol. 1993; 75: 1354-1363
        • Arroll B.
        • Hill D.
        • Sharpe N.
        • Beaglehole R.
        The effect of exercise episode duration on blood pressure.
        Hypertension. 1994; 12: 1413-1415
        • Kingwell B.A.
        • Tran B.
        • Cameron J.D.
        • Jennings G.L.
        • Dart A.M.
        Enhanced vasodilation to acetylcholine in athletes is associated with lower plasma cholesterol.
        Am J Physiol. 1996; 270: H2008-2013
        • Leeson C.P.M.
        • Whincup P.H.
        • Cook D.G.
        • et al.
        Flow-mediated dilation in 9–11 year old children.
        Circulation. 1997; 96: 2233-2238