1
|
El Amrousy D, El-Afify D, Salah S. Insulin resistance, leptin and adiponectin in lean and hypothyroid children and adolescents with obesity. BMC Pediatr 2022; 22:245. [PMID: 35501770 PMCID: PMC9059419 DOI: 10.1186/s12887-022-03318-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Obesity usually complicates hypothyroidism. Adipokines like leptin and adiponectin secreted by adipose tissue modulate insulin resistance (IR), appetite, and obesity. The association between adipokines, IR, and thyroid hormone has not been sufficiently studied in children. We investigated leptin and adiponectin as well as IR and their association with thyroid hormone in both lean and hypothyroid children and adolescents with obesity. METHODS The study included 30 lean hypothyroid, 30 hypothyroid children and adolescents with obesity, and 30 healthy lean children as the control group. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), fasting blood glucose, fasting insulin, homeostatic model assessment method of insulin resistance (HOMA-IR), leptin, and adiponectin levels were estimated in all participants. RESULTS Fasting insulin, HOMA-IR, and leptin levels were significantly elevated in hypothyroid children compared to the control group; more in hypothyroid children with obesity. In contrast, adiponectin levels were significantly lower in the hypothyroid children with obesity compared to the lean hypothyroid children and controls. HOMA-IR was positively correlated to TSH and BMI but inversely correlated with fT3 and fT4 in hypothyroid children. There was no correlation between IR and either leptin or adiponectin levels. Leptin and adiponectin levels correlated well with BMI in hypothyroid children and adolescents with obesity. CONCLUSION Insulin resistance and leptin levels are increased in hypothyroid children and adolescents; more in those with obesity. IR is not related to leptin and adiponectin levels, however, leptin and adiponectin levels correlate well with BMI in hypothyroid children and adolescents with obesity. IMPACT Insulin resistance (IR) and leptin levels increase in hypothyroid children and adolescent; more with obesity. IR is not related to leptin and adiponectin levels, however leptin and adiponectin levels correlated well with BMI in hypothyroid children and adolescents with obesity.
Collapse
Affiliation(s)
- Doaa El Amrousy
- grid.412258.80000 0000 9477 7793Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dalia El-Afify
- grid.412258.80000 0000 9477 7793Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Shaimaa Salah
- grid.411978.20000 0004 0578 3577Pediatric Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| |
Collapse
|
2
|
Özcabi B, Tarçın G, Şengenç E, Tahmiscioğlu Bucak F, Ercan O, Bolayırlı İM, Evliyaoğlu O. Is Waist-height Ratio Associated with Thyroid Antibody Levels in Children with Obesity? J Clin Res Pediatr Endocrinol 2021; 13:152-159. [PMID: 33006550 PMCID: PMC8186330 DOI: 10.4274/jcrpe.galenos.2020.2020.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Obesity is known to affect thyroid function. Recently, waist-height ratio (WHtR) has been considered as a useful marker of subclinical hypothyroidism in obese cases, but its relation with thyroid autoimmunity still remains unclear. We evaluated the effect of body fat mass, WHtR, and metabolic parameters on thyroid autoantibody levels in children with obesity. METHODS This was a cross-sectional study carried out with an obese [n=56, male/female (M/F): 29/26] and a healthy group (n=38, M/F: 19/19). All subjects underwent anthropometric measurements, laboratory investigations for thyroid function tests, thyroid peroxidase (TPO-ab) and thyroglobulin-antibodies (Tg-ab), transaminases, blood glucose, insulin levels, and lipids after overnight fasting; homeostatic model assessment for insulin resistance (HOMA-IR) was calculated for assessment of insulin resistance. Fat mass was estimated by multiple frequency bioimpedance analysis in the obese group, which was further divided into two subgroups according to the median of WHtR. All parameters were compared between the groups/subgroups. RESULTS In the obese group, weight, height, body mass index (BMI), free triiodothyronine, thyrotropin, TPO-ab, insulin, low density lipoprotein-cholesterol, total cholesterol, alanine aminotransferase levels, and HOMA-IR were significantly higher than the controls group (p<0.05 for all). Median of WHtR was 0.6 in the obese group. In the “WHtR >0.6” subgroup (n=28), weight, BMI, fat mass, TPO-ab, Tg-ab, insulin and triglyceride levels were higher than WHtR ≤0.6 subgroup (p<0.05). A positive correlation was obtained between Tg-ab and WHtR (rho=0.28, p=0.041). CONCLUSION Euthyroid children with obesity and a WHtR >0.6 are likely to have higher thyroid antibody levels, and Tg-ab levels have a positive correlation with WHtR, which reveals an association of central adiposity with thyroid autoantibody levels in these cases.
Collapse
Affiliation(s)
- Bahar Özcabi
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Gürkan Tarçın
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Esma Şengenç
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Feride Tahmiscioğlu Bucak
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - İbrahim Murat Bolayırlı
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Biochemistry, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey,* Address for Correspondence: İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 212 414 30 00 E-mail:
| |
Collapse
|
3
|
Kara O. Influence of subclinical hypothyroidism on metabolic parameters in obese children and adolescents. Clin Exp Pediatr 2020; 63:110-114. [PMID: 32164046 PMCID: PMC7073379 DOI: 10.3345/cep.2019.01536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/30/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SH) is a common condition in obese children. However, its effect on glucose and lipid metabolism in obese children remains controversial. PURPOSE The present study aimed to investigate the association between SH and metabolic parameters. METHODS A total of 215 obese children and adolescents aged 6-18 years were included in this retrospective cross-sectional study. The patients' anthropometric measurements such as thyrotropin (TSH), free thyroxine (fT4), fasting plasma glucose, and insulin levels, as well as homeostasis model assessment for insulin resistance (HOMA-IR) index, and lipid profiles were evaluated. The patients were allocated to the SH group (fT4 normal, TSH 5-10 mIU/L) (n=77) or the control group (fT4 normal, TSH<5 mIU/L) (n=138). The glucose and lipid metabolisms of the 2 groups were compared. RESULTS SH was identified in 77 of 215 patients (36%). Mean body mass index was similar in both groups. The mean serum insulin, HOMA-IR, and triglyceride (TG) levels were higher and the mean high-density lipoprotein cholesterol level was lower in the SH group than in the control group (P=0.007, P=0.004, P=0.01, and P=0.02, respectively). A positive correlation was observed between TSH level and insulin level, HOMA-IR, and TG level. CONCLUSION SH was identified in some of the obese children and adolescents. A clear association was observed between SH, insulin resistance, and dyslipidemia in obese children.
Collapse
Affiliation(s)
- Ozlem Kara
- Department of Pediatric Endocrinology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| |
Collapse
|
4
|
Iqbal AM, Lteif AN, Kumar S. Association between mild hyperthyrotropinemia and hypercholesterolemia in children with severe obesity. J Pediatr Endocrinol Metab 2019; 32:561-568. [PMID: 31129653 DOI: 10.1515/jpem-2018-0519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/17/2019] [Indexed: 11/15/2022]
Abstract
Background Severe obesity is associated with a number of cardiometabolic risk factors. Thyroid-stimulating hormone (TSH) levels are often slightly increased in children with obesity. The clinical significance of the mild elevation in TSH in children with obesity is unclear. Objective To examine the association between TSH and lipids in children with severe obesity. Methods We performed a retrospective analysis of records of children with severe obesity with simultaneous measurements of TSH and lipids. Children with TSH <0.3 mIU/L and ≥10 mIU/L were excluded. The relationship between TSH and lipids was evaluated using univariate/multiple variable linear and logistic regression. Results The study included 834 children (age 13.8 ± 4.1 years, males 46%, body mass index [BMI]: 36.9 ± 7.6 kg/m2; BMI z-score 2.6 ± 0.4). Seventy-four (8.9%) children had TSH between 5 and <10 mIU/L (high TSH [HTSH]). TSH was positively associated with non-high-density lipoprotein (HDL) cholesterol (β: 1.74; 95% confidence interval [CI] 0.29-3.20, p = 0.02). Total cholesterol and non-HDL cholesterol were higher in males with HTSH compared to those with normal TSH (175.5 vs. 163.5 mg/dL, p = 0.02 and 133.7 vs. 121.4 mg/dL, p = 0.02, respectively). The odds of elevated non-HDL cholesterol (≥145 mg/dL) was higher in males with HTSH relative to those with normal TSH (odds ratio [OR]: 2.78; 95% CI 1.35-5.69, p = 0.005). Conclusions TSH levels were positively associated with non-HDL cholesterol in children with severe obesity. Males with mildly elevated TSH had higher total cholesterol and non-HDL cholesterol compared to males with normal TSH. Further studies are warranted to determine if levothyroxine therapy would result in improvement in total cholesterol or non-HDL cholesterol in children with severe obesity with mildly elevated TSH.
Collapse
Affiliation(s)
- Anoop Mohamed Iqbal
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Cho WK, Nam HK, Kim JH, Rhie YJ, Chung S, Lee KH, Suh BK. Thyroid Function in Korean Adolescents with Obesity: Results from the Korea National Health and Nutrition Examination Survey VI (2013-2015). Int J Endocrinol 2018; 2018:6874395. [PMID: 30250485 PMCID: PMC6140097 DOI: 10.1155/2018/6874395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In this study, we investigated the status of thyroid function and its association with metabolic risk factors in Korean adolescents. METHODS Among 2679 subjects aged 10-19 years who participated in the Korea National Health and Nutrition Examination Survey VI (2013-2015), 1067 adolescents (M = 559, F = 508) with available data on free T4 (FT4) and thyroid-stimulating hormone (TSH) were included. Study participants were classified into normal weight [body mass index (BMI) below 85th percentile, 80.7%], overweight (85th ≤ BMI< 95th percentile, 8.7%), and obesity (BMI ≥ 95th percentile, 10.6%). RESULTS With increasing levels of BMI category, the means of TSH increased (2.73 ± 0.06, 2.77 ± 0.02, and 3.24 ± 0.22 mIU/L, P = 0.031) and FT4 decreased (1.30 ± 0.01, 1.26 ± 0.02, and 1.25 ± 0.02 ng/mL, P = 0.001). Positive linear associations were observed between TSH and BMI z-score (P = 0.031), waist circumference (P = 0.013), waist-height ratio (P = 0.002), systolic blood pressure (P = 0.001), total cholesterol (P = 0.008), and triglyceride (P = 0.002) after adjusting for age and sex. With per-unit increase in TSH, the odds ratios of having abdominal obesity (OR = 1.18, 95% CI, 1.01-1.38) and triglyceride ≥ 150 mg/dL (OR = 1.18, 95% CI, 1.04-1.34) were significantly increased after adjusting for age, sex, and BMI. CONCLUSIONS In adolescents with obesity, TSH was higher and FT4 was lower than in adolescents with normal weight. Hyperthyrotropinemia was associated with abnormal metabolic risk factors including abdominal obesity and elevated triglyceride.
Collapse
Affiliation(s)
- Won Kyoung Cho
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi-do 16247, Republic of Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, College of Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu Seoul 08308, Republic of Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Young-Jun Rhie
- Department of Pediatrics, College of Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do 15355, Republic of Korea
| | - Sochung Chung
- Department of Pediatrics, College of Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, College of Medicine, Korea University Anam Hospital, 73 Inchon-ro, Seongbuk-gu Seoul 02841, Republic of Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| |
Collapse
|
6
|
Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
| |
Collapse
|
7
|
García-García E, Vázquez-López MA, García-Fuentes E, Galera-Martínez R, Gutiérrez-Repiso C, García-Escobar I, Bonillo-Perales A. Thyroid Function and Thyroid Autoimmunity in Relation to Weight Status and Cardiovascular Risk Factors in Children and Adolescents: A Population-Based Study. J Clin Res Pediatr Endocrinol 2016; 8:157-62. [PMID: 26761948 PMCID: PMC5096470 DOI: 10.4274/jcrpe.2687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE In obese subjects, slight increases have been observed in thyrotropin [thyroid-stimulating hormone (TSH)] levels, but data in children are scarce. The aim of this study was to evaluate whether thyroid function and autoimmunity vary with weight status in a healthy population of children and adolescents and to determine whether hyperthyrotropinemia is associated with any cardiovascular risk factor. METHODS This cross-sectional epidemiological study was conducted in Almería (Spain) on a representative sample of 1317 healthy subjects aged 2-16 years. Thyroid function, thyroid autoimmunity and cardiovascular risk factors were measured. Chi-square test, analysis of variance and multiple linear regression were used in the statistical analyses. RESULTS The obese children and adolescents had thyrotropin levels (mean ± standard deviation) of 3.12±2.44 mU/L. These levels were higher than those of overweight subjects (2.79±1.51 mU/L) and of normal weight subjects (2.73±1.30 mU/L) (p=0.02). Levels of free thyroxine and urinary iodine did not differ significantly between the groups. The prevalence (95% confidence interval) of thyroid autoimmunity was lower in the individuals with normal weight (2.9%; 2.0-4.2) than in the overweight (6.3%; 3.9-9.9) and obese subjects (5.6%, 2.5-11.3) (p=0.02). TSH levels were associated with obesity (β=0.36; p<0.001) and thyroid autoimmunity (β=1.10; p<0.001). They were not associated with any cardiovascular risk factor. CONCLUSION Obese children and adolescents had higher levels of thyrotropin than those who were overweight and of normal weight. The differences among the groups were of very little clinical significance and could possibly be linked to the higher prevalence of thyroid autoimmunity in obese subjects. The hyperthyrotropinemia in these subjects was not associated with any cardiovascular risk factor.
Collapse
Affiliation(s)
- Emilio García-García
- Hospital Torrecárdenas, Clinic of Pediatrics, Almeria, Spain Phone: +34 605076059 E-mail:
| | | | | | | | | | | | | |
Collapse
|
8
|
Javed A, Balagopal PB, Vella A, Fischer PR, Piccinini F, Dalla Man C, Cobelli C, Giesler PD, Laugen JM, Kumar S. Association between thyrotropin levels and insulin sensitivity in euthyroid obese adolescents. Thyroid 2015; 25:478-84. [PMID: 25777801 PMCID: PMC4426325 DOI: 10.1089/thy.2015.0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Thyrotropin (TSH) levels display a positive association with body mass index (BMI), and the prevalence of isolated hyperthyrotropinemia is higher in obese adolescents compared to their normal weight controls. However, the metabolic significance of the higher TSH in obese adolescents is less clear. The objective of this study was to determine the relationship between TSH concentrations and insulin sensitivity, lipids, and adipokines in euthyroid, non-diabetic, obese adolescents. METHODS Thirty-six euthyroid, non-diabetic, obese adolescents between the ages of 12 and 18 years underwent a 75 g oral glucose tolerance test. Insulin sensitivity (Si) and pancreatic β-cell function as assessed by disposition index (DI) were measured using the oral glucose minimal model approach. Cholesterol (total, low-density lipoprotein [LDL-C], and high-density lipoprotein [HDL-C]), triglycerides (TG), interleukin-6 (IL-6), total and high molecular weight (HMW) adiponectin, and retinol binding protein-4 (RBP4) were also determined. Associations between measures of thyroid function and Si, DI, lipids, and adipokines were computed using Pearson's correlation coefficient and multiple regression analysis. RESULTS The mean age of the subjects was 14.3±1.88 years, and the mean BMI was 32.5±4.65 kg/m2; 97% were non-Hispanic white and 47% were male. The mean TSH was 2.7±1.2 mIU/L. Increasing serum TSH was correlated with decreasing Si (log Si) in the entire cohort (p=0.03), but this relationship persisted only in males (p=0.02). The correlation between TSH and Si in males remained significant after adjusting for BMI (p=0.02). There was no correlation between TSH and pancreatic β-cell function as assessed by DI (p=0.48). TSH correlated positively with LDL-C (p=0.04) and IL-6 (p=0.03), but these associations vanished or weakened after adjusting for BMI (LDL-C p-value=0.44; IL-6 p-value=0.07). CONCLUSIONS This study suggests a sex-specific association between TSH and insulin sensitivity in euthyroid, non-diabetic, obese adolescent males. Prospective studies are warranted to explore further this sexual dimorphism in the relationship between thyroid function and insulin sensitivity and to determine if obese adolescents with insulin resistance receiving thyroid supplements for hypothyroidism would benefit from targeting TSH levels in the lower half of normal range.
Collapse
Affiliation(s)
- Asma Javed
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Adrian Vella
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Philip R. Fischer
- Division of General Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Paula D. Giesler
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeanette M. Laugen
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|