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Chiriacò M, Nesti L, Natali A, Santoro N, Caprio S, Tricò D. Proatherogenic changes in lipoprotein particles associated with a high triglyceride to high-density lipoprotein cholesterol ratio in youths. Obesity (Silver Spring) 2023; 31:1894-1902. [PMID: 37227148 PMCID: PMC10330115 DOI: 10.1002/oby.23767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE A high triglyceride (TG) to high-density lipoprotein cholesterol (HDL) ratio (TG/HDL) predicts atherosclerosis and cardiovascular events. This study examined whether a proatherogenic distribution of plasma lipoprotein subclasses is associated with a high TG/HDL ratio in youths with obesity. METHODS Lipoprotein particle concentration and size were measured by proton nuclear magnetic resonance in a multiethnic cohort of 592 adolescents with overweight/obesity (age 13 ± 3 years, 58% females, BMI z score 2.1 ± 0.8) who were phenotyped with a 3-hour oral glucose tolerance test and abdominal magnetic resonance imaging. RESULTS The highest TG/HDL quartile showed a higher particle concentration of very low-density lipoprotein (VLDL; +178%, p < 0.0001), intermediate-density lipoprotein (+338%, p < 0.0001), and low-density lipoprotein (LDL; +42%, p < 0.0001), compared with the lowest quartile. The prevalence of large VLDL, very small LDL, and small HDL progressively increased across TG/HDL quartiles. The TG/HDL ratio correlated positively with the average particle size of VLDL (r = 0.37, p < 0.0001) and negatively with particle size of both LDL (r = -0.51, p < 0.0001) and HDL (r = -0.69, p < 0.0001). These associations were independent of sex, age, race/ethnicity, body mass, fasting plasma glucose, and insulin sensitivity. CONCLUSIONS In youths with obesity, an elevated TG/HDL ratio is associated with high concentrations of proatherogenic lipoprotein subclasses. This phenotype may explain the increased cardiovascular risk associated with a high TG/HDL ratio.
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Affiliation(s)
- Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Santoro
- Kansas University Medical Center, Kansas City, KS, USA
- Department of Medicine and Health Sciences, “V.Tiberio” University of Molise, Campobasso, Italy
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Talluri R, Sherman AK, Goth N, Simpson K, Kuzava L, Raghuveer G, White DA. The influence of somatic maturity on the relationship between the triglyceride/high-density lipoprotein ratio and vascular health in children and adolescents with dyslipidemia. Am J Hum Biol 2023; 35:e23815. [PMID: 36196910 PMCID: PMC9931626 DOI: 10.1002/ajhb.23815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Both the triglyceride to HDL cholesterol (TG/HDL) ratio and timing of pubertal maturation have been identified as independent contributors to the development of atherosclerosis. OBJECTIVE The purpose of our study was to determine the relationship between the TG/HDL ratio and measures of vascular health in children and adolescents with dyslipidemia stratified by somatic maturity. We hypothesized that somatic maturity would have a significant interaction with TG/HDL ratio and vascular health. METHODS This was a longitudinal analysis of 120 children and adolescents (age 8-14 years) with dyslipidemia recruited from a pediatric preventive cardiology clinic. At baseline and each follow-up visit, a non-fasting serum lipid panel was collected and vascular health (carotid artery intima--media thickness, pulse wave velocity, augmentation index) was assessed. Peak height velocity (PHV) was calculated at each visit, and participants were stratified into groups by maturity offset (pre-PHV, mid-PHV, post-PHV). A mixed model design permitted baseline and follow-up visits to be classified as discrete data points. RESULTS Of the n = 235 data points (pre-PHV = 23%, mid-PHV = 19%, and post-PHV = 58%), we identified no significant interaction between TG/HDL ratio, maturity offset, and measures of vascular structure or function. There was also no significant relationship found between TG/HDL and maturity group. Within the mid-pubertal group, there was weak relationship found between TG/HDL and augmentation index. CONCLUSION Despite the well-described relationship between early pubertal maturation and development of cardiovascular risk factors in adulthood, we found that vascular damage resulting from an elevated TG/HDL ratio is not independently associated with somatic maturity.
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Affiliation(s)
- Rachna Talluri
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Ashley K. Sherman
- Division of Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Natalie Goth
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Kayla Simpson
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Laura Kuzava
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Geetha Raghuveer
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - David A. White
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, USA
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
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Abstract
BACKGROUND The relationship between different surrogates of insulin resistance and left ventricular geometry in obese children is still unclear. OBJECTIVE We sought to explore the relationship between commonly used measures of insulin sensitivity/resistance (homeostatic model assessment index, serum uric acid, and triglycerides to high-density lipoprotein cholesterol ratio) and left ventricular geometry in normotensive obese children. METHODS In this cross-sectional study, 32 normotensive obese children were examined. Transthoracic echocardiography was used to measure left ventricular mass index and relative wall thickness. Homeostasis model assessment index, serum uric acid level, and a ratio of triglycerides to high-density lipoprotein cholesterol were used as markers of the insulin resistance. Simple and partial correlation analyses (to control for the effects of body mass index) were conducted to explore relationship between studied variables and left ventricular mass index or relative wall thickness as outcome variables. RESULTS We found positive correlations between homeostasis model assessment index and relative wall thickness (r = 0.47, p = 0.03) which remained significant after controlling for the effect of body mass index, z-score (r = 0.48, p = 0.03). The cutoff level of homeostasis model assessment index with the optimum sensitivity (Sn) and specificity (Sp) derived from the receiver operating characteristic (ROC) curves for predicting concentric remodelling was ≥5.51 with Sn = 83.33 and Sp = 68.75. CONCLUSION There is a positive relationship between homeostasis model assessment index and relative wall thickness of obese normotensive children which may help to distinguish at risk obese normotensive children for the development of concentric left ventricular remodelling.
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Kosmeri C, Milionis H, Vlahos AP, Benekos T, Bairaktari E, Cholevas V, Siomou E. The impact of dyslipidemia on early markers of endothelial and renal dysfunction in children. J Clin Lipidol 2021; 15:292-300. [PMID: 33478934 DOI: 10.1016/j.jacl.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dyslipidemia has been associated with endothelial dysfunction in childhood. Impairment of renal function has been demonstrated in dyslipidemic adults. OBJECTIVE The aim of this study was to assess markers of early endothelial and renal dysfunction in dyslipidemic children. METHODS This was a cross-sectional study of 100 children with dyslipidemia and 100 age- and sex-matched control subjects without dyslipidemia aged 7-16 years. Renal dysfunction was assessed by measurement of serum creatinine and cystatin C levels, urinary beta 2-microglobulin levels, urinary albumin to creatinine (Alb:Cr) ratio, and by the estimated glomerular filtration rate (eGFR), based on serum creatinine or cystatin C. Endothelial dysfunction and early vascular changes were evaluated by ultrasound assessment of flow mediated dilation (FMD) of the brachial artery, and carotid intima-media thickness (cIMT), respectively. RESULTS The markers of early renal dysfunction showed no difference between the dyslipidemic children and control subjects except for the urinary Alb:Cr ratio that was higher in the dyslipidemic children (median, 0.007 mg/mg vs 0.005 mg/mg, p = 0.004). The urinary Alb:Cr ratio was positively correlated with the triglyceride to high-density lipoprotein cholesterol ratio (r = 0.28, p = 0.013). FMD values were lower in the dyslipidemic children than in the control subjects (8.504 ± 4.73% vs 10.535 ± 4.35%, p = 0.004), but cIMT did not differ between groups. This decrease in FMD values was evident in children aged ≥10 years. FMD was independently associated with the level of lipoprotein (a) (beta = -0.29, p = 0.01). CONCLUSION Among markers of endothelial and renal dysfunction investigated, FMD was found to be lower and the urinary Alb:Cr ratio higher in children with dyslipidemia.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece.
| | - Haralampos Milionis
- Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Antonios P Vlahos
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Thomas Benekos
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Bairaktari
- Laboratory of Clinical Chemistry, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios Cholevas
- Pediatric Research Laboratory, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
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Bălănescu A, Bălănescu P, Comănici V, Stan I, Acs B, Prisăcariu L, Brezan F, Ciomârtan T, Gherghina I. Lipid profile pattern in pediatric overweight population with or without NAFLD in relation to IDF criteria for metabolic syndrome: a preliminary study. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2018; 56:47-54. [DOI: 10.1515/rjim-2017-0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Indexed: 01/17/2023] Open
Abstract
Abstract
Background and aims. The aim of this study is to assess the lipid profile pattern of pediatric overweight and/or obese patients with Non-Alcoholic Fatty Liver Disease (NAFLD) in relation to IDF Consensus Criteria for Metabolic Syndrome (MetS).
Material and Methods. We conducted a cross-sectional preliminary study on 45 consecutive pediatric patients. Overweight or obese children aged from 3 to 18 years were included. Standardized measurement of blood pressure and anthropometric parameters were performed. Biological evaluation included inflammatory status, lipid profile, glycemic profile, full blood count and liver function tests. Abdominal ultrasound was performed in all patients.
Results. Prevalence of MetS was 44.4%. A number of 21 patients (46.7%) had NAFLD. MetS patients had higher risk for NAFLD (OR = 9.5, 95% CI = 2.42-37.24). Also patients with positive familial history of type 2 diabetes had a 6.61 fold higher risk for NAFLD (OR = 6.61, 95% CI = 1.74-25.1). We performed a subgroup analysis in patients under ten years old. Patients under the age of ten which had both NAFLD and MetS met more frequently the hypertriglyceride criterion. After adjusting for age and MetS presence, triglyceride levels independently associated with NAFLD (adjusted R square = 0.46, unstandardized B coefficient = 34.51, 95% CI = 4.01-65.02, p = 0.02).
Conclusion. NAFLD obese patients had higher prevalence of MetS, higher BMI and particular lipid profile pattern. Triglyceride levels independently associated with NAFLD after adjusting for age and MetS presence. According to our findings we suggest early triglyceride testing (even below the age of ten) in selected patients.
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Affiliation(s)
- Anca Bălănescu
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
| | - Paul Bălănescu
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- CDPC Clinical Immunology Department, “Colentina” Clinical Hospital , Bucharest
- Clinical Research Unit RECIF (Reseau d’Epidemiologie Clinique International Francophone) , Bucharest
| | - Valentina Comănici
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
| | - Iustina Stan
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
| | - Beata Acs
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
| | - Laura Prisăcariu
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
| | - Florin Brezan
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
| | - Tatiana Ciomârtan
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
| | - Ioan Gherghina
- “Carol Davila” University of Medicine and Pharmacy , Bucharest
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health , Bucharest
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Aguirre M, Briceño Y, Gómez-Pérez R, Zerpa Y, Camacho N, Paoli M. Triglycerides/High density lipoprotein cholesterol ratio as a cardiometabolic risk marker in children and adolescents from Mérida city, Venezuela. ENDOCRINOL DIAB NUTR 2018; 65:74-83. [PMID: 29290474 DOI: 10.1016/j.endinu.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/21/2017] [Accepted: 10/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the behavior of the triglycerides/HDL-cholesterol ratio (TG/HDL) as a cardiometabolic risk marker in children and adolescents from Mérida, Venezuela. METHODS A total of 1292 children and adolescents aged 7-18 years who attended educational institutions in the Libertador Municipality were enrolled into this study. Anthropometric measurements and blood pressure values were recorded. Fasting blood glucose, insulin and lipid levels were measured. The TG/HDL ratio, HOMA-IR, and QUICKI indexes were calculated. Subjects were categorized as with and without cardiometabolic risk based on the presence or absence of 2or more risk factors. Cut-off points for the TG/HDL ratio were determined by constructing ROC curves. RESULTS Significantly higher mean TG/HDL ratios were found in pubertal (2.2 ± 1.7) as compared to prepubertal subjects (1.8 ± 1.5; P=.001), with no sex differences. Two or more risk factors were found in 14.7% (n=192) of the participants, in whom TG/HDL ratios were significantly higher as compared to those with no risk (3.5±2.9 versus 1.6±0.8 in prepubertal and 4.1 ± 3.5 versus 1.8 ± 0.9 in pubertal subjects; P=.0001). According to cardiometabolic risk, cut-off points for the TG/HDL ratio of 1.8 and 2.5 were found for prepubertal and pubertal children respectively. These cut-off points showed risks (odds ratio) higher than 2.5 for conditions such as metabolic syndrome, elevated non-HDL-C, abdominal obesity, and elevated HOMA-IR. CONCLUSION In this sample of children and adolescents, an elevated TG/HDLc ratio was found to be a good marker for predicting cardiometabolic risk.
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Affiliation(s)
- Miguel Aguirre
- Centro de Investigaciones Endocrino-Metabólicas Dr. Félix Gómez, Facultad de Medicina, Universidad del Zulia, Servicio de Endocrinología, Hospital Universitario de Maracaibo, Maracaibo, Estado Zulia, Venezuela
| | - Yajaira Briceño
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Roald Gómez-Pérez
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Yajaira Zerpa
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Nolis Camacho
- Unidad de Nutrición, Crecimiento y Desarrollo Infantil, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Mariela Paoli
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela.
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Pathogenesis of Insulin Resistance and Glucose Intolerance in Childhood Obesity. CONTEMPORARY ENDOCRINOLOGY 2018. [DOI: 10.1007/978-3-319-68192-4_23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ighbariya A, Weiss R. Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know? J Clin Res Pediatr Endocrinol 2017; 9:49-57. [PMID: 29280741 PMCID: PMC5790325 DOI: 10.4274/jcrpe.2017.s005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Metabolic syndrome describes a clustering of typical cardiovascular risk factors. The syndrome is also known as "Insulin Resistance syndrome" as a substantial part of the pathophysiology is driven by resistance to the metabolic effects of insulin. The major cause of insulin resistance in childhood is a typical lipid partitioning pattern characterized by increased deposition of lipids within insulin responsive tissues, such as the liver and skeletal muscle and within the viscera. This lipid deposition pattern is also associated with infiltration of intra-abdominal tissues with cells of the immune system, inducing systemic, low-grade inflammation typically observed in insulin resistant obese children and adolescents. Several clues derived from a careful history and physical examination, along with a basic laboratory workup, provide clues in regards to risk stratification in obese children.
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Affiliation(s)
- Ahmad Ighbariya
- Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel
,* Address for Correspondence: Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel E-mail:
| | - Ram Weiss
- Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel
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Jayanthi R, Srinivasan AR, Hanifah M, Maran AL. Associations among Insulin Resistance, Triacylglycerol/High Density Lipoprotein (TAG/HDL ratio) and Thyroid hormone levels-A study on Type 2 diabetes mellitus in obese and overweight subjects. Diabetes Metab Syndr 2017; 11 Suppl 1:S121-S126. [PMID: 28043815 DOI: 10.1016/j.dsx.2016.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/12/2016] [Indexed: 12/01/2022]
Abstract
AIM Triacylglycerol/High density lipoprotein (TAG/HDL) ratio, a surrogate marker of LDL particle size (small dense) was included in our study to observe the link with insulin resistance and thyroid co-morbidity. METHODS Ninety three patients with T2DM of both genders were enrolled from a tertiary health care unit in Puducherry, during the latter half of 2015. The cardio-metabolic risk factors were assessed through body mass index (BMI), blood pressure, fasting blood glucose and lipid profile, glycated haemoglobin and homeostasis model assessment of insulin resistance (HOMA-IR). Serum free T4, T3 and TSH were also measured to evaluate the thyroid co-morbidity as a function of insulin resistance. RESULTS In addition to insulin resistance, results of our study were focussed on thyroid comorbidity. In overweight diabetic patients, the ROC curve analyses demonstrated that the best marker for insulin resistance was Triacylglycerol/High density lipoprotein (TAG/HDL), with the area under the ROC curve being 0.902. Thyroxine (T4) was less significant when compared to TAG/HDL with area under the ROC curve of 0.583. Triiodothyronine (T3) and T4 were more significant in obese group with areas under the curve being 0.842 and 0.816 respectively when compared against insulin resistance (cut-off value for HOMA-IR 2.69). The optimal cut-off points for overweight were: TAG≥101mg/dl; T4≥1.16ng/dl; TAG/HDL≥2.26 whereas for obese: TC≥163.5mg/dl; TAG≥141.5mg/dl; T3≥2.42pg/ml; T4≥0.96ng/ml. CONCLUSIONS In overweight type 2 diabetics, TAG/HDL ratio could be used as a reliable marker for insulin resistance with thyroid co-morbidity and T3, T4 were better objective markers in obese type 2 diabetics.
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Affiliation(s)
- Rajendran Jayanthi
- Department of Biochemistry, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, Pondicherry 607403, India
| | - Abu Raghavan Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, Pondicherry 607403, India.
| | - Mohammed Hanifah
- Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, India
| | - Anandraj Lokesh Maran
- Department of Community Medicine, Mahatma Gandhi Medical College & Research, Institute Sri Balaji Vidyapeeth, India
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Riaño-Galán I, Fernández-Somoano A, Rodríguez-Dehli C, Valvi D, Vrijheid M, Tardón A. Proatherogenic Lipid Profile in Early Childhood: Association with Weight Status at 4 Years and Parental Obesity. J Pediatr 2017; 187:153-157.e2. [PMID: 28529017 DOI: 10.1016/j.jpeds.2017.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/27/2017] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine lipid profiles in early childhood and evaluate their association with weight status at 4 years of age. Additionally, we evaluated whether the risk of overweight or having an altered lipid profile was associated with parental weight status. STUDY DESIGN Five hundred eighty two mothers and their 4-year-old children from 2 Spanish population-based cohorts were studied. Weight status in children at 4 years of age was classified as overweight or obese using the International Obesity Task Force criteria. Plasma total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were determined in children and lipid ratios were calculated. A proatherogenic lipid profile was defined as having the 3 lipid ratios in the third tertile. RESULTS A total of 12.9% of children were overweight and 6.4% were obese. Weight status at 4 years of age was related to maternal prepregnancy body mass index, paternal body mass index, gestational diabetes, and birth weight, but not with other sociodemographic characteristics of the mother. We found no association with gestational age, sex of the child, or breastfeeding. The risk of overweight/obesity was increased 4.17-fold if mothers were overweight/obese (95% CI 1.76-9.88) and 5.1-fold (95% CI 2.50-10.40) if both parents were overweight/obese. There were 133 children (22.8%) with a proatherogenic lipid profile. The risk of a proatherogenic lipid profile was increased 2.44-fold (95% CI 1.54-3.86) if they were overweight/obese at 4 years of age and 2-fold if the father was overweight/obese (95% CI 1.22-3.35). CONCLUSIONS Four-year-old overweight/obese children have higher lipid risk profiles. Offspring of overweight/obese parents have an increased risk for obesity and a proatherogenic lipid profile.
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Affiliation(s)
- Isolina Riaño-Galán
- Pediatric Service, Hospital San Agustin, Avilés, Asturias, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Medicine, Universidad de Oviedo, Oviedo, Asturias, Spain.
| | | | - Damaskini Valvi
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Martine Vrijheid
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Medicine, Universidad de Oviedo, Oviedo, Asturias, Spain
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Di Bonito P, Pacifico L, Chiesa C, Valerio G, Miraglia Del Giudice E, Maffeis C, Morandi A, Invitti C, Licenziati MR, Loche S, Tornese G, Franco F, Manco M, Baroni MG. Impaired fasting glucose and impaired glucose tolerance in children and adolescents with overweight/obesity. J Endocrinol Invest 2017; 40:409-416. [PMID: 27854028 DOI: 10.1007/s40618-016-0576-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/03/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate in a large sample of overweight/obese (OW/OB) children and adolescents the prevalence of prediabetic phenotypes such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), and to assess their association with cardiometabolic risk (CMR) factors including hepatic steatosis (HS). METHODS Population data were obtained from the CARdiometabolic risk factors in children and adolescents in ITALY study. Between 2003 and 2013, 3088 youths (972 children and 2116 adolescents) received oral glucose tolerance test (OGTT) and were included in the study. In 798 individuals, abdominal ultrasound for identification of HS was available. RESULTS The prevalence of IFG (3.2 vs. 3.3%) and IGT (4.6 vs. 5.0%) was similar between children and adolescents. Children with isolated IGT had a 2-11 fold increased risk of high LDL-C, non-HDL-C, Tg/HDL-C ratio, and low insulin sensitivity, when compared to those with normal glucose tolerance (NGT). No significant association of IFG with any CMR factor was found in children. Among adolescents, IGT subjects, and to a lesser extent those with IFG, showed a worse CMR profile compared to NGT subgroup. In the overall sample, IGT phenotype showed a twofold increased risk of HS compared to NGT subgroup. CONCLUSIONS Our study shows an unexpected similar prevalence of IFG and IGT between children and adolescents with overweight/obesity. The IGT phenotype was associated with a worse CMR profile in both children and adolescents. Phenotyping prediabetes conditions by OGTT should be done as part of prediction and prevention of cardiometabolic diseases in OW/OB youth since early childhood.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - L Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, 00161, Rome, Italy.
| | - C Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - G Valerio
- Department of Movement and Wellness Sciences, Parthenope University, Naples, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - A Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - C Invitti
- Department of Medical Sciences and Rehabilitation, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - S Loche
- Pediatric Endocrine Unit, Regional Hospital for Microcitemia, Cagliari, Italy
| | - G Tornese
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - F Franco
- Pediatric Unity, AOU Udine, Udine, Italy
| | - M Manco
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - M G Baroni
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
- Endocrinology, Department Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Bervoets L, Massa G. Classification and clinical characterization of metabolically "healthy" obese children and adolescents. J Pediatr Endocrinol Metab 2016; 29:553-60. [PMID: 26910741 DOI: 10.1515/jpem-2015-0395] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 12/14/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Some obese children do not show cardiometabolic complications such as prediabetes, dyslipidemia or insulin resistance. The objective of the study was to classify obese children and adolescents as metabolically "healthy" obese (MHO) on the basis of three different definitions, and to compare cardiometabolic features with metabolically unhealthy obese (MUO) children and adolescents. METHODS The study included 156 obese children and adolescents aged between 10 and 18. Subjects were classified as MHO or MUO using three definitions based on the: (1) pediatric International Diabetes Federation (IDF) criteria; (2) homeostatic model assessment of insulin resistance (HOMA-IR); (3) combination of the previous two definitions. Cardiometabolic features were compared between MHO and MUO subjects. RESULTS Six to 19% obese children and adolescents were classified as MHO, and showed a better insulin sensitivity, lower prevalence of prediabetes, lower triglycerides and lower triglyceride-to-HDL-C ratio compared to MUO. CONCLUSIONS Less than 20% obese children and adolescents are identified as MHO and show a healthier cardiometabolic profile as compared to MUO. Implementation of the proposed classifications in future clinical research could contribute towards the standardization of the MHO definition and offer new insights into the manifestation of the pediatric MHO phenotype.
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Quispe R, Manalac RJ, Faridi KF, Blaha MJ, Toth PP, Kulkarni KR, Nasir K, Virani SS, Banach M, Blumenthal RS, Martin SS, Jones SR. Relationship of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to the remainder of the lipid profile: The Very Large Database of Lipids-4 (VLDL-4) study. Atherosclerosis 2015; 242:243-50. [PMID: 26232164 DOI: 10.1016/j.atherosclerosis.2015.06.057] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/09/2015] [Accepted: 06/29/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND High levels of the triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio are associated with obesity, metabolic syndrome, and insulin resistance. OBJECTIVES We evaluated variability in the remaining lipid profile, especially remnant lipoprotein particle cholesterol (RLP-C) and its components (very low-density lipoprotein cholesterol subfraction 3 and intermediate-density lipoprotein cholesterol), with variability in the TG/HDL-C ratio in a very large study cohort representative of the general U.S. METHODS We examined data from 1,350,908 US individuals who were clinically referred for lipoprotein cholesterol ultracentrifugation (Atherotech, Birmingham, AL) from 2009 to 2011. Demographic information other than age and sex was not available. Changes to the remaining lipid profile across percentiles of the TG/HDL-C ratio were quantified, as well as by three TG/HDL-C cut-off points previously proposed in the literature: 2.5 (male) and 2 (female), 3.75 (male) and 3 (female), and 3.5 (male and female). RESULTS The mean age of our study population was 58.7 years, and 48% were men. The median TG/HDL-C ratio was 2.2. Across increasing TG/HDL-C ratios, we found steadily increasing levels of RLP-C, non-HDL-C and LDL density. Among the lipid parameters studied, RLP-C and LDL density had the highest relative increase when comparing individuals with elevated TG/HDL-C levels to those with lower TG/HDL-C levels using established cut-off points. Approximately 47% of TG/HDL-C ratio variance was attributable to RLP-C. CONCLUSIONS In the present analysis, a higher TG/HDL-C ratio was associated with an increasingly atherogenic lipid phenotype, characterized by higher RLP-C along with higher non-HDL-C and LDL density.
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Affiliation(s)
- Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Raoul J Manalac
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Kamil F Faridi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA; University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; South Beach Preventive Cardiology Center, University of Miami, Miami, FL, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
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Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, Miraglia del Giudice E, Pacifico L, Pellegrin MC, Tomat M, Baroni MG. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis 2015; 25:489-494. [PMID: 25813687 DOI: 10.1016/j.numecd.2015.01.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/12/2015] [Accepted: 01/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Lipid ratios to estimate atherosclerotic disease risk in overweight/obese children are receiving great attention. We aimed to compare the performance of non-high-density lipoprotein-cholesterol (HDL-C) versus triglycerides-to-HDL-C ratio (Tg/HDL-C) in identifying cardiometabolic risk factors (CMRFs) or preclinical signs of organ damage in outpatient Italian overweight/obese children. METHODS AND RESULTS In this retrospective, cross-sectional study, 5505 children (age 5-18 years) were recruited from 10 Italian centers for the care of obesity, of which 4417 (78%) showed obesity or morbid obesity. Anthropometric, biochemical, and blood pressure variables were analyzed in all children. Liver ultrasound scan, carotid artery ultrasound, and echocardiography were performed in 1257, 601, and 252 children, respectively. The entire cohort was divided based on the 75th percentile of non-HDL-C (≥130 mg/dl) or Tg/HDL-C ratio (≥2.2). The odds ratio for insulin resistance, high blood pressure, metabolic syndrome, presence of liver steatosis, increased levels of carotid intima-media thickness (cIMT) and concentric left ventricular hypertrophy (cLVH) was higher in children with high levels of Tg/HDL-C with respect to children with high levels of non-HDL-C. CONCLUSIONS In an outpatient setting of overweight/obese children, Tg/HDL-C ratio discriminated better than non-HDL-C children with CMRFs or preclinical signs of liver steatosis, and increased cIMT and cLVH.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, Pozzuoli Hospital (Napoli), Naples, Italy
| | - G Valerio
- Department of Movement Sciences and Wellness, Parthenope University, Naples, Italy.
| | - G Grugni
- Division of Auxology, Italian Auxological Institute, Verbania, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | - M Manco
- Bambino Gesù Children's Hospital, Rome, Italy
| | - E Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, Second University of Napoli, Naples, Italy
| | - L Pacifico
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - M C Pellegrin
- Department of Pediatrics, University of Trieste, Trieste, Italy
| | - M Tomat
- Pediatric Unity, AOU Udine, Udine, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
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Differences in the triglyceride to HDL-cholesterol ratio between Palestinian and Israeli adults. PLoS One 2015; 10:e0116617. [PMID: 25635396 PMCID: PMC4312056 DOI: 10.1371/journal.pone.0116617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 12/11/2014] [Indexed: 12/02/2022] Open
Abstract
Aims To evaluate differences in the triglyceride to HDL-cholesterol ratio (TG/HDL), thought to be a proxy measure of insulin resistance, between Palestinian and Israeli adults in view of the greater incidence of coronary heart disease and high prevalence of diabetes in Palestinian Arabs. Research Methods A population-based observational prevalence study of cardiovascular and diabetes risk factors in Jerusalem. Participants (968 Palestinians, 707 Israelis, sampled at ages 25-74 years) underwent fasting and 2h post-75g oral challenge plasma glucose determinations. Metabolic risk was assessed using the surrogate index TG/HDL. Sex-specific comparisons were stratified by categories of body mass index and sex-specific waist circumference quartiles, adjusted by regression for age, glucose tolerance status and use of statins. Results Prevalence of overweight and obesity was substantially larger in Palestinians (p = 0.005). Prevalence of diabetes was 2.4 and 4 fold higher among Palestinian men and women, respectively (p<0.001). Adjusted TG/HDL was higher in Palestinians than Israelis across BMI and waist circumference categories (p<0.001 for both). Higher TG/HDL in Palestinians persisted in analyses restricted to participants with normal glucose tolerance and off statins. Notably, higher TG/HDL among Palestinians prevailed at a young age (25-44 years) and in normal weight individuals of both sexes. Conclusions Palestinians have a higher TG/HDL ratio than Israelis. Notably, this is evident also in young, healthy and normal weight participants. These findings indicate the need to study the determinants of this biomarker and other measures of insulin resistance in urban Arab populations and to focus research attention on earlier ages: childhood and prenatal stages of development.
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Bailey DP, Savory LA, Denton SJ, Davies BR, Kerr CJ. The triglyceride to high-density lipoprotein ratio identifies children who may be at risk of developing cardiometabolic disease. Acta Paediatr 2014; 103:e349-53. [PMID: 24796207 DOI: 10.1111/apa.12677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/07/2014] [Accepted: 04/30/2014] [Indexed: 01/02/2023]
Abstract
AIM It is important to develop simple, reliable methods to identify high-risk individuals who may benefit from intervention. This study investigated the association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio and cardiometabolic risk, cardiorespiratory fitness and physical activity in children. METHODS Anthropometric, biochemical parameters, cardiorespiratory fitness and accelerometry determined physical activity were assessed in 155 children (80 girls) from 10 to 14 years of age from Bedfordshire, UK. Participants were grouped into high and low TG/HDL ratio groups, according to published thresholds. MANCOVA and logistic regression were used in the analysis. RESULTS Cardiometabolic risk factor levels were significantly higher in participants with a high TG/HDL ratio (p < 0.05). The odds of having high waist circumference (OR = 13.99; 95% CI 2.93, 69.25), elevated systolic blood pressure (5.27; 1.39, 20.01), high non-HDL cholesterol (19.47; 4.42, 85.81) and ≥2 cardiometabolic risk factors (15.32; 3.10, 75.79) were higher in participants with a high TG/HDL ratio. The TG/HDL ratio values were significantly lower in those with high cardiorespiratory fitness (p = 0.01), but there was no association with physical activity. CONCLUSION These findings support the use of the TG/HDL ratio to identify children with cardiometabolic risk factors who may be at risk of developing cardiometabolic disease.
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Affiliation(s)
- Daniel P. Bailey
- Department of Sport Science and Physical Activity; Institute for Sport and Physical Activity Research; University of Bedfordshire; Bedford Bedfordshire UK
| | - Louise A. Savory
- Department of Sport Science and Physical Activity; Institute for Sport and Physical Activity Research; University of Bedfordshire; Bedford Bedfordshire UK
| | - Sarah J. Denton
- Institute of Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
| | - Ben R. Davies
- Centre for Exercise, Nutrition & Health Sciences; School for Policy Studies; University of Bristol; Bristol UK
| | - Catherine J. Kerr
- Department of Sport and Health Sciences; Faculty of Sport and Health Sciences; Oxford Brookes University; Headington Campus; Oxford UK
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Pacifico L, Bonci E, Andreoli G, Romaggioli S, Di Miscio R, Lombardo CV, Chiesa C. Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents. Nutr Metab Cardiovasc Dis 2014; 24:737-743. [PMID: 24656140 DOI: 10.1016/j.numecd.2014.01.010] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/17/2013] [Accepted: 01/07/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS The triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio has been reported as a useful marker of atherogenic lipid abnormalities, insulin resistance, and cardiovascular disease. We evaluated in a large sample of children and adolescents the association of TG/HDL-C ratio with early signs of morphological vascular changes and cardiometabolic risk factors including nonalcoholic fatty liver disease (NAFLD). METHODS AND RESULTS The study population, including 548 children (aged 6-16 years), of whom 157 were normal-weight, 118 overweight, and 273 obese, had anthropometric, laboratory, liver and carotid ultrasonography (carotid artery intima-media thickness-cIMT) data collected. Subjects were stratified into tertiles of TG/HDL-C. There was a progressive increase in body mass index (BMI), BMI-SD score (SDS), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and cIMT values across TG/HDL-C tertiles. The odds ratios for central obesity, insulin resistance, high hsCRP, NAFLD, metabolic syndrome, and elevated cIMT increased significantly with the increasing tertile of TG/HDL-C ratio, after adjustment for age, gender, pubertal status, and BMI-SDS. In a stepwise multivariate logistic regression analysis, increased cIMT was associated with high TG/HDL-C ratio [OR, 1.81 (95% CI, 1.08-3.04); P < 0.05], elevated BP [5.13 (95% CI, 1.03-15.08); P < 0.05], insulin resistance [2.16 (95% CI, 1.30-3.39); P < 0.01], and NAFLD [2.70 (95% CI, 1.62-4.56); P < 0.01]. CONCLUSION TG/HDL-C ratio may help identify children and adolescents at high risk for structural vascular changes and metabolic derangement.
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Affiliation(s)
- L Pacifico
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy
| | - E Bonci
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - G Andreoli
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy
| | - S Romaggioli
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy
| | - R Di Miscio
- Department of Radiological Sciences, Sapienza University of Rome, Italy
| | - C V Lombardo
- Department of Radiological Sciences, Sapienza University of Rome, Italy
| | - C Chiesa
- Institute of Translational Pharmacology, National Research Council, Via del Fosso del Cavaliere 100, 00133 Rome, Italy.
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Abstract
The epidemic of childhood obesity worldwide has led to increased incidence of the metabolic syndrome and type 2 diabetes in the pediatric and adolescent population. As such, there is increasing concern that this large population of children is at risk for the long-term complications of diabetes, specifically cardiovascular disease. With cardiovascular disease remaining the leading cause of death in adults, this presents a significant public health concern as these children age. In this article, we discuss cardiovascular disease and risk in children and adolescents with type 2 diabetes, including the epidemiology of type 2 diabetes, atherosclerotic cardiovascular disease, obesity, hypertension, and left ventricular function.
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Mietus-Snyder M, Drews KL, Otvos JD, Willi SM, Foster GD, Jago R, Buse JB. Low-density lipoprotein cholesterol versus particle number in middle school children. J Pediatr 2013; 163:355-62. [PMID: 23415622 PMCID: PMC3659184 DOI: 10.1016/j.jpeds.2013.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/04/2012] [Accepted: 01/04/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To characterize lipids and lipoproteins in a diverse school-based cohort and identify features associated with discordance between low-density lipoprotein cholesterol (LDL-C) and LDL particle (LDL-P). STUDY DESIGN Sixth-grade children enrolled in the HEALTHY trial (n = 2384; mean age 11.3 ± 0.6 years; 54.2% female) were evaluated for standard lipids, lipoprotein particles measured by nuclear magnetic resonance, and homeostatic model of insulin resistance. Characteristics of subgroups with values of LDL-C and LDL-P discordant by >20 percentile units, an amount reasoned to be clinically significant, were compared. RESULTS Four-hundred twenty-eight (18%) of children were in the LDL-P < LDL-C subgroup and 375 (16%) in the LDL-P > LDL-C subgroup. Those with LDL-P > LDL-C had significantly greater body mass index, waist circumference, homeostatic model of insulin resistance, triglycerides, systolic and diastolic blood pressure, and reflected a greater Hispanic ethnic composition but fewer of black race than both the concordant (LDL-P ≅ LDL-C) and opposite discordant (LDL-P < LDL-C) subgroups. CONCLUSIONS There is as much lipoprotein cholesterol compositional heterogeneity in sixth graders as has been described in adults and a discordant atherogenic phenotype of LDL-P > LDL-C, common in obesity, is often missed when only LDL-C is considered. Conversely, many children with moderate-risk cholesterol measures (75th to 99th percentile) have a lower LDL-P burden.
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Affiliation(s)
- Michele Mietus-Snyder
- George Washington University School of Medicine & Health Sciences, Children’s National Medical Center
| | | | | | | | - Gary D. Foster
- Center for Obesity Research and Education, Temple University
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol
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Oliveira AC, Oliveira AM, Oliveira N, Oliveira A, Almeida M, Veneza LM, Oliveira AL, Adan L, Ladeia AM. Is triglyceride to high-density lipoprotein cholesterol ratio a surrogates for insulin resistance in youth? Health (London) 2013. [DOI: 10.4236/health.2013.53066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Burns SF, Lee SJ, Arslanian SA. Surrogate lipid markers for small dense low-density lipoprotein particles in overweight youth. J Pediatr 2012; 161:991-6. [PMID: 22809659 PMCID: PMC3576033 DOI: 10.1016/j.jpeds.2012.06.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/27/2012] [Accepted: 06/06/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine if the ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL) and non-HDL cholesterol concentration could identify youth with small dense low-density lipoprotein (LDL). STUDY DESIGN One hundred forty-one (75 black and 66 white) overweight adolescents (9 to <18 years) had a fasting measurement of plasma lipids and LDL particle concentrations and size. Receiver operating characteristic curves were used to indicate the ability of different TG/HDL ratios and non-HDL cholesterol concentrations to identify overweight youth with atherogenic LDL concentration and size. RESULTS Youth with a TG/HDL ratio of ≥3 vs <3 had higher concentrations of small dense LDL (1279.5 ± 60.1 vs 841.8 ± 24.2 nmol/L, P < .001) and smaller LDL particle size (20.3 ± 0.1 vs 21.2 ± 0.1 nm, P < .001). In receiver operating characteristic analyses a TG/HDL cut-point of 3 best predicted LDL concentration in white youth, and 2.5 in black youth. Non-HDL cholesterol cut-point of 120 mg/dL and 145 mg/dL predicted LDL particle concentration in white and in black youth, respectively. TG/HDL ratio with body mass index or waist circumference explained 71% and 79% of the variance, respectively, in total small LDL. CONCLUSIONS TG/HDL ratio and non-HDL cholesterol can identify overweight youth with atherogenic LDL particles. These easily obtained clinical lipid markers, in combination with body mass index and waist circumference, could be cost effective, in observational or interventional studies, for screening and follow-up of youth at heightened risk for atherogenic LDL.
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Affiliation(s)
- Stephen F. Burns
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
- Physical Education and Sports Science Academic Group, Nanyang Technological University, Singapore
| | - So Jung Lee
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Silva A. Arslanian
- Division of Weight Management and Wellness, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
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Brumbaugh DE, Crume TL, Nadeau K, Scherzinger A, Dabelea D. Intramyocellular lipid is associated with visceral adiposity, markers of insulin resistance, and cardiovascular risk in prepubertal children: the EPOCH study. J Clin Endocrinol Metab 2012; 97:E1099-105. [PMID: 22508709 PMCID: PMC3387397 DOI: 10.1210/jc.2011-3243] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The intramyocellular deposition of lipid associates with metabolic dysregulation in adolescents and adults. Relatively little is known about the deposition of fat in muscle before the onset of puberty. OBJECTIVE Our objective was to describe the relationship between intramyocellular lipid (IMCL) accumulation and 1) visceral adiposity and 2) markers of insulin resistance and cardiovascular disease risk in a cohort of prepubertal and early pubertal children. STUDY DESIGN Data were collected as part of a retrospective cohort study, Exploring Perinatal Outcomes among Children (EPOCH). Multiple linear regression models were constructed for data analysis. RESULTS A total of 441 children participated in the study (226 prepubertal, 215 early pubertal). In prepubertal children, there was a significant relationship between IMCL and visceral fat (parameter estimate 0.019, P = 0.002) that remained after controlling for body mass index. Independent of overall adiposity, in all children, IMCL was associated with the triglyceride to high-density lipoprotein ratio (parameter estimate 0.1418, P = 0.002). CONCLUSIONS This study demonstrates a concerning and related pattern of IMCL and visceral fat deposition in prepubertal children. Intramuscular fat deposition is linked to markers of insulin resistance and cardiovascular disease risk.
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Affiliation(s)
- David E Brumbaugh
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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Mäntyselkä P, Kautiainen H, Saltevo J, Würtz P, Soininen P, Kangas AJ, Ala-Korpela M, Vanhala M. Weight change and lipoprotein particle concentration and particle size: a cohort study with 6.5-year follow-up. Atherosclerosis 2012; 223:239-43. [PMID: 22658258 DOI: 10.1016/j.atherosclerosis.2012.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/04/2012] [Accepted: 05/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Obesity and overweight are related to unfavourable lipoprotein subclass profiles. Here we studied the relation between weight change and lipoprotein particle concentrations and sizes in a general population cohort in a longitudinal setting. METHODS The cohort included 683 adults with a 6.5-year follow-up. Lipoprotein particle subclasses and mean particle sizes of VLDL, LDL, and HDL were measured by nuclear magnetic resonance spectroscopy. RESULTS During the follow-up period, a weight loss of at least 5% was associated with decreased particle concentrations of all apoB-containing subclasses and increased concentrations of large HDL particles. Coherently, weight gain (≥5%) was associated with increases in all apoB-containing subclasses and decreases in total and medium HDL particle concentrations. The relatively largest increase occurred for large HDL particle concentration (24.1%, 95% CI 15.8-32.5) in weight loss and for large VLDL particle concentration (33.0%, 19.6-46.4) in weight gain. Weight change correlated positively with changes in apoB-containing lipoprotein particle concentrations and also with the change in average VLDL particle size. Negative correlations were found between weight change and the change in average LDL (r = -0.10) and HDL (r = -0.32) particle size, but not between weight change and total HDL particle concentration. CONCLUSION Moderate weight loss is related to favourable and weight gain to unfavourable changes in lipoprotein subclass profiles. These population level findings underline the importance of weight control as a modifier of cardiovascular risk factors.
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Affiliation(s)
- Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.
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24
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Di Bonito P, Moio N, Scilla C, Cavuto L, Sibilio G, Sanguigno E, Forziato C, Saitta F, Iardino MR, Di Carluccio C, Capaldo B. Usefulness of the high triglyceride-to-HDL cholesterol ratio to identify cardiometabolic risk factors and preclinical signs of organ damage in outpatient children. Diabetes Care 2012; 35:158-62. [PMID: 22040842 PMCID: PMC3241301 DOI: 10.2337/dc11-1456] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether the high triglyceride-to-HDL cholesterol (TG-to-HDL-C) ratio is associated with cardiometabolic risk (CMR) factors and preclinical signs of organ damage in an outpatient population of white children and adolescents. RESEARCH DESIGN AND METHODS The study population included 884 subjects (aged 6-16 years), of whom 206 (23%) were normal weight, 135 (15%) were overweight, and 543 (61%) were obese. Biochemical variables were analyzed in the whole sample, whereas homocysteine and left ventricular (LV) geometry and function were evaluated in 536 and 258 children, respectively. RESULTS The percentage of pubertal children (P < 0.001), as well as measurements of BMI, waist circumference, homeostasis model assessment of insulin resistance, white blood cell count, alanine aminotransferase (ALT), systolic blood pressure (P < 0.0001, for all), creatinine (P < 0.001), and diastolic blood pressure (P < 0.02), increased from the lowest to the highest tertile of the TG-to-HDL-C ratio. Age, sex, homocysteine, and glomerular filtration rate did not change. Moreover, interventricular septum thickness, relative wall thickness, and LV mass index (P = 0.01 to P < 0.0001) increased across tertiles of the TG-to-HDL-C ratio. Children with a TG-to-HDL-C ratio ≥2.0 showed a two- to threefold higher risk of elevated ALT levels and concentric LV hypertrophy than those with a TG-to-HDL-C ratio <2.0, independent of confounding factors. CONCLUSIONS The high TG-to-HDL-C ratio is associated with several CMR factors and preclinical signs of liver and cardiac abnormalities in the outpatient, white pediatric population. Thus, a TG-to-HDL-C ratio ≥2.0 may be useful in clinical practice to detect children with a worsened CMR profile who need monitoring to prevent cardiovascular disease in adulthood.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, S. Maria delle Grazie, Pozzuoli Hospital, Naples, Italy.
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Abstract
Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic SyndromeRetinol-binding protein 4 is an adipocytokine separately implicated in the development of obesity-related insulin resistance and proatherogenic lipid profile, however, its role in humans is unclear. This study was carried out to assess the role of retinol-binding protein 4 as a potential marker of metabolic syndrome in obese Asian Indians (a high-risk population for diabetes). 52 obese (BMI >23 kg/m2) Asian Indians were grouped into those with and without metabolic syndrome based on IDF criteria and compared with healthy controls. The anthropometric and biochemical parameters (fasting blood sugar, lipid profile, serum insulin, high-sensitivity C-reactive protein, and retinol-binding protein 4) were estimated. The obese groups had significantly altered adiposity indices, insulin resistance parameters (fasting blood sugar (only in the metabolic syndrome group), serum insulin, HOMA-IR and QUICKI), index of inflammation (C-reactive protein) and proatherogenic dyslipidemic profile (serum triglycerides, VLDL-cholesterol, and triglyceride/HDL-cholesterol ratio). Retinol-binding protein 4 levels were elevated in the obese groups, but were not significant. Retinol-binding protein 4 levels were correlated with anthro-pometric parameters and atherogenic lipids, while C-reactive protein was correlated with anthropometric and insulin resistance parameters in the entire group of subjects. Although these correlations were not observed in the obese groups, in the control group, retinol-binding protein 4 was correlated to the lipid parameters and C-reactive protein to adiposity indices. Thus, the role of retinol-binding protein 4 as a potential marker of metabolic syndrome is limited to the prediction of proatherogenic risk among Asian Indians.
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