Retinal vessel diameter, obesity and metabolic risk factors in school children (JuvenTUM 3)

Atherosclerosis. 2012 Mar;221(1):242-8. doi: 10.1016/j.atherosclerosis.2011.12.029. Epub 2011 Dec 27.


Background: The prevalence of childhood obesity is high and its association with future cardiovascular disease in adulthood is well established. The cross-sectional data presented analyze the prevalence of obesity and the association between metabolic risk factors, physical inactivity and retinal vessel diameter in young school children.

Methods: The examination included 578 school children aged 11.1±0.6 years from secondary schools in the District of Munich, Germany. Anthropometric measurements and blood sampling were conducted using standard protocols for children. Physical activity was evaluated by use of a questionnaire. Retinal microvascular diameters and the arteriolar to venular ratio (AVR) were assessed with a non-mydriatic vessel analyser (SVA-T) using a computer-based program.

Results: In our population, 128 (22.2%) children were overweight (ow) or obese (ob). The mean retinal arteriolar and venular calibres were 208.0±15.6 μm and 236.2±16.2 μm, respectively, with a mean AVR of 0.88±0.01. Girls had significantly wider arteriolar and venular diameters compared to boys (p<0.001). ow and ob children had a lower AVR compared to normal weight (nw) children (mean(95% CI); nw: 0.89(0.88-0.89); ow: 0.87(0.86-0.88); ob: 0.85(0.83-0.87); p≤0.05). Wider venular diameters were independently associated with higher BMI and higher hsCRP. Blood pressure was associated with retinal vessel constriction. Higher physical inactivity and BMI were independently associated with a reduced AVR (p=0.032 and p<0.001, respectively).

Conclusions: Cardiometabolic risk factors and physical inactivity are associated with retinal microvascular alterations in young children, comparable to associations in adults. Retinal vessel imaging seems to be a feasible assessment for the detection of microvascular impairments in children at risk of developing cardiovascular disease in adulthood.

Trial registration: NCT00988754.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Analysis of Variance
  • Arterioles / pathology
  • Biomarkers / blood
  • Blood Pressure
  • Body Mass Index
  • C-Reactive Protein / analysis
  • Child
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Linear Models
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / diagnosis
  • Metabolic Syndrome / epidemiology*
  • Metabolic Syndrome / physiopathology
  • Motor Activity
  • Obesity / blood
  • Obesity / diagnosis
  • Obesity / epidemiology*
  • Obesity / physiopathology
  • Prevalence
  • Retinal Diseases / blood
  • Retinal Diseases / diagnosis
  • Retinal Diseases / epidemiology*
  • Retinal Diseases / physiopathology
  • Retinal Vessels / pathology*
  • Retinal Vessels / physiopathology
  • Risk Assessment
  • Risk Factors
  • Surveys and Questionnaires
  • Venules / pathology


  • Biomarkers
  • C-Reactive Protein

Associated data