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Wrist Circumference May Identify Children at Risk for Heart Disease


A new study published in Circulation: Journal of the American Heart Association suggests measuring the wrist bone may be a way to identify which overweight children and adolescents face an increased risk of developing cardiovascular disease.

Excess fat is one of the main determinants of insulin resistance and represents the metabolic basis for developing future cardiovascular disease. Raffaella Buzzetti, M.D., senior study author and professor in the Department of Clinical Sciences at "Sapienza" University of Rome, Italy, and colleagues conducted their study looking for an easy-to-detect clinical marker of insulin resistance which can be used to identify young subjects at increased risk of cardiovascular disease.

The study enrolled 477 overweight/obese children and adolescents (mean age 10.31±2.80 years). All of the children underwent blood tests to measure their insulin levels and to quantify the amount of insulin resistance. Each child had manual measurement of wrist circumference done.

Fifty-one subjects were randomly selected to undergo nuclear magnetic resonance imaging of the wrist to evaluate transversal wrist area at the Lister tubercle level.

The analysis of the entire study group indicated that the wrist circumference accounted for 12% of the variance in insulin resistance and in insulin levels. The imaging analysis indicated that the wrist bone size accounted for 17% of the variance in insulin resistance.

The researchers found that the correlation between the cross-section of the wrist bones and the level of insulin in the blood or the amount of insulin resistance were much stronger than the correlation between the body mass index (BMI) and insulin levels or insulin resistance. BMI is a numeric value of weight and height used clinically to estimate whether a person is normal weight, underweight, overweight or obese.

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"This is the first evidence that wrist circumference is highly correlated to evidence of insulin resistance," said Buzzetti. "Wrist circumference is easily measured and if our work is confirmed by future studies, wrist circumference could someday be used to predict insulin resistance and cardiovascular disease risk."

Many studies have shown that atherosclerotic cardiovascular disease — caused by narrowing of the arteries — begins to develop in childhood. Insulin resistance, a condition in which the body makes insulin but can't use it efficiently to break down blood sugar, is a metabolic risk factor for later development of cardiovascular disease.

Higher insulin levels increase the risk of developing insulin resistance, which in turn increases the risk of developing cardiovascular disease. Although excess body fat is linked to several heart disease risk factors including insulin resistance, measuring body fat in children is problematic partly because of how rapidly their bodies change during puberty, researchers said.

Several recent studies show that high blood insulin levels are associated with increased bone mass. The way in which insulin may act as a growth factor has become clearer with the discovery of insulin-like growth factor-1, a hormone with a chemical structure similar to insulin that regulates bone cell production.

Wrist circumference could be a marker for increased bone metabolism in the presence of high insulin levels. If so, wrist circumference may be an easy-to-detect measure of skeletal frame size that's not severely confounded by body fat variation around the time of puberty, Buzzetti said.

"One of the major priorities of clinical practice today is the identification of young people at increased risk for insulin resistance," she said. "This is a very, very strong link. Wrist circumference mirrors insulin resistance levels."

Marco Capizzi, Gaetano Leto, Antonio Petrone, Simona Zampetti, Raffaele Edo Papa, Marcello Osimani, Marialuisa Spoletini, Andrea Lenzi, John Osborn, Marco Mastantuono, Andrea Vania, and Raffaella Buzzetti; Wrist Circumference Is a Clinical Marker of Insulin Resistance in Overweight and Obese Children and Adolescents; Circulation, Apr 2011; doi:10.1161/CIRCULATIONAHA.110.012898

American Heart Association Press Release