Metabolic syndrome, hepatic steatosis, and cardiovascular risk in children.
OBJECTIVE
Pediatric metabolic syndrome (MetS) is a well-recognized entity; however, there is no consensus on its exact value in predicting long-term cardiovascular (CV) risk. Hepatic steatosis (HS) is another emerging condition associated with pediatric obesity, and data have been reported suggesting a possible role of HS in CV risk linked to MetS. The aim of the present study was to evaluate the usefulness of HS and MetS cluster in predicting CV risk linked to pediatric obesity.


METHODS
We studied 803 overweight and obese children (395 girls and 408 boys, mean age 9.4 ± 2.5 y, body mass index z-score 2.2 ± 0.53) with complete clinical and biological assessment. MetS was defined using the modified criteria of the American Heart Association. The diagnosis and severity of the HS was based on ultrasound. To assess CV risk, all patients underwent ultrasonography to measure carotid intima-media thickness (cIMT)-a validated marker of subclinical vascular disease.


RESULTS
The overall prevalence of MetS was 13.07%; HS was significantly higher in patients with MetS (40.9 versus 18.5%; P < 0.001; odds ratio, 3.059; 95% confidence interval, 1.98-4.7). Spearman's correlation between HS grade and the number of MetS criteria met by each patient was significant (r = 0.285; P < 0.001). No statistical difference was recorded in cIMT and cIMT z-scores between patients with or without MetS, until inclusion of HS as an additional criterion for the diagnosis of MetS. In this case, there was a significant difference in cIMT z-scores between the two groups. In multiple linear regression analysis, the cIMT z-score value was better predicted with HS grade and the MetS cluster (adjusted R2= 2.6%; P = 0.002) than when using the MetS cluster only.


CONCLUSIONS
HS could be used as additional criterion in detecting pediatric MetS phenotype at higher risk for long-term CV morbidity.
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Unit of Pediatrics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
Irene
I
Rutigliano
Department of Medical and Surgical Sciences, Radiology, University of Foggia, Foggia, Italy.
Roberta
R
Vinci
Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine des Adolescents, Unité Diabète, Hypertension, Nutrition, Le Kremlin-Bicêtre, France.
Gianpaolo
G
De Filippo
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Monica
M
Mancini
Department of Medical and Surgical Sciences, Radiology, University of Foggia, Foggia, Italy.
Luca
L
Stoppino
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Maria
M
d'Apolito
Laboratory Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
Ida
I
Giardino
Department of Medical and Surgical Sciences, Radiology, University of Foggia, Foggia, Italy.
Luca
L
Macarini
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Massimo
M
Pettoello Mantovani
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. Electronic address: angelo.campanozzi@unifg.it.
Angelo
A
Campanozzi
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D016000:Cluster Analysis; D005234:Fatty Liver / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000209:etiology; D050177:Overweight / Q000150:complications / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
Cardiovascular risk; Children; Hepatic steatosis; Metabolic syndrome; Pediatric obesity