Rutigliano Irene, Vinci Roberta, De Filippo Gianpaolo, Mancini Monica, Stoppino Luca, d'Apolito Maria, Giardino Ida, Macarini Luca, Pettoello Mantovani Massimo, Campanozzi Angelo
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Unit of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
Department of Medical and Surgical Sciences, Radiology, University of Foggia, Foggia, Italy.
Nutrition. 2017 Apr;36:1-7. doi: 10.1016/j.nut.2016.10.017. Epub 2016 Nov 22.
Pediatric metabolic syndrome (MetS) is a well-recognized entity; however, there is no consensus on its exact value in predicting long-term cardiovascular (CV) risk. Hepatic steatosis (HS) is another emerging condition associated with pediatric obesity, and data have been reported suggesting a possible role of HS in CV risk linked to MetS. The aim of the present study was to evaluate the usefulness of HS and MetS cluster in predicting CV risk linked to pediatric obesity.
We studied 803 overweight and obese children (395 girls and 408 boys, mean age 9.4 ± 2.5 y, body mass index z-score 2.2 ± 0.53) with complete clinical and biological assessment. MetS was defined using the modified criteria of the American Heart Association. The diagnosis and severity of the HS was based on ultrasound. To assess CV risk, all patients underwent ultrasonography to measure carotid intima-media thickness (cIMT)-a validated marker of subclinical vascular disease.
The overall prevalence of MetS was 13.07%; HS was significantly higher in patients with MetS (40.9 versus 18.5%; P < 0.001; odds ratio, 3.059; 95% confidence interval, 1.98-4.7). Spearman's correlation between HS grade and the number of MetS criteria met by each patient was significant (r = 0.285; P < 0.001). No statistical difference was recorded in cIMT and cIMT z-scores between patients with or without MetS, until inclusion of HS as an additional criterion for the diagnosis of MetS. In this case, there was a significant difference in cIMT z-scores between the two groups. In multiple linear regression analysis, the cIMT z-score value was better predicted with HS grade and the MetS cluster (adjusted R = 2.6%; P = 0.002) than when using the MetS cluster only.
HS could be used as additional criterion in detecting pediatric MetS phenotype at higher risk for long-term CV morbidity.
儿童代谢综合征（MetS）是一个已被充分认识的实体；然而，对于其在预测长期心血管（CV）风险的确切价值尚无共识。肝脂肪变性（HS）是另一种与儿童肥胖相关的新出现的病症，已有数据表明HS在与MetS相关的CV风险中可能发挥作用。本研究的目的是评估HS和MetS聚类在预测与儿童肥胖相关的CV风险中的有用性。
我们研究了803名超重和肥胖儿童（395名女孩和408名男孩，平均年龄9.4±2.5岁，体重指数z评分2.2±0.53），对其进行了完整的临床和生物学评估。MetS采用美国心脏协会的改良标准进行定义。HS的诊断和严重程度基于超声检查。为评估CV风险，所有患者均接受超声检查以测量颈动脉内膜中层厚度（cIMT），这是一种经过验证的亚临床血管疾病标志物。
MetS的总体患病率为13.07%；MetS患者的HS患病率显著更高（40.9%对18.5%；P<0.001；比值比，3.059；95%置信区间，1.98 - 4.7）。HS分级与每位患者满足的MetS标准数量之间的Spearman相关性显著（r = 0.285；P<0.001）。在将HS作为MetS诊断的附加标准纳入之前，有或无MetS的患者在cIMT和cIMT z评分方面未记录到统计学差异。在此情况下，两组之间的cIMT z评分存在显著差异。在多元线性回归分析中，与仅使用MetS聚类相比，HS分级和MetS聚类能更好地预测cIMT z评分值（调整R = 2.6%；P = 0.002）。
HS可作为检测具有长期CV发病高风险的儿童MetS表型的附加标准。
