Dyslipidemia and its risk factors in overweight and obese children and adolescents
DOI:
https://doi.org/10.14306/renhyd.18.3.67Keywords:
Dyslipidemias, Hyperlipidemias, Prevalence, Risk Factors, Obesity, Child, AdolescentAbstract
Introduction: Obesity and overweight are frequently associated with metabolic complications. Objective: to estimate the prevalence of dyslipidemia in overweight and obese children and adolescents and its risk factors (RF), and the concordance between different cut-off values (Cook et al. vs. American Academy of Cardiology) of triglycerides (TG) and HDL-C.
Material and Methods: 139 patients (aged 8-14 years) with overweight or obesity, attending the outpatient Pediatric Clinic, Division of Nutrition, San Martin University Hospital, Buenos Aires, Argentina, from February 2005 to January 2013, were studied. The design was descriptive, observational, prospective, crossover and comparison of independent samples. Dyslipidemia was considered when: Total cholesterol (TC)≥200 mg/dl or HDL-C≤40 mg/dl or TG≥110 mg/dl or LDL-C≥130mg/dl. Increased waist circumference (WC≥90th percentile, according Freedman et al.), low weight at birth (<2,5 kg.), family history of dyslipidemia and acute myocardial infarction (AMI) were considered as risk factors. The concordance between the cut-off values of TG (≥110 and ≥150 mg/dl) and also of HDL-C (≤40 and <35 mg/dl) were analyzed.
Results: The prevalence of dyslipidemia was 50,4%; the most abnormal lipid fractions was the TG (31,7%) and the most frequently RF was the increased WC (55,4%). The concordance between cut-off values was weak for TG (Kappa index=0.38), and moderate for HDL-C (Kappa index=0,52).
Conclusions: The high prevalence of dyslipidemia was similar to other reports. The risk factors for dyslipidemia were the increased WC and family history of dyslipidemia. Due to the degree of concordance for TG and HDL-C it is relevant the cut-off values to be considered.
References
Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008; 122(1): 198-208.
César M, Manterola A, Eymann A. Hipercolesterolemia. Consenso sobre factores de riesgo de enfermedad cardiovascular en pediatría. Arch Argent Pediatr. 2005; 103(4): 358-66.
Juonala M, Viikari JS, Kähönen M, Solakivi T, Helenius H, Jula A, et al. Childhood levels of serum apolipoproteins B and A-I predict carotid intima-media thickness and brachial endothelial function in adulthood: the cardiovascular risk in young Finns study. J Am Coll Cardiol. 2008; 52(4): 293-9.
National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels In Children and Adolescents. Blood Cholesterol levels in children and adolescents. Pediatrics.1992; 89: 525-84.
Valdez R, Greenlund KJ, Khoury MJ, Yoon PW. Is the Family History a Useful Tool for Detecting Children at Risk for Diabetes and Cardiovascular Diseases? A Public Health Perspective. Pediatrics. 2007;120(Suppl 2): S78-S86.
Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998; 338(23): 1650-6.
Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimalmedial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine Study. Circulation. 2001; 104(23): 2815-19.
Steinberger J, Moorehead C, Katch V, Rocchini AP. Relationship between insulin resistance and abnormal lipid profile in obese adolescents. J Pediatr. 1995; 126: 690-5.
American Academy of Pediatrics. Committee on Nutrition. Cholesterol in Childhood. Pediatrics. 1998; 101(1): 141- 47.
Marin P, Mollerach M, Braguinsky J. Obesidad abdomino visceral. En: Braguinsky J, et al. Obesidad. Segunda edición. Buenos Aires, Argentina. Editorial El Ateneo, 1996: 139-62.
Litwak L, Rey R, Masnatta L, Cuniberti L, Werba J. Síndrome Polimetabólico. Una situación frecuente en la práctica diaria. Revista Argentina de Endocrinología y Metabolismo. 1996; 33:4-18.
Kolovou GD, Anagnostopoulou KK, Cokkinos DV. Pathophysiology of dyslipidaemia in the metabolic syndrome. Posgrad Med J. 2005; 81(956): 358-66.
Steinberger J, Daniels SR; American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young); American Heart Association Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003; 107(10): 1448-53.
Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 1999; 69(2): 308-17.
Vieira Cunha Lima SC, Oliveeira Lyra C, Galvão Bacurau Pinheiro L, Medeiros de Azevedo PR, Arrais RF and Campos Pedrosa LF. Association between dislipidemia and anthropometric indicators in adolescents. Nutr Hosp. 2011; 26(2): 304-10.
Teixeira PJ, Sardinha LB, Going SB, Lohman TG. Total and regional fat an serum cardiovascular disease risk factors in lean ad obese children and adolescents. Obes Res. 2001; 9(8): 432-42.
Osmond C,Barker DJ. Fetal, Infant, and Childhood Growth Are Predictors of Coronary Heart Disease, Diabetes, and Hypertension in Adult Men and Women. Environ Health Perspect. 2000; 108(Suppl 3): 545-553.
Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003; 157(8):
-7.
Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K, et al. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003; 107(11): 1562-6.
Lejarraga H, Anigstein C, Di Candia A, et al. Normas y Técnicas Antropométricas para la evaluación pediátrica del crecimiento físico. En: Comité de Crecimiento y Desarrollo de la Sociedad Argentina de Pediatría. Criterios de Diagnóstico y Tratamiento. Crecimiento y Desarrollo. Primera edición. Buenos Aires: Sociedad Argentina de Pediatría; 1986. p. 11-7.
Rolland-Cachera MF, Sempé M, Guilloud-Bataille M, Patois E, Péquignot-Guggenbuhl F, Fautrad V. Adiposity indices in children. Am J Clin Nutr. 1982; 36(1): 178-84.
Callaway C, Chumlea W, Bouchard C, Himes JH, Lohman TG, Martin AD, et al. Circumferences. En: Lohman TG, Roche, Martorell. Anthropometric standardization reference manual. Champain, IL: Human Kinetics Books; 1988. p. 39-54.
Tanner JM. Normal growth and techniques of growth assessment. Clin Endocrinol Metab. 1986; 15(3): 411-51.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18(6): 499-502.
Kwiterovich PO Jr. Recognition and management of dyslipidemia in children and adolescents. J Clin Endocrinol Metab. 2008; 93(11): 4200-9.
Piazza N, Casavalle P, Ferraro M, Ozuna B, Desantadina V, Kovalskys I. Guías de práctica clínica para la prevención, el diagnóstico y el tratamiento de la obesidad. Arch Argent Pediatr. 2011; 109(3): 256-66.
Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, et al. Coronary risk factors measured in childhood and young adult life are associated with coronary calcification in young adults: the Muscatine Study. J Am Coll Cardiol. 1996; 27(2): 277-84.
Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA. 2003; 290(17): 2271-76.
Gidding SS, McMahan CA, McGill HC, Colangelo LA, Schreiner PJ, Williams OD, et al. Prediction of coronary artery calcium in young adults using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score: the CARDIA study. Arch Intern Med. 2006; 166(21): 2341-47.
McMahan CA, Gidding SS, Viikari JS, Juonala M, Kähönen M, Hutri-Kähönen N, et al. Association of Pathobiologic Determinants of Atherosclerosis in Youth risk score and 15-year change in risk score with carotid artery intima-media thickness in young adults (from the Cardiovascular Risk in Young Finns Study). Am J Cardiol. 2007; 100(7): 1124-9.
Juonala M, Viikari JS, Rönnemaa T, Marniemi J, Jula A, Loo BM, et al. Associations of dyslipidemias from childhood to adulthood with carotid intima-media thickness, elasticity, and brachial flow-mediated dilatation in adulthood: the Cardiovascular Risk in Young Finns Study. Arterioscler Thromb Vasc Biol. 2008; 28(5): 1012-7.
Romero-Velarde E, Campollo-Rivas O, Celis de la Rosa A, Vásquez-Garibay EM, Castro-Hernández JF, Cruz-Osorio RM. Factores de riesgo de dislipidemia en niños y adolescentes con obesidad. Salud Publica Mex. 2007; 49(2): 103-8.
Marcos-Daccarett NJ, Núñez-Rocha GM, Salinas-Martínez AM, Santos-Ayarzagoitia M, Decanini-Arcaute H. Obesidad como Factor de Riesgo para Trastornos Metabólicos en Adolescentes Mexicanos, 2005. Rev Salud Publica (Bogota). 2007; 9(2):180-93.
Centers for Disease Control and Prevention (CDC). Prevalence of abnormal lipid levels among youths - United States, 1999-2006. MMWR Morb Mortal Wkly Rep. 2010; 59(2): 29-33.
Kelishadi R, Cook SR, Motlagh ME, Gouya MM, Ardalan G, Motaghian M, et al. Metabolically obese normal weight and phenotypically obese metabolically normal youths: the CASPIAN Study. J Am Diet Assoc. 2008; 108(1): 82-90.
Pajuelo J, Rocca J, Gamarra M. Obesidad infantil: sus características antro-pométricas y bioquímicas. Anales de Facultad de Medicina. 2003; 64(1): 21-6.
Casavalle P, Romano L, Maselli M, et al. Concordancia entre los diferentes criterios diagnósticos de Síndrome Metabólico en niños y adolescentes obesos y con sobrepeso. Revista Obesidad - Sociedad Argentina de Obesidad y Trastornos Alimentarios (SAOTA). 2011; 22(1): 20-6.
Casavalle P, Romano L, Maselli M, et al. Prevalencia de Síndrome Metabólico según diferentes criterios en niños y adolescentes con sobrepeso y obesidad. Revista ALAD (Asociación Latinoamericana de Diabetes). 2010; XVIII(3): 112-18.
Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004; 89(1): 108-13.
Lee J, Lauer RM, Clarke WR. Lipoproteins in the progeny of young men with coronary artery disease: children with increased risk. Pediatrics. 1986; 78(2): 330-7.
Salonen M, Tenhola S, Laitinen T, Lyyra-Laitinen T, Romppanen J, J äskeläinen J, et al. Tracking serum lipid levels and the association of cholesterol concentrations, blood pressure and cigarette smoking with carotid artery intima-media thickness in young adults born small for gestational age. Circ J. 2010; 74(11): 2419-25.