Erol Meltem, Bostan Gayret Özlem, Hamilçıkan Şahin, Can Emrah, Yiğit Özgu L
Department of Pediatrics, Bagcilar Training and Research Hospital, Istanbul, Turkey.
Arch Argent Pediatr. 2017 Apr 1;115(2):133-139. doi: 10.5546/aap.2017.eng.133.
Dyslipidemia is one of the major complications of obesity; vitamin D deficiency and insulin resistance are attending metabolic complications in dyslipidemic obese children. Objective. To determine if vitamin D deficiency and insulin resistance are risk factors for dyslipidemia in obese children.
This study was conducted in the Department of Pediatrics at Bagcilar Training and Research Hospital in Istanbul, Turkey between 2014 and 2015. Obese patients whose age range was 8-14 were included in the study. The serum triglyceride, total cholesterol, low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol, fasting glucose, insulin, alanine aminotransferase, vitamin D levels were measured; a liver ultrasonography was performed. Homeostatic model assessment (HOMA-IR), was used to calculate insulin resistance.
108 obese children were included; 39 (36.11%) had dyslipidemia. The average fasting blood glucose (88.74 ± 7.58 vs. 95.31 ± 6.82; p= 0.0001), insulin level (14.71 ± 12.44 vs. 24.39 ± 15.02; p= 0.0001) and alanine aminotransferase level (23.45 ± 11.18 vs. 30.4 ± 18.95; p= 0.018) were significantly higher in the children with dyslipidemia. In the dyslipidemic obese children, the average hepatosteatosis rate and HOMA-IR level were higher; 28 (71.9%) had hepatosteatosis, 37 (94.87%) had insulin resistance; the vitamin D levels were <20 ng/ml in 69.3%. Vitamin D deficiency was significantly more common (p= 0.033). The multivariate regression analysis confirmed that the increase in the HOMA-IR level (p= 0.015) and the low vitamin D level (p= 0.04) were important risk factors for dyslipidemia.
Obese children in our region exhibit low vitamin D and increased HOMA-IR levels, which are efficient risk factors of dyslipidemia.
血脂异常是肥胖的主要并发症之一；维生素D缺乏和胰岛素抵抗是血脂异常肥胖儿童常见的代谢并发症。目的：确定维生素D缺乏和胰岛素抵抗是否为肥胖儿童血脂异常的危险因素。
本研究于2014年至2015年在土耳其伊斯坦布尔巴伊西拉尔培训与研究医院儿科进行。纳入年龄在8至14岁的肥胖患者。测量血清甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、空腹血糖、胰岛素、丙氨酸转氨酶、维生素D水平；进行肝脏超声检查。采用稳态模型评估（HOMA-IR）计算胰岛素抵抗。
纳入108名肥胖儿童；39名（36.11%）患有血脂异常。血脂异常儿童的平均空腹血糖（88.74±7.58对95.31±6.82；p=0.0001）、胰岛素水平（14.71±12.44对24.39±15.02；p=0.0001）和丙氨酸转氨酶水平（23.45±11.18对30.4±18.95；p=0.018）显著更高。在血脂异常的肥胖儿童中，平均肝脂肪变性率和HOMA-IR水平更高；28名（71.9%）有肝脂肪变性，37名（94.87%）有胰岛素抵抗；69.3%的维生素D水平<20 ng/ml。维生素D缺乏明显更常见（p=0.033）。多因素回归分析证实，HOMA-IR水平升高（p=0.015）和维生素D水平低（p=0.04）是血脂异常的重要危险因素。
我们地区的肥胖儿童维生素D水平低且HOMA-IR水平升高，这是血脂异常的有效危险因素。
