Physical activity intervention improved the number and functionality of endothelial progenitor cells in low birth weight children

https://doi.org/10.1016/j.numecd.2019.08.011Get rights and content

Highlights

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    PA program may represent an effective strategy to improve vascular repair markers and angiogenic factors in LBW children.

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    PA program counteracts the adverse effect of LBW on SBP, EPCs, plasma levels of NO and VEGF-A.

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    Our findings support the implementation of lifestyle interventions to reduce the negative impact of LBW.

Abstract

Background and aims

The purpose of this study was to investigate whether an intervention with physical activity (PA) would promote positive effects on the angiogenic factors, mobilization, and functionality of circulating endothelial progenitor cells (EPCs) in children with low birth weight (LBW).

Methods and results

Thirty-five children participated in a 10-week PA program (intensity: 75–85% of heart rate reserve, frequency: four times/week, and duration: 45 min). Before and after the PA program, we evaluated anthropometric parameters, blood pressure levels, biochemical profile, number of EPCs, number of EPC colony forming units, and plasma levels of vascular endothelial growth factor-A (VEGF-A), nitric oxide (NO), and matrix metalloproteinases (MMPs) 2 and 9. We found a significant main effect of the PA program on waist circumference (ηp2 = 0.489), cardiorespiratory fitness (ηp2 = 0.463), and MMP-9 (ηp2 = 0.582). Birth weight or the PA program produced significant independent effects on systolic blood pressure (birth weight: ηp2 = 0.431; PA program: ηp2 = 0.615) and EPC colony forming units (birth weight: ηp2 = 0.541; PA program: ηp2 = 0.698) with no significant interactions. The combination of birth weight and the PA program produced a significant interaction effect on the number of circulating EPCs (ηp2 = 0.123), NO (ηp2 = 0.258), and VEGF-A (ηp2 = 0.175). The variation in the number of EPCs from baseline to 10 weeks of the PA program correlated positively with the change in NO (P = 0.002) and VEGF-A (P = 0.004).

Conclusions

A 10-week PA program attenuates the adverse effect of LBW on the number and functionality of EPCs; this effect occurs through an improvement in circulating levels of NO and VEGF-A.

Clinical trials

https://www.clinicaltrials.gov. Unique Identifier: NCT02982967. Date: December/2016.

Introduction

Low birth weight (LBW) is a leading public health concern, particularly in developing countries, where LBW rates have increased in recent years [1]. Newborns with LBW are known to have a higher risk of mortality and morbidity from birth through the first month of life [1]. Importantly, LBW is also associated with an increased risk of developing hypertension and cardiometabolic complications later in life, with the development of vascular abnormalities starting early in childhood [2], [3], [4], [5]. Several studies have already been carried out to examine these key issues, but little is known about the role of effective interventions that could prevent the later repercussions of LBW. Previous reports have shown a positive effect of physical activity to attenuate the impact of low birth weight on different metabolic parameters, such as insulin, leptin, and adiposity [6], [7], [8].

Physical activity represents an efficient non-pharmacologic tool with great potential for adjunct therapy in individuals at risk of poor vascular and metabolic health [9], [10], [11], [12], [13]. It is known that the practice of regular physical activity has beneficial effects on body composition, vascular function, and arterial stiffness [9], [10], [11], [12], [13]. It has also been shown that physical activity can promote the improvement of endothelial progenitor cell (EPC) mobilization, recruitment, and function [14], [15]. However, there is a lack of research examining the impact of the physical activity in children with LBW. Evidence has shown that vascular dysfunction is an important late complication of LBW [4], [5]. Recent studies have emerged claiming that there is a possible imbalance between endothelial injury and repair in children with a history of LBW, and that EPCs can influence this unfavorable balance [16], [17].

Considering the reports regarding the effect of physical activity on EPCs, as well as the relationship between these progenitor cells with birth weight, it is important to define whether and how physical activity could protect against the deleterious effect of LBW on EPCs. Thus, the purpose of this study was to investigate the effects of an intervention program with physical activity on the number and function of EPCs in prepubertal children who either did or did not have LBW. Further, angiogenic and other growth factors associated with EPC mobilization into the bloodstream, namely vascular endothelial growth factor-A (VEGF-A), nitric oxide (NO), and matrix metalloproteinases (MMPs) were evaluated and correlated with changes in the number of EPCs and EPC functionality.

Section snippets

Methods

This study was conducted with a group of children seen in the Youth Healthcare Centre located in São Paulo, Brazil. All protocol activities and procedures were approved by the Ethics Committee of the Federal University of São Paulo (Number: 220.565). In this Center, we screened 151 children aged 6–14 years. The first contact with the parents or guardians of the children occurred during a visit in the Youth Healthcare Centre. The purpose of this visit was to provide information about the study,

Results

We evaluated 35 children divided into two groups according to their birth weight (LBW, n = 12; NBW, n = 23). In the LBW group, the average birth weight was 2395 g (Range: 2200–2495) with a length at birth of 41.3 cm (range: 38–45). Among these children, we found a prematurity rate of 5.2% (n = 3). On the other hand, the average birth weight among NBW children was 3353 g (range: 3040–3680) with a length at birth of 49.4 cm (Range: 47–52). These groups did not differ in age (LBW: 8.5 ± 0.39; NBW:

Discussion

To our knowledge, the present data provide the first evidence that ten weeks of a PA program with moderate-to-vigorous intensity may represent an effective strategy to improve vascular repair markers and angiogenic factors in LBW children. The present results suggest that the PA program counteracts the adverse effect of LBW on systolic blood pressure, functional properties/number of circulating EPCs, and plasma levels of both NO and VEGF-A. These findings have important public health

Source of funding

This research was supported by a project grant from the FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil) (Project Number: 2013/03139-0).

Disclosures

None.

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    © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.