The triglyceride/HDL-cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors
Zaira Quijada
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorCorresponding Author
Mariela Paoli
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Mariela Paoli, MDUrb. La MaraAv. 3, No. 122MéridaVenezuelaTel: (58) 414-9789995;fax: (58) 274-2403221;e-mail: [email protected]Search for more papers by this authorYajaira Zerpa
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorNolis Camacho
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorRosanna Cichetti
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorVanessa Villarroel
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorGabriela Arata-Bellabarba
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorRoberto Lanes
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorZaira Quijada
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorCorresponding Author
Mariela Paoli
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Mariela Paoli, MDUrb. La MaraAv. 3, No. 122MéridaVenezuelaTel: (58) 414-9789995;fax: (58) 274-2403221;e-mail: [email protected]Search for more papers by this authorYajaira Zerpa
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorNolis Camacho
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorRosanna Cichetti
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorVanessa Villarroel
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorGabriela Arata-Bellabarba
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorRoberto Lanes
a Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; b Unidad de Crecimiento y Desarrollo, Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela; c Laboratorio de Neuroendocrinología, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela; and d Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
Search for more papers by this authorAbstract
Objectives: To determine the presence of traditional and emergent cardiovascular risk factors and to evaluate the triglyceride/high-density lipoprotein cholesterol (Tg/HDL-C) ratio as a marker for cardiovascular disease and metabolic syndrome (MS) in obese children.
Material and methods: Sixty-seven prepubertal children of both sexes, between the ages of 6 and 12 yr, 20 normal-weight children, 18 overweight, and 29 obese subjects, were studied. Anthropometric measures, blood pressure, body mass index (BMI), and fat mass (FM), were measured. Plasma glucose, serum insulin, lipid profile, C-reactive protein (CRP), and leptin concentrations were quantified. Glucose and insulin concentrations 2 h post-glucose load were determined. The Tg/HDL-C ratio, homeostasis model assessment index (HOMA), and quantitative insulin sensitivity check index (QUICKI) were calculated.
Results: Systolic, diastolic, and mean blood pressures (MBP), low-density lipoprotein cholesterol (LDL-C), Tg/HDL-C, total cholesterol/HDL-C, LDL-C/HDL-C ratios, basal and 2 h postload insulin, CRP, and leptin were significantly higher and the QUICKI index were lower in the obese group. MBP, Tg/HDL-C ratio, HOMA, CRP, and leptin levels showed a positive and significant correlation and QUICKI a negative correlation with abdominal circumference, BMI, and FM. The Tg/HDL-C ratio correlated positively with MBP. The frequency of MS in the obese group was 69%. While Tg/HDL-C ratio, CRP, and leptin were higher and the values of QUICKI were lower in subjects with MS, it was the Tg/HDL-C ratio and the BMI that significantly explained the MS.
Conclusions: Obesity increases the cardiovascular risk in childhood. The Tg/HDL-C ratio could be a useful index in identifying children at risk for dyslipidemia, hypertension, and MS.
References
- 1 Williams C, Hayman L, Daniels S et al. Cardiovascular health in chilhood. Circulation 2002: 106: 143–160.
- 2 Villalobos J, Hernández W, Maulino N et al. Diabetes tipo 2 en niños y adolescentes. Experiencia de la unidad de diabetes del hospital de niños J.M. de Los Ríos. Rev Venez Endocrinol Metab 2004: 2: 18–23.
- 3 Dalmau J. Nuevos factores de riesgo cardiovascular detectables en la edad pediátrica. An Esp Pediatr 2001: 54: 4–8.
- 4 Berenson G, Srinivasan S, Bao W, Newman W, Tracy R, Wattigney W, for the Bogalusa Heart Study. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998: 338: 1650–1656.
- 5 Wilson P, D’ Agostino R, Levy D, Belanger A, Silbershatz H, Kannel W. Prediction of coronary heart disease using risk factor categories. Circulation 1998: 97: 1837–1847.
- 6 Hackam D, Anand S. Emerging risk factors for atherosclerotic vascular disease. JAMA 2003: 290: 932–940.
- 7 Kapiotis S, Holzer G, Schaller G et al. A proinflamatory state is detectable in obese children and is accompanied by functional and morphological vascular changes. Arterioscler Thromb Vasc Biol 2006: 26: 2541–2546.
- 8 McLaughlin T, Reaven G, Abbasi F et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005: 96: 399–404.
- 9 Barter P, McPherson R, Song K et al. FERUM insulin and inflammatory markers in overweight individuals with and without dyslipidemia. J Clin Endocrinol Metab 2007: 92: 2041–2045.
- 10 Hannon T, Bacha F, Lee S, Janosky J, Arslanian S. Use of markers of dyslipidemia to identify overweight youth with insulin resistance. Pediatr Diabetes 2006: 7: 260–266.
- 11 Raitakari O, Juonala M, Kahonen M, Taittonen L. Cardiovascular risk factors in childhood and corotid artery intima—media thickness in adulthood. JAMA 2003: 290: 2277–2283.
- 12 Ardura J. Factores de riesgo cardiovascular y hábitos saludables en la edad pediátrica. An Pediatr 2003: 58: 409–410.
- 13 López M, Landaeta M. Manual de crecimiento y desarrollo. Caracas: Fundacredesa, 1991.
- 14 National Health and Nutrition Examination Survey. Anthropometry Procedures Manual Dic. 2000: 1–65 (available from www.cdc.gov/nchs/data/nhanes/bm.pdf Accessed 15 November 2006.
- 15 Friedewald W, Levy R, Friderickson D. Estimatión of the concentration of low density protein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972: 18: 449–515.
- 16 Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab 2004: 89: 2526–2539.
- 17 Sociedad Venezolana de Endocrinología y Metabolismo. Consenso Nacional de Diabetes Tipo 2. Venezuela 2003. Definición, Clasificación y Diagnóstico de la Diabetes Mellitus. Caracas, Venezuela: Traducciencia 2003, pp. 25–26.
- 18 National Institutes of Health. Report of The Expert Panel on Blood Cholesterol Levels in Children and Adolescents. U.S. NIH Publication No 91-2732. Bethesda, Maryland: Department of Health and Human Services, 1991.
- 19 Paoli M, Pereira A. Sindrome metabólico en el niño y adolescente. Rev Venez Endocrinol Metab 2006: 4: 2–14.
- 20 Whincup P, Gilg J, Donald A et al. Arterial distensibility. The influence of adiposity, the metabolic syndrome, and classic risk factors. Circulation 2005: 112: 1789–1797.
- 21 Juonala M, Jarvisalo M, Maki-Torkko N, Kahonen M, Viikari J, Raitakari O. Risk factors identified in childhood and decreased carotid artery elasticity in adulthood. The Cardiovascular Risk in Young Finns Study. Circulation 2005: 112: 1486–1493.
- 22 Urbina E, Gidding S, Bao W, Elhasabany A, Berenson G. Association of fasting blood sugar level, insulin level, and obesity with left ventricular mass in healthy children and adolescents: the Bogalusa Heart Study. Am Heart J 1999: 138: 122–127.
- 23 Desideri G, De Simone M, Iughetti L et al. Early activation of vascular endothelial cells and platelets in obese children. J Clin Endocrinol Metab 2005: 90: 3145–3152.
- 24 McGill H, McMahan C, Herderick E, Malcom G, Tracey R, Strong J. Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 2000: 72: 1307–1315.
- 25 Tounian P, Aggoun Y, Dubern B et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001: 358: 1400–1404.
- 26 Van Dam R, Willett W, Manson J, Hu F. The relationship between overweight in adolescence and premature death in women. Ann Intern Med 2006: 145: 91–97.
- 27 Reaven G. The metabolic syndrome or the insulin resistance syndrome? different names, different concepts, and different goals. Endocrinol Metab Clin North Am 2004: 33: 283–303.
- 28 Cook S, Weitzman M, Auinger P, Nguyen M, Dietz W. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003: 157: 821–827.
- 29 Executive summary of he third report of the National Cholesterol Education Program (NCEP) expert panel on detection evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001: 285: 2486–2497.
- 30 Ferranti S, Gauvreau K, Ludwig D, Neufeld E, Newburger J, Rifai N. Prevalence of the metabolic syndrome in american adolescents. Findings from the Third National and Nutrition Examination Survey. Circulation 2004: 110: 2494–2497.
- 31 Cruz M, Weigensberg M, Huang T et al. The metabolic syndrome in overweight hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab 2004: 89: 108–113.
- 32 Weiss R, Dziura J, Burgert T et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004: 350: 2362–2374.
- 33 Mendoza S, Contreras G, Ineichen E et al. Lipids and lipoproteins in Venezuelan and American schoolchildren: within and cross-cultural comparisons. Pediatr Res 1980: 14: 272–277.
- 34 Paoli-Valeri M, Guzmán M, Jiménez-López M, Arias-Ferreira A, Briceño-Fernández M, Arata-Bellabarba G. Perfil lipídico aterogénico en niños con hipotiroidismo subclínico. An Pediatr (Barc) 2005: 62: 128–134.
- 35 Işcan A, Yiğitoğlu MR, Vurgun N, Uyanik BS, Akyildiz M. Low levels of high density lipoprotein cholesterol in Turkish children: an important risk factor. Acta Paediatr Jpn 1998: 40: 41–46.
- 36 Stan S, Levy E, Delvin EE et al. Distribution of LDL particle size in a population-based sample of children and adolescents and relationship with other cardiovascular risk factors. Clin Chem 2005: 51: 1192–1200.
- 37 Dhuper S, Cohen H, Daniel J et al. Utility of the modified ATP III defined metabolic syndrome and severe obesity as predictors of insulin resistance in overweight children and adolescents: a cross-sectional study. Cardiovasc Diabetol 2007: 6: 4 doi: 10.1186/1475-2840-6-4.
- 38 Liao Y, Kwon S, Shaughnessy S et al. Critical evaluation of Adult Treatment Panel III criteria in identifying insulin resistance with dyslipidemia. Diabetes Care 2004: 27: 978–983.
- 39 Lambert M, Paradis G, O’loughlin J, Delvin EE, Hanley JA, Levy E. Insulin resistance in a representative sample of children and adolescent from Quebec, Canada. Int J Obes Relat Metab Disord 2004: 28: 833–841.
- 40 Gunczler P, Lanes R. Relationship between different fasting-based insulin sensitivity indices in obese children and adolescents. J Pediatr Endocrinol Metab 2006: 19: 259–265.
- 41 Pasceri V, Willerson J, Yeh E. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000: 102: 2165–2168.
- 42 Valle-Jimenez M, Estepa RM, Camacho RM, Estrada RC, Luna FG, Guitarte FB. Endothelial dysfunction is related to insulin resistance and inflammatory biomarker levels in obese prepubertal children. Eur J Endocrinol 2007: 156: 497–502.
- 43 Kelesidis I, Mantzoros CH. Leptin and its emerging role in children and adolescents. Clin Pediatr Endocrinol 2006: 15: 1–14.
- 44 Kaufman CL, Kaiser DR, Steinberger J, Kelly AS, Dengel DR. Relationship of cardiac autonomic function with metabolic abnormalities in childhood obesity. Obesity 2007: 15: 1164–1171.
- 45 Lyoussi B, Ragala M, M’Guil M, Chraibi A, Israili Z. Gender specific leptinemia and its relationship with some components of the metabolic syndrome in Moroccans. Clin Exp Hypertens 2005: 4: 377–394.
- 46 Singhal A, Farooqi IS, Cole TJ et al. Influence of leptin on arterial distensibility: a novel link between obesity and cardiovascular disease? Circulation 2002: 106: 1919–1924.
- 47 Francischetti EA, Genelhu VA. Obesity-hypertension: an ongoing pandemic. Int J Clin Pract 2007: 61: 269–280.
- 48 Weghuber D, Zaknun D, Nasel C et al. Early cerebrovascular disease in a 2-year-old with extreme obesity and complete metabolic syndrome due to feeding of excessively high amounts of energy. Eur J Pediatr 2007: 166: 37–41.