Marín-Echeverri Catalina, Aristizábal Juan C, Gallego-Lopera Natalia, Santa-Ramírez Hugo A, Hoyos-Gómez Marcela, Ruiz-Pineda Adriana Marcela, Arias Andrés A, Barona-Acevedo Jacqueline
Escuela de Microbiología, Universidad de Antioquia UdeA, Medellín, Colombia.
Grupo de Investigación de Fisiología y Bioquímica (PHYSIS), Escuela de Nutrición y Dietética, Universidad de Antioquia UdeA, Medellín, Colombia.
J Pediatr Endocrinol Metab. 2018 Nov 27;31(11):1179-1189. doi: 10.1515/jpem-2018-0140.
Background Abdominal obesity (AO) is linked to inflammation and insulin resistance (IR). However, there is limited information on whether preschoolers with AO present these risk factors. We evaluated the association between AO and cardiovascular risk factors in preschoolers. Methods We enrolled 232 children (2-5 years), of whom 50% had AO. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG), apolipoprotein B (Apo-B) and apolipoprotein A-1 (Apo-A1), glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1β, monocyte chemoattractant protein (MCP-1/CCL2), leptin, adiponectin, vascular cell adhesion molecule (VCAM-1/CD106) and intercellular adhesion molecule (ICAM-1/CD54) were measured. The homeostatic model assessment of IR (HOMA-IR) was calculated. We analyzed these variables according to the presence of AO and other metabolic syndrome (MetS) components. Results A total of 75.8% of children with AO had one or more risk factors for MetS. Children with AO had significantly higher body mass indexes (BMIs), insulin, HOMA-IR, TG, very low-density lipoprotein-cholesterol (VLDL-c) and TC/HDL-c ratio and lower HDL-c, compared to children without AO; but there were no differences in inflammatory markers. After adjusting for BMI, sex and age, the differences between groups were not significant for any variable. Waist circumference (WC) was correlated with insulin (r=0.547; p<0.001), TG (r=0.207; p=0.001), ICAM-1 (r=0.213; p=0.039), hs-CRP (r=0.189; p=0.015) and glucose (r=0.187; p=0.004). After adjusting for BMI, age and sex, AO plus one MetS component contributed to individual variation in glucose, insulin, HOMA-IR and TG. Conclusions AO in preschool children is associated with greater IR and atherogenic lipid profiles, although these findings seem to be more related to general obesity than just central obesity. In addition, our data suggest that IR may precede the elevation of systemic cytokines in obese children, unlike findings in adults. More studies in pediatric populations are needed to elucidate these associations.
背景 腹部肥胖（AO）与炎症和胰岛素抵抗（IR）相关。然而，关于患有AO的学龄前儿童是否存在这些危险因素的信息有限。我们评估了学龄前儿童中AO与心血管危险因素之间的关联。方法 我们纳入了232名2至5岁的儿童，其中50%患有AO。检测了血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、甘油三酯（TG）、载脂蛋白B（Apo-B）和载脂蛋白A-1（Apo-A1）、葡萄糖、胰岛素、高敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-1β、单核细胞趋化蛋白（MCP-1/CCL2）、瘦素、脂联素、血管细胞黏附分子（VCAM-1/CD106）和细胞间黏附分子（ICAM-1/CD54）。计算了IR的稳态模型评估（HOMA-IR）。我们根据AO和其他代谢综合征（MetS）组分的存在情况分析了这些变量。结果 共有75.8%的AO患儿有一项或多项MetS危险因素。与无AO的儿童相比，AO患儿的体重指数（BMI）、胰岛素、HOMA-IR、TG、极低密度脂蛋白胆固醇（VLDL-c）和TC/HDL-c比值显著更高，而HDL-c更低；但炎症标志物无差异。在调整了BMI、性别和年龄后，两组间任何变量的差异均无统计学意义。腰围（WC）与胰岛素（r=0.547；p<0.001）、TG（r=0.207；p=0.001）、ICAM-1（r=0.213；p=0.039）、hs-CRP（r=0.189；p=0.015）和葡萄糖（r=0.187；p=0.004）相关。在调整了BMI、年龄和性别后，AO加一项MetS组分导致了葡萄糖、胰岛素、HOMA-IR和TG的个体差异。结论 学龄前儿童中的AO与更大的IR和动脉粥样硬化性脂质谱相关，尽管这些发现似乎更多地与总体肥胖而非单纯的中心性肥胖有关。此外，我们的数据表明，与成人的发现不同，IR可能在肥胖儿童全身细胞因子升高之前出现。需要在儿科人群中进行更多研究以阐明这些关联。
