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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1. World Health Organization (2016). Childhood overweight and obesity. World Health Organization.
2. 2. Goliasch G, Wiesbauer F, Blessberger H, Demyanets S, Wojta J, Huber K, et al. Premature myocardial infarction is strongly associated with increased levels of remnant cholesterol. J Clin Lipidol. 2015;9:801–6.
3. 3. Zhu L, Lu Z, Zhu L, Ouyang X, Yang Y, He W, et al. Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people. Kardiol Pol. 2015;73:931–8.
4. 4. Cai G, Shi G, Xue S, Lu W. The atherogenic index of plasma is a strong and independent predictor for coronary artery disease in the Chinese Han population. Medicine (Baltimore). 2017 Sep;96(37):e8058. doi: 10.1097/MD.0000000000008058
5. 5. Akboga MK, Balci KG, Maden O, Ertem AG, Kirbas O, Yayla C, et al. Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease. Biomark Med. 2016;10(4):375–83.
6. 6. Aydin E, Ates I, Fettah Arikan M, Yilmaz N, Dede F. The ratio of monocyte frequency to HDL cholesterol level as a predictor of asymptomatic organ damage in patients with primary hypertension. Hypertens Res. 2017;40:758–64.
7. 7. Demir V, Samet Y, Akboga MK. Assessment of monocyte to high density lipoprotein cholesterol ratio and lymphocyte-to-monocyte ratio in patients with metabolic syndrome. Biomark Med. 2017 Jul;11(7):535-40.
8. 8. Uslu AU, Sekin Y, Tarhan G, Canakcı N, Gunduz M, Karagulle M. Evaluation of Monocyte to High-Density Lipoprotein Cholesterol Ratio in the Presence and Severity of Metabolic Syndrome. Clin Appl Thromb Hemost. 2018 Jul;24(5):828-33.

9. 9. Johnsen SH, Fosse E, Joakimsen O, Mathiesen EB, Stensland-Bugge E, Njølstad I, et al. Monocyte count is a predictor of novel plaque formation: a 7 year follow-up study of 2610 persons without carotid plaque at baseline the Tromso Study. Stroke. 2005;36 (4):715–9.
10. 10. Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed). 1986;292:13–5.
11. 11. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, et al. Weight, height, head circumference and body mass index references for Turkish children. Journal of Child Health and Diseases. 2008;51:1-14.
12. 12. Hatipoğlu N, Öztürk A, Mazicioğlu M, Kurtoglu S, Seyhan S, Lokoglu F. Waist circumference percentiles for 7- to 17-year–old Turkish children and adolescents. Eur J Pediatr. 2008;167:383-9.
13. 13. Zimmet P, Alberti KG, Kaufman F. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatr Diabetes. 2007;8:299–306.
14. 14. Demir K, Özen S, Konakçı E, Aydın M, Darendeliler F. A Comprehensive Online Calculator for Pediatric Endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol. 2017;9:182-4.
15. 15. Kurtoglu S, Hatipoglu N, Mazıcıoglu M, Kendirci M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Ped Endo. 2010;2:100-6.
16. 16. Akbas EM, Timuroglu A, Ozcicek A, Ozcicek F, Demirtas L, Gungor A, et al. Association of uric acid, atherogenic index of plasma and albuminuria in diabetes mellitus. Int J Clin Exp Med. 2014;7(12):5737–43.
17. 17. Dobiasova M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER (HDL)). Clin Biochem. 2001;34(7):583–8.
18. 18. Sousa NPS, Salvador EP, Barros AK, Polisel CG, Carvalho WRG. Anthropometric Predictors of Abdominal Adiposity in Adolescents. Journal of Exercise Physiologyonline. 2016;19:66-76
19. 19. Sapunar J, Aguilar-Farías N, Navarro J, Araneda G, Chandía-Poblete D, Manríquez V, et al. High prevalence of dyslipidemia and high atherogenic index of plasma in children and adolescents. Rev Med Chil. 2018 Dec;146(10):1112-22
20. 20. Wang Q, Zheng D, Liu J, Fang L, Li Q. Atherogenic index of plasma is a novel predictor of non-alcoholic fatty liver disease in obese participants: a cross-sectional study. Lipids Health Dis. 2018 Dec 13;17(1):284. doi: 10.1186/s12944-018-0932-0
21. 21. Luptáková L, Siváková D, Cvíčelová M, Wsólová L, Danková Z, Michnová A, et al. Power of biomarkers and their relative contributions to metabolic syndrome in Slovak adult women. Ann Hum Biol. 2013 Mar;40(2):132-38. doi: 10.3109/03014460.2012.748828.
22. 22. Zhang X, Zhang X, Li X, Feng J, Chen X. Association of metabolic syndrome with atherogenic index of plasma in an urban Chinese population: A 15-year prospective study. Nutr Metab Cardiovasc Dis. 2019 Nov;29(11):1214-9. doi: 10.1016/j.numecd.2019.07.006.
23. 23. Mudhaffar Sami Khazaál. Atherogenic index of plasma (AIP) as a parameter in predicting cardiovascular risk in males compared to the conventional dyslipidemic indices (Cholesterol ratios). Karbala J Med. 2013 Jun;6 (1):1506-13.
24. 24. Giannini C, de Giorgis T, Scarinci A, Ciampani M, Marcovecchio ML, Chiarelli F, et al. Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children. Atherosclerosis. 2008;197:448–56. doi:10.1016/j.atherosclerosis.2007.06.023
25. 25. Vrablík M, Dobiášová M, Zlatohlávek L, Urbanová Z, Češka R. Biomarkers of cardiometabolic risk in obese/overweight children: effect of lifestyle interven-tion. Physiol Res. 2014;63(6):743–52.
26. 26. Jimenez-Rivera C, Hadjiyannakis S, Davila J, Hurteau J, Aglipay M, Barrowman N, et al. Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity. BMC Pediatr. 2017;17:113.
27. 27. Westerbacka J, Lammi K, Hakkinen AM, Rissanen A, Salminen I, Aro A, et al. Dietary fat content modifies liver fat in overweight nondiabetic subjects. J Clin Endocrinol Metab. 2005;90:2804-9.
28. 28. Fadaei R, Meshkani R, Poustchi H, Fallah S, Moradi N, Panahi G, et al. Association of carotid intima media thickness with atherogenic index of plasma, apo B/apo A-Iratio and paraoxonase activity in patients with non-alcoholic fatty liver disease. Arch Physiol Biochem. 2019;Feb;125(1):19-24. doi: 10.1080/13813455.2018.1429475.
29. 29. Rohatgi A. High-density lipoprotein function measurement in human studies: focus on cholesterol efflux capacity. Prog Cardiovasc Dis. 2015;58(1):32-40.
30. 30. Van de Woestijne AP, van der Graaf Y, Liem AH, Cramer MJ, Westerink J, Visseren FL. SMART Study Group. Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid lowering medication. J Am Coll Cardiol. 2013;62(20):1834-41.