Clinic for Pediatrics I, Pediatric Endocrinology, University Hospital Halle (Saale), Halle, Germany.
Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Pediatr Obes. 2023 Mar;18(3):e12989. doi: 10.1111/ijpo.12989. Epub 2022 Nov 6.
Associations between body mass index (BMI)- standard deviation score (SDS)/waist-to-height ratio (WHtR) were studied with (i) serum uric acid (sUA)/gamma-glutamyl-transferase (GGT) and (ii) cardiometabolic risk markers in children with obesity, considering sex, pubertal development, and degree of weight loss/type of patient care.
102 936 children from the Adiposity-Follow-up registry (APV; 47% boys) were included. Associations were analysed between sUA/GGT and anthropometrics, transaminases, lipids, fasting insulin (FI), homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides to HDL-cholesterol (TG/HDL)-ratio. Follow-up analyses (3-24 months after baseline) considered a BMI-SDS reduction ≥0.2 (n = 11 096) or ≥0.5 (n = 3728). Partialized correlation analyses for sex and BMI-SDS were performed, taking pubertal development into consideration.
At baseline, BMI-SDS showed the strongest correlations to sUA (r = 0.35; n = 26 529), HOMA-IR/FI (r = 0.30; n = 5513 /n = 5880), TG/HDL-ratio (r = 0.23; n = 24 501), and WHtR to sUA (r = 0.32; n = 10 805), GGT (r = 0.34; n = 11 862) and Alanine-aminotransferase (ALAT) (r = 0.33; n = 11 821), with stronger correlations in boys (WHtR and GGT: r = 0.36, n = 5793) and prepubertal children (r = 0.36; n = 2216). GGT and sUA (after partializing effects of age, sex, BMI-SDS) showed a correlation to TG/HDL-ratio (r = 0.27; n = 24 501). Following a BMI-SDS reduction ≥0.2 or ≥0.5, GGT was most strongly related to Aspartate-aminotransferase (ASAT)/ ALAT, most evident in prepuberty and with increasing weight loss, and also to TG/HDL-ratio (r = 0.22; n = 1528). Prepubertal children showed strongest correlations between BMI-SDS/WHtR and GGT. ΔBMI-SDS was strongly correlated to ΔsUA (r = 0.30; n = 4160) and ΔGGT (r = 0.28; n = 3562), and ΔWHtR to ΔGGT (r = 0.28; n = 3562) (all p < 0.0001).
Abdominal obesity may trigger hyperuricemia and hepatic involvement already in prepuberty. This may be stronger in infancy than anticipated to date. Even moderate weight loss has favourable effects on cardiometabolic risk profile and glucose homeostasis.
研究肥胖儿童的体质指数（BMI）-标准偏差评分（SDS）/腰高比（WHtR）与（i）血清尿酸（sUA）/γ-谷氨酰转移酶（GGT）和（ii）心脏代谢风险标志物之间的关系，同时考虑性别、青春期发育和减重程度/患者护理类型。
纳入了 Adiposity-Follow-up 注册研究（APV）中的 102936 名儿童（47%为男孩）。分析了 sUA/GGT 与身高、体重、转氨酶、血脂、空腹胰岛素（FI）、稳态模型评估的胰岛素抵抗（HOMA-IR）、三酰甘油与高密度脂蛋白胆固醇（TG/HDL）比值之间的关系。在基线后 3-24 个月的随访分析中，考虑 BMI-SDS 降低≥0.2（n=11096）或≥0.5（n=3728）。进行了部分相关分析，考虑了青春期发育和 BMI-SDS 的性别差异。
在基线时，BMI-SDS 与 sUA（r=0.35；n=26529）、HOMA-IR/FI（r=0.30；n=5513/n=5880）、TG/HDL-ratio（r=0.23；n=24501）和 WHtR 与 sUA（r=0.32；n=10805）、GGT（r=0.34；n=11862）和丙氨酸氨基转移酶（ALAT）（r=0.33；n=11821）的相关性最强，在男孩（WHtR 和 GGT：r=0.36，n=5793）和青春期前儿童（r=0.36；n=2216）中相关性更强。GGT 和 sUA（在部分考虑了年龄、性别、BMI-SDS 的影响后）与 TG/HDL-ratio 呈相关性（r=0.27；n=24501）。BMI-SDS 降低≥0.2 或≥0.5 后，GGT 与天门冬氨酸氨基转移酶（ASAT）/丙氨酸氨基转移酶（ALAT）的相关性最强，在青春期前和减重幅度较大时最为明显，与 TG/HDL-ratio 也呈相关性（r=0.22；n=1528）。青春期前儿童的 BMI-SDS/WHtR 与 GGT 之间相关性最强。ΔBMI-SDS 与 ΔsUA（r=0.30；n=4160）和 ΔGGT（r=0.28；n=3562）呈强相关性，ΔWHtR 与 ΔGGT（r=0.28；n=3562）呈强相关性（均 p<0.0001）。
腹部肥胖可能早在青春期前就引发高尿酸血症和肝脏受累。这可能比目前预期的更为明显。即使是适度的减重也对心脏代谢风险状况和葡萄糖稳态有有利影响。
