J Pediatr Endocrinol Metab 2017; aop Stuart Keel*, Catherine Itsiopoulos, Konstandina Koklanis, Meri Vukicevic, Fergus Cameron and Laima Brazionis Vascular risk factors are associated with retinal arteriolar narrowing and venular widening in children and adolescents with type 1 diabetes DOI 10.1515/jpem-2016-0398 Received October 14, 2016; accepted December 19, 2016 Abstract Background: The aim of the study was to describe the rela- tionship of retinal arteriolar and venular calibre with vas- cular risk factors in children and adolescents with type 1 diabetes. Methods: In this hospital-based cross-sectional study, the medical files of 483 children and adolescents with type 1 diabetes were audited to collect retinal images and rel- evant clinical data. Retinal vascular calibre was measured using standardised protocols. Results: After multivariable adjustments, a vascular risk profile that included: older age, higher serum creatinine, higher systolic blood pressure (SBP), higher body mass index (BMI), abnormal estimated glomerular filtration rate (eGFR), lower high-density lipoproteins (HDL) cholesterol, longer duration of diabetes and higher serum sodium was associated with narrower central retinal artery equivalent (CRAE) (95% CI = − 4.10/− 0.76, p = 0.004). A specific risk profile, including higher total cholesterol level, higher BMI, lower physical activity level, higher HbA 1c , higher tri- glyceride levels, female gender and lower socio-economic status, was associated with wider central retinal vein equivalent (CRVE) (95% CI = 1.14/5.62, p = 0.003). Conclusions: In summary, these findings support evi- dence that cardiovascular disease may have its origins early in life. Prospective and/or intervention studies are required to confirm whether the observed associations are involved in the causal pathway for retinal vascular calibre. Keywords: microvasculature; retina; retinal vascular calibre; type 1 diabetes. Introduction Retinal vascular calibre provides a means to study early structural changes and pathological features of the human microcirculation [1]. An increasing knowledge of the influence that various systemic, environmental and genetic factors have on retinal vascular calibre has enabled a better understanding of the pathophysiology of the body’s microvasculature [2–4]. The vascular architec- ture of the retina is believed to follow an optimal pattern which allows for best possible blood distribution while utilising the least amount of energy [5]. Any deviations from this normal structure, most notably in the form of retinal arteriolar narrowing and retinal venular dilation, can be an indication of pathogenic processes [5]. Emerging evidence suggests that quantitative assess- ment of retinal vascular calibre may have the potential to provide additional prognostic information beyond current traditional risk factors for several cardiovascular, cerebro- vascular and metabolic related diseases [2, 6–8]. Recent research has revealed promising findings when explor- ing the relationship between retinal vascular calibre and the common microvascular complications associated with type 1 diabetes. That is, several studies have high- lighted that retinal arteriolar dilation is present in inci- dent diabetic retinopathy and may precede the common signs of early retinopathy in these individuals [9–14]. Fur- thermore, Broe and co-workers (2014) report that wider retinal venules and narrower arterioles were predictive of nephropathy in a young population-based cohort with type 1 diabetes [15]. Despite this, the pathophysiological mechanisms underlying variations in retinal vascular calibre are *Corresponding author: Dr. Stuart Keel, Centre for Eye Research, Melbourne University, 75 Commercial Road, Melbourne, 3000, Australia, Phone: + 61-400597884, Fax: + 03-9479-3692, E-mail: stuart.keel@unimelb.edu.au; and Department of Clinical Vision Sciences, Latrobe University, Melbourne, Victoria, Australia Catherine Itsiopoulos: College of Science, Health and Engineering, La Trobe University, Melbourne, Australia Konstandina Koklanis and Meri Vukicevic: School of Allied Health, La Trobe University, Melbourne, Australia Fergus Cameron: Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, Victoria, Australia Laima Brazionis: Department of Medicine, The University of Melbourne, St Vincent’s Hospital, Melbourne, Australia Brought to you by | provisional account Unauthenticated Download Date | 2/22/17 9:24 AM