Çocukluk Çağı Obezitesinin Koroidal Yapılar Üzerine Etkisinin Değerlendirilmesi

Yıl 2024, Cilt: 8 Sayı: 1, 6 - 12, 29.04.2024

Serdar Bilici , Tuba Gültekin Erol , Esra Bilici , Sılay Cantürk Uğurbaş , Suat Hayri Uğurbaş

https://doi.org/10.25048/tudod.1400388

Öz

Amaç: Çocukluk çağı obezitesinin koroidal yapılar üzerindeki etkilerini spektral domain optik koherens tomografi ile değerlendirmek.
Gereç ve Yöntemler: Çalışmaya her gruptan (sağlıklı, fazla kilolu, obez ve morbid-obez) 20’ şer toplamda 80 çocuk dahil edildi.
Olguların insülin direnci, dislipidemi ve metabolik sendrom gibi komorbiditelerinin varlığı kaydedildi. Olguların optik koherens
tomografi görüntülerinden elde edilen subfoveal koroid kalınlığı (SFKK) ve koroid vaskülarite indeksi (KVİ) değerleri karşılaştırıldı.
Bulgular: Gruplar yaş ve aksiyel uzunluk ortalamaları açısından benzer bulundu (sırasıyla p=0,504 ve p=0,805). Sağlıklı, fazla kilolu,
obez ve morbid-obez çocuklarda medyan (min-maks) SFKK sırasıyla 398,5 (319,0-453,5) μm, 299,0 (274,7-387,0) μm, 295,5 (257,0-
385,0) μm ve 304,5 (272,2-386,0) μm idi. Fazla kilolu ve obez çocuklarda SFKK sağlıklı çocuklara göre daha inceydi (p=0,032). Ancak obezite şiddeti ile SFKK istatistiksel olarak ilişkili bulunmadı (p=0,722). Gruplar arasında KVİ, toplam koroid alanı, luminal alan ve
stromal alan açısından anlamlı fark yoktu (sırasıyla p=0,710, p=0,452, p=0,221 ve p=0,863). Dislipidemisi olan obez çocuklarda SFKK,
dislipidemisi olmayanlara göre daha düşük bulundu (292,0(166-431) μm vs 348,0(173-491) μm, p=0,003). Eşlik eden insülin direnci ve
metabolik sendrom varlığının ise SFKK üzerine etkisi gözlenmedi (p=0,336 ve p=0,211, sırasıyla).
Sonuç: Çocukluk çağı obezitesi ve eşlik eden dislipidemi varlığı, KVİ' de herhangi bir anlamlı değişiklik yapmadan SFKK'de azalmaya
yol açmaktadır. Ancak obezite şiddeti ve eşlik eden insülin direnci veya metabolik sendroma sahip olmanın SFKK veya KVİ üzerinde
etkisi gözlenmemiştir. SFKK parametresinde incelme görülmesi çocukluk çağı obezitesi ve dislipidemi varlığına bağlı mikrovasküler
bozukluklar ile ilişkili olabilir.

Anahtar Kelimeler

Çocukluk çağı obezitesi, koroid vaskülarite endeksi, subfoveal koroid kalınlığı, optik koherens tomografi

Evaluating the Effect of Childhood Obesity on Choroidal Structures

Öz

Aim: To evaluate the effect of childhood obesity on choroidal structures with spectral-domain optical coherence tomography (SD-OCT).
Material and Methods: A total of 80 children (20 children per each group; healthy, overweight, obese, and morbid-obese) were included
in the study. Accompanying comorbidities such as insulin resistance, dyslipidemia, and metabolic syndrome were recorded. The
subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) measurements were obtained from SD-OCT images and
compared between groups.
Results: No notable differences were found between groups regarding the means of age and axial length (p=0.504, and p=0.805,
respectively). The SFCT medians (min-max) of healthy, overweight, obese, and morbid-obese children were 398.5 (319.0-453.5) μm,
299.0 (274.7-387.0) μm, 295.5 (257.0-385.0) μm, and 304.5 (272.2-386.0) μm respectively. Overweight and obese children had thinner
choroid than non-obese healthy children (p=0.032). Besides, no significant correlation was observed between the severity of obesity and
SFCT (p=0.722). In terms of CVI, total choroidal area, luminal area, and stromal area; no significant differences were found between
groups (p=0.710, p=0.452, p=0.221, and p=0.863, respectively). Obese children with dyslipidemia had thinner SFCT than those not have
dyslipidemia (292.0 (166-431)μm vs 348.0(173-491)μm, p=0.003), while insulin resistance and metabolic syndrome had no effect on
SFCT (p=0.336, and p=0.211, respectively).
Conclusion: Childhood obesity and accompanying dyslipidemia led to a decrease in SFCT without any significant change in the CVI.
However, the severity of obesity and having insulin resistance or metabolic syndrome had no effect on either SFCT or CVI. The thinning
in the SFCT may be related to microvascular disorders due to childhood obesity and dyslipidemia

Anahtar Kelimeler

Childhood obesity, choroidal vascularity index, subfoveal choroidal thickness, optical coherence tomography

Etik Beyan

This study was approved by Zonguldak Bülent Ecevit University Ethics Committee (2022/06-09).

Destekleyen Kurum

No financial support was received.

Teşekkür

Special thanks to Dr. Esra Gultekin for the statistical analysis.

Kaynakça

• 1. Kosti RI, Panagiotakos DB. The epidemic of obesity in children and adolescents in the world. Cent Eur J Public Health. 2006;14:151-159.
• 2. Jiang SZ, Lu W, Zong XF, Ruan HY, Liu Y. Obesity and hypertension. Exp Ther Med. 2016;12:2395-2399.
• 3. Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Cir Res. 2016;118:1752-1770.
• 4. Tutunchi H, Naeini F, Ebrahimi-Mameghani M, Mobasseri M, Naghshi S, Ostadrahimi A. The association of the steatosis severity, NAFLD fibrosis score and FIB-4 index with atherogenic dyslipidaemia in adult patients with NAFLD: A cross-sectional study. Int J Clin Pract. 2021;75:14131.
• 5. Alim S, Demir AK. Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi. Turk J Diab Obes. 2019;3:79-83.
• 6. Küçük N, Alpay A. The Effect of Dexamethasone Implant on Retinal Nerve Fiber Layer and Optic Nerve Cup-to-Disk Ratio in Patients with Diabetic Macular Edema. Turk J Diab Obes. 2022;6:143-148.
• 7. Bilici S, Selçuk N, Gültekin-Erol T, Uğurbaş SH. COVID-19 Karantina Sürecinin Diyabetik Makula Ödemi Tedavisine Etkileri. Turk J Diab Obes. 2023;7:122-127.
• 8. Ciccone MM, Miniello V, Marchioli R, Scicchitano P, Cortese F, Palumbo V, Primitivo SG, Sassara M, Ricci G, Carbonara S, Gesualdo M, Diaferio L, Mercuro G, De Pergola G, Giordano P, Favale S. Morphological and functional vascular changes induced by childhood obesity. Eur J Cardiovasc Prev Rehabil. 2011;18(6):831-835.
• 9. Barton M, Baretella O, Meyer MR. Obesity and risk of vascular disease: importance of endothelium-dependent vasoconstriction. Br J Pharmacol. 2012;165:591-602.
• 10. Bulus AD, Can ME, Baytaroglu A, Can GD, Cakmak HB, Andiran N. Choroidal Thickness in Childhood Obesity. Ophthalmic Surg Lasers Imaging Retina. 2017;48:10-17.
• 11. Aydemir GA, Aydemir E, Asik A, Bolu S. Changes in ocular pulse amplitude and choroidal thickness in childhood obesity patients with and without insulin resistance. Eur J Ophthalmol. 2022;32:2018-2025.
• 12. Topcu-Yilmaz P, Akyurek N, Erdogan E. The effect of obesity and insulin resistance on macular choroidal thickness in a pediatric population as assessed by enhanced depth imaging optical coherence tomography. J Pediatr Endocrinol Metab. 2018;31:855-860.
• 13. Erşan I, Battal F, Aylanç H, Kara S, Arikan S, Tekin M, Gencer B, Tufan HA. Noninvasive assessment of the retina and the choroid using enhanced-depth imaging optical coherence tomography shows microvascular impairments in childhood obesity. JAAPOS. 2016;20:58-62.
• 14. Uslu Dogan C, Culha D. Subfoveal choroidal thickness and peripapillary retinal nerve fiber layer thickness in young obese males. Eur J Ophthalmol. 2021;31:3190-3195.
• 15. Öncül H, Çağlayan M, Fuat Alakus M, Yılmaz Öncül F, Dag U, Arac E, Metin K. Evaluation of the subfoveal choroidal and outer retinal layer thickness in obese women. Clin Exp Optom. 2021;104:178-186.
• 16. Gupta P, Jing T, Marziliano P, Cheung CY, Baskaran M, Lamoureux EL, Wong TY, Cheung CM, Cheng CY. Distribution and determinants of choroidal thickness and volume using automated segmentation software in a population-based study. Am J Ophthalmol. 2015;159:293-301.
• 17. Sansom LT, Suter CA, McKibbin M. The association between systolic blood pressure, ocular perfusion pressure and subfoveal choroidal thickness in normal individuals. Acta Ophthalmol. 2016;94:157-158.
• 18. Iovino C, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Govetto A, Vagge A, Di Zazzo A, Forlini M, Finocchio L, Carnevali A, Triolo G, Giannaccare G. Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter. J Clin Med. 2020;9:595.
• 19. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006;95:194-198.
• 20. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-419.
• 21. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709- 757.
• 22. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S; IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007;8:299-306.
• 23. Tan KA, Laude A, Yip V, Loo E, Wong EP, Agrawal R. Choroidal vascularity index - a novel optical coherence tomography parameter for disease monitoring in diabetes mellitus? Acta Ophthalmol. 2016;94:612-616.
• 24. Järvisalo MJ, Jartti L, Näntö-Salonen K, Irjala K, Rönnemaa T, Hartiala JJ, Celermajer DS, Raitakari OT. Increased aortic intima- media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation. 2001;104(24):2943-2947.
• 25. Armstrong KR, Cote AT, Devlin AM, Harris KC. Childhood obesity, arterial stiffness, and prevalence and treatment of hypertension. Curr Treat Options Cardiovasc Med. 2014;16:339.
• 26. Takiuchi S, Kamide K, Miwa Y, Tomiyama M, Yoshii M, Matayoshi T, Horio T, Kawano Y. Diagnostic value of carotid intima-media thickness and plaque score for predicting target organ damage in patients with essential hypertension. J Hum Hypertens. 2004;18(1):17-23.
• 27. Wang JJ, Taylor B, Wong TY, Chua B, Rochtchina E, Klein R, Mitchell P. Retinal vessel diameters and obesity: a population- based study in older persons. Obesity (Silver Spring). 2006;14(2):206-214.
• 28. Taylor B, Rochtchina E, Wang JJ, Wong TY, Heikal S, Saw SM, Mitchell P. Body mass index and its effects on retinal vessel diameter in 6-year-old children. Int J Obes (Lond). 2007;31(10):1527-1533.
• 29. Kurniawan ED, Cheung CY, Tay WT, Mitchell P, Saw SM, Wong TY, Cheung N. The relationship between changes in body mass index and retinal vascular caliber in children. J Pediatr. 2014;165:1166-1171
• 30. Tenlık A, Kulak AE, Güler E, Totan Y, Gürağaç FB, Boyraz M. Evaluation of Ganglion Cell-Inner Plexiform and Retinal Nerve Fiber Layer Thicknesses in Obese Children and Their Associations with Obesity Severity and Duration. Turk J Diab Obes. 2018;2:29-34.
• 31. Li XQ, Jeppesen P, Larsen M, Munch IC. Subfoveal choroidal thickness in 1323 children aged 11 to 12 years and association with puberty: the Copenhagen Child Cohort 2000 Eye Study. Invest Ophthalmol Vis Sci. 2014;55:550-555.
• 32. Nilsson SF. Nitric oxide as a mediator of parasympathetic vasodilation in ocular and extraocular tissues in the rabbit. Invest Ophthalmol Vis Sci. 1996;37:2110-2119.
• 33. Stapleton PA, James ME, Goodwill AG, Frisbee JC. Obesity and vascular dysfunction. Pathophysiology. 2008;15:79-89.
• 34. Kamide K. Role of Renin-Angiotensin-Aldosterone System in Metabolic Syndrome and Obesity-related Hypertension. Curr Hypertens Rev. 2014 Aug 12. Epub ahead of print.
• 35. Sekaran S, Cunningham J, Neal MJ, Hartell NA, Djamgoz MB. Nitric oxide release is induced by dopamine during illumination of the carp retina: serial neurochemical control of light adaptation. Eur J Neurosci. 2005;21:2199-2208.
• 36. Schmetterer L, Krejcy K, Kastner J, Wolzt M, Gouya G, Findl O, Lexer F, Breiteneder H, Fercher AF, Eichler HG. The effect of systemic nitric oxide-synthase inhibition on ocular fundus pulsations in man. Exp Eye Res. 1997;64(3):305-312.
• 37. Reitsamer HA, Zawinka C, Branka M. Dopaminergic vasodilation in the choroidal circulation by d1/d5 receptor activation. Invest Ophthalmol Vis Sci. 2004;45:900-905.
• 38. Murata T, Nagai R, Ishibashi T, Inomuta H, Ikeda K, Horiuchi S. The relationship between accumulation of advanced glycation end products and expression of vascular endothelial growth factor in human diabetic retinas. Diabetologia. 1997;40:764-769.
• 39. Esmaeelpour M, Považay B, Hermann B, Hofer B, Kajic V, Hale SL, North RV, Drexler W, Sheen NJ. Mapping choroidal and retinal thickness variation in type 2 diabetes using three-dimensional 1060-nm optical coherence tomography. Invest Ophthalmol Vis Sci. 2011;52(8):5311-5316.
• 40. Agarwal A, Saini A, Mahajan S, Agrawal R, Cheung CY, Rastogi A, Gupta R, Wang YM, Kwan M, Gupta V; OCTA Study Group. Effect of weight loss on the retinochoroidal structural alterations among patients with exogenous obesity. PLoS One. 2020;15(7):e0235926.
• 41. Ozcelik-Kose A, Imamoglu S, Aktekin A, Balci S, Yıldız MB, Ozturk Y, Yenerel NM. Effect of bariatric surgery on macular and peripapillary choroidal structures in young patients with morbid obesity. Can J Ophthalmol. 2022;57(6):370-375.