Obez çocuk ve adölesanlarda metabolic sendrom ve non-alkolik karaciğer yağlanmasını öngörmede yeni belirteçler: Plazma aterojenik indeks ve monosit / yüksek dansiteli lipoprotein kolesterol oranı

Abstract

Amaç: Bu çalışmada obezitesi olan çocuk ve adölesan hastalarda plazma aterojenik indeks (PAİ) ve monosit / HDL oranı (MHO) ile metabolik sendrom (MS), insülin direnci (İD), bel çevresi (BÇ) ve non-alkolik karaciğer yağlanması (NAKY) arasındaki ilişkinin araştırılması amaçlanmıştır. Yöntemler: Çalışma kesitsel olup, 172 obez çocuk hasta ile 63 sağlıklı kontrol hastası içermekteydi. Antropometrik ve biyokimyasal parametreler [ağırlık, boy, beden kitle indeksi (BKİ) standart deviasyon skoru (SDS), BÇ, hemogram, aspartat transaminaz (AST), alanin transaminaz (ALT), insulin, glukoz, total kolesterol (TC), yüksek-dansiteli lipoprotein kolesterol (HDL-C), trigliserid (TG), düşük-dansiteli lipoprotein kolesterol (LDL-C), HOMA-IR, PAİ ve MHO ] değerlendirildi. Plazma aterojenik indeks; düşük (<0,11), orta (0,11–0,21) ve yüksek (>0,21) risk diye üç gruba ayrıldı. Metabolik sendrom tanımı Uluslararası Diyabet Fedarasyonuna göre yapıldı. Bulgular: Obez hasta grubunda BKİ SDS, BÇ, HOMA-IR, TC, TG, LDL-C, AST, ALT, PAİ değeri ve MHO anlamlı ölçüde yüksek saptandı (her biri için P<0,05). On yaş üzeri 146 hastada MS araştırıldı ve 49 hastada (%33,6) pozitif saptandı. Ortalama PAİ ve ortanca MHO değeri obez ve MS’u olanlarda, obez ve MS’u olmayanlara göre anlamlı ölçüde yüksek saptandı (p değeri sırasıyla; <0,001, 0,017 ). Plazma aterojenik index ile BÇ, HOMA-IR, TG, ALT, MHO ve karaciğerin yağlanma derecesi arasında anlamlı pozitif korelasyon saptandı (r=0,34, P<0,001, r=0,289, P<0,001, r=0,863, P<0,001, r=0,292, P<0,001, r=0,447, P<0,001, r=0,298, P<0,001 sırasıyla). Sonuç: Hem PAİ hem de MHO basit, ucuz ve kolay hesaplanabilen parametrelerdir. Obez çocuklarda PAİ değerinin, abdominal obezite, NAKY, İD ve MS’u öngörmede bir belirteç olarak kullanılabilir. Ayrıca obez çocuklarda yüksek MHO’nın artmış kardiyovasküler hastalık riski ve MS ile ilişkili olduğu düşünülebilir.

Keywords

• plazma aterojenik indeks
• monosit HDL oranı
• obezite
• metabolik sendrom
• çocuklar

Novel markers in predicting non-alcoholic liver fatty and metabolic syndrome in obese children and adolescents: Atherogenic index of plasma and monocyte / high-density lipoprotein cholesterol ratio

Abstract

Aim: The aim of this study is to investigate the relationship between metabolic syndrome (MetS), insulin resistance, waist circumference (WC) and non-alcoholic fatty liver disease (NAFLD) with atherogenic index of plasma (AIP) and monocyte/ high-density lipoprotein cholesterol ratio (MHR) among obese children and adolescents. Methods: The cross-sectional study consisted of 172 obese and 63 healthy children. Anthropometric and biochemical parameters [Weight, height and BMI SDS, WC, Complete blood count, aspartate-aminotransferase (AST), alanine-aminotransferase (ALT), insulin, glucose, total cholesterol (TC), high-density lipoprotein (HDL-C), triglyceride (TG) and low-density lipoprotein (LDL-C), homeostasis model assessment-insulin resistance (HOMA-IR), AIP, MHR] were assessed. The AIP was classified into three groups: Low (<0.11), intermediate (0.11–0.21) and high (>0.21) risk. The MetS definition proposed by the International Diabetes Federation was adopted. Results: BMI SDS, WC, HOMA-IR, TC, TG, LDL-C, AST, ALT, AIP, and MHR parameters were significantly higher among the obesity group (P<0.05 for each). The MetS was analyzed in 146 obese children older than 10 years of age and found positive in 49 (33.6%) children. The mean AIP and median MHR were significantly higher in the group with MetS than in the group without (P<0.001, P=0.017, respectively). A significant positive correlation was determined between AIP and WC, HOMA-IR, TG, ALT, MHR, and steatosis degree (r=0.34, P<0.001, r=0.289, P<0.001, r=0.863, P<0.001, r=0.292 P<0.001, r=0.447, P<0.001, r=0.298, P<0.001 respectively). Conclusion: Both AIP and MHR are simple, cheap, and easily calculable parameters. The AIP might be used as an effective marker to predict MetS, abdominal obesity, NAFLD and IR in obese children. In addition, the high MHR in obese children may be associated with an increased risk of cardiovascular disease and MetS.

Keywords

• atherogenic index of plasma
• monocyte to HDL cholesterol ratio,
• obesity
• metabolic syndrome
• children

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