Hirschler Valeria, Maccallini Gustavo, Molinari Claudia, Urrutia Inés M, Castano On Behalf Of The San Antonio de Los Cobres Study Group Luis A
1 University of Buenos Aires , Buenos Aires, Argentina .
Diabetes Technol Ther. 2014 Feb;16(2):84-90. doi: 10.1089/dia.2013.0239.
Whether apolipoproteins (Apos) are better cardiovascular disease (CVD) markers than metabolic syndrome (MS) is widely debated. Measurement of Apo B is standardized, simple, and inexpensive and does not require fasting. The aim of this study was to compare the ability of nontraditional CVD markers such as Apo B, Apo B/Apo A, non-high-density lipoprotein cholesterol (HDL-C), vitamin D, and homeostasis model assessment of insulin resistance (HOMA-IR) to identify children with MS.
A cross-sectional study of 355 Argentinean Koya schoolchildren (166 boys) 9.6±2.3 years old was performed in November 2011. Anthropometric measures, blood pressure, Tanner stages, and serum levels of glucose, lipids, insulin, Apo A, Apo B, and vitamin D were measured.
The prevalence of overweight/obesity was 10.7% (n=38), and that of underweight was 14.6% (n=52) using Centers for Disease Control and Prevention criteria. The prevalence of central obesity was 10.9% (38/355), high triglycerides was 11.1% (39/355), low HDL-C was 44.9% (158/355), hypertension was 12.8% (45/355), hyperglycemia was 0.3% (1/355), and MS was 4.2% (15/355). Several multiple logistic regression analyses showed that MS was significantly associated with HOMA-IR (odds ratio [OR], 3.6 [95% confidence interval (CI) 1.51-8.52]), non-HDL-C (OR, 1.03 [95% CI 1.007-1.049]), Apo B (OR, 1.06 [95% CI 1.03-1.09]), and Apo B/Apo A (OR, 78.3 [95% CI 3.67-1,674.4]) adjusted for age and gender. Furthermore, the areas under the receiver operator characteristic curves were as follows: Apo B, 0.77 (95% CI 0.63-0.90); Apo B/Apo A, 0.76 (95% CI 0.63-0.88); non-HDL-C, 0.72 (95% CI 0.57-0.85); and HOMA-IR, 0.69 (95% CI 0.49-0.90). These values indicate that these variables were acceptable predictors for MS.
This is the first study of nontraditional markers in South American Indian children. MS was associated with multiple nontraditional markers of future CVD risk such as non-HDL-C, Apo B, and Apo B/Apo A. However, Apo B was the best predictor for MS, suggesting that it could be used as a risk marker of future CVD in this community.
载脂蛋白（Apos）是否比代谢综合征（MS）更适合作为心血管疾病（CVD）的标志物，这一问题存在广泛争议。载脂蛋白B（Apo B）的检测标准化、操作简单且成本低廉，并且无需空腹。本研究旨在比较非传统CVD标志物如Apo B、Apo B/Apo A、非高密度脂蛋白胆固醇（HDL-C）、维生素D以及胰岛素抵抗稳态模型评估（HOMA-IR）识别患有MS儿童的能力。
2011年11月，对355名9.6±2.3岁的阿根廷科亚学龄儿童（166名男孩）进行了一项横断面研究。测量了人体测量指标、血压、坦纳分期以及血糖、血脂、胰岛素、Apo A、Apo B和维生素D的血清水平。
根据美国疾病控制与预防中心标准，超重/肥胖患病率为10.7%（n = 38），体重过轻患病率为14.6%（n = 52）。中心性肥胖患病率为10.9%（38/355），高甘油三酯血症患病率为11.1%（39/355），低HDL-C患病率为44.9%（158/355），高血压患病率为12.8%（45/355），高血糖患病率为0.3%（1/355），MS患病率为4.2%（15/355）。多项多因素logistic回归分析显示，在校正年龄和性别后，MS与HOMA-IR（比值比[OR]，3.6[95%置信区间（CI）1.51 - 8.52]）、非HDL-C（OR，1.03[95% CI 1.007 - 1.049]）、Apo B（OR，1.06[95% CI 1.03 - 1.09]）以及Apo B/Apo A（OR，78.3[95% CI 3.67 - 1,674.4]）显著相关。此外，受试者工作特征曲线下面积如下：Apo B为0.77（95% CI 0.63 - 0.90）；Apo B/Apo A为0.76（95% CI 0.63 - 0.88）；非HDL-C为0.72（95% CI 0.57 - 0.85）；HOMA-IR为0.69（95% CI 0.49 - 0.90）。这些数值表明这些变量是MS的可接受预测指标。
这是首次对南美印第安儿童非传统标志物进行的研究。MS与未来CVD风险的多个非传统标志物相关，如非HDL-C、Apo B和Apo B/Apo A。然而，Apo B是MS的最佳预测指标，表明它可作为该社区未来CVD的风险标志物。
