New Factors Of Cardiometabolic Risk In Severely Obese Children: Influence Of Pubertal Status

Nutr Hosp. 2010;25(5):845-851 ISSN 0212-1611 • CODEN NUHOEQ S.V.R. 318

Original

New factors of cardiometabolic risk in severely obese children: influence of pubertal status
P. Codoñer-Franch1,2, R. Murria-Estal3, M. Tortajada-Girbés1, C. del Castillo-Villaescusa1 y V. Valls-Bellés2, E. Alonso-Iglesias4
1 Department of Pediatrics, Dr Peset University Hospital, Valencia, Spain. 2Departmentof Pediatrics, Obstetrics and Gynecology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain. 3Clinical Biochemistry Laboratory, Dr Peset University Hospital, Valencia, Spain. 4Department of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain.

Abstract The aim of this prospective study was to evaluate theutility of new biochemical markers to assess cardiometabolic risk in severely obese children and adolescents. A total of 107 subjects aged 7 to 14 years, were clinically assessed and anthropometric measures and percentage of fat mass by single frequency bioimpedance analysis were recorded. Of these, 44 were non-overweight and 63 severely obese (body mass index Z-score >2.5) which were stratified byTanner stages. To estimate the metabolic risk the following variables were considered for analysis: Waist circumference/height >0.5, fasting glucose >100 mg/dL, triglycerides >110 mg/dL, HDL-C 95th percentile for age and gender. Fasting insulinemia, apoprotein A1 and B, high-sensitive C-reactive protein, alanine aminotransferase, homocysteine, and folic and uric acids were determined. In severelyobese children, metabolic risk was present more frequently in mid puberty. The normalized anthropometric parameters with respect to 50th percentile for age and gender did not differ in the presence of metabolic risk. Insulin resistance was an independent determinant of metabolic risk, adjusted by Tanner stages. Elevated high-sensitive C-reactive protein was noted without any effect of metabolic riskor pubertal stage. Homocysteine, apoprotein B, and alanine aminotransferase values increased with metabolic risk and were not influenced by puberty. Although insulin resistance remains the main factor influencing metabolic risk, biochemical markers as homocysteine, apoprotein B, and alanine aminotransferase, may be useful for identifCorrespondence: P. Codoñer-Franch. Departamento de Pediatría.Hospital Universitario Dr. Peset. Avenida Gaspar Aguilar, 90. 46017 Valencia. e-mail: pilar.codoner@uv.es Recibido: 6-X-2009. Revisado: 26-XI-2009. Aceptado: 30-XI-2009.

NUEVOS FACTORES DE RIESGO CARDIOMETABÓLICO EN NIÑOS CON OBESIDAD SEVERA: INFLUENCIA DEL ESTADO PUBERAL Resumen El objetivo de este estudio prospectivo ha sido evaluar la utilidad de nuevos marcadores bioquímicos para evaluar elriesgo cardiometabólico en niños y adolescentes extremadamente obesos. Un total de 107 sujetos de entre 7 a 14 años, se valoraron clínicamente registrando sus medidas antropométricas y el porcentaje de masa grasa mediante bioimpedancia. De ellos, 44 presentaban un peso normal para su edad y género y 63 estaban gravemente obesos (puntuación Z del índice de masa corporal > 2,5), los cuales fueronestratificados por estadios de Tanner. Para valorar el riesgo metabólico se consideraron las siguientes variables: Circunferencia cintura/altura> 0,5, glucosa en ayunas >100 mg/dL, triglicéridos >110 mg/dL, HDL-C percentil 95 para edad y género. Se determinaron la insulinemia en ayunas, apoproteinas A1 y B, proteína C reactiva ultrasensible, alaninaminotransferasa, homocisteína y ácidos fólico yúrico. En los niños obesos severos, la presencia de factores de riesgo metabólico se producía con más frecuencia en la pubertad. Los parámetros antropométricos normalizados con respecto al percentil 50 para la edad y género no se diferenciaban según existiera o no mayor riego metabólico. La resistencia a la insulina fue un factor independiente de riesgo metabólico, ajustado por etapas de Tanner. La...