An Indispensable Parameter in Lipid Ratios to Discriminate between Morbid Obesity and Metabolic Syndrome in Children: High Density Lipoprotein Cholesterol
Obesity is a low-grade inflammatory disease and may lead to health problems such as hypertension, dyslipidemia, diabetes. It is also associated with important risk factors for cardiovascular diseases. This requires the detailed evaluation of obesity, particularly in children. The aim of this study is to enlighten the potential associations between lipid ratios and obesity indices and to introduce those with discriminating features among children with obesity and metabolic syndrome (MetS). A total of 408 children (aged between six and eighteen years) participated in the scope of the study. Informed consent forms were taken from the participants and their parents. Ethical Committee approval was obtained. Anthropometric measurements such as weight, height as well as waist, hip, head, neck circumferences and body fat mass were taken. Systolic and diastolic blood pressure values were recorded. Body mass index (BMI), diagnostic obesity notation model assessment index-II (D2 index), waist-to-hip, head-to-neck ratios were calculated. Total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDLChol), low-density lipoprotein cholesterol (LDLChol) analyses were performed in blood samples drawn from 110 children with normal body weight, 164 morbid obese (MO) children and 134 children with MetS. Age- and sex-adjusted BMI percentiles tabulated by World Health Organization were used to classify groups; normal body weight, MO and MetS. 15th-to-85th percentiles were used to define normal body weight children. Children, whose values were above the 99th percentile, were described as MO. MetS criteria were defined. Data were evaluated statistically by SPSS Version 20. The degree of statistical significance was accepted as p≤0.05. Mean±standard deviation values of BMI for normal body weight children, MO children and those with MetS were 15.7±1.1, 27.1±3.8 and 29.1±5.3 kg/m2, respectively. Corresponding values for the D2 index were calculated as 3.4±0.9, 14.3±4.9 and 16.4±6.7. Both BMI and D2 index were capable of discriminating the groups from one another (p≤0.01). As far as other obesity indices were considered, waist-to hip and head-to-neck ratios did not exhibit any statistically significant difference between MO and MetS groups (p≥0.05). Diagnostic obesity notation model assessment index-II was correlated with the triglycerides-to-HDL-C ratio in normal body weight and MO (r=0.413, p≤0.01 and r=0.261, (p≤0.05, respectively). Total cholesterol-to-HDL-C and LDL-C-to-HDL-C showed statistically significant differences between normal body weight and MO as well as MO and MetS (p≤0.05). The only group in which these two ratios were significantly correlated with waist-to-hip ratio was MetS group (r=0.332 and r=0.334, p≤0.01, respectively). Lack of correlation between the D2 index and the triglycerides-to-HDL-C ratio was another important finding in MetS group. In this study, parameters and ratios, whose associations were defined previously with increased cardiovascular risk or cardiac death have been evaluated along with obesity indices in children with morbid obesity and MetS. Their profiles during childhood have been investigated. Aside from the nature of the correlation between the D2 index and triglycerides-to-HDL-C ratio, total cholesterol-to-HDL-C as well as LDL-C-to- HDL-C ratios along with their correlations with waist-to-hip ratio showed that the combination of obesity-related parameters predicts better than one parameter and appears to be helpful for discriminating MO children from MetS group.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1316672Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 459
 S. K. Kunutsor,F. Zaccardi, J. Karppi, S. Kurl,and J.A. Laukkanen, “Is high serum LDL/HDL cholesterol ratio an emerging risk factor for sudden cardiac death? Findings from the KIHD study,” J. Atheroscler. Thromb.,vol. 24, no. 6, pp. 600-608, June 2017.
 S. C. Thambiah, I. N. Samsudin, E. George, S. Y. Zharari Sham, H. M. Lee, M. A. Muhamad, Z. Hussei, N. Mohd Noor, and M. Mohamad, “Relationship between dyslipidemia and glycaemic status in patients with Type 2 diabetes mellitus,” Malays. J. Pathol., vol. 38, no. 2, pp. 123-130, Aug.2016.
 A. Kucuk, A. UgurUslu, A. Icli, E. Cure, S. Arslan, K. Turkmen, A. Toker, and M. Kayrak, “The LDL/HDL ratio and atherosclerosis in anlylosing spondylitis,” Z. Rheumatol.,vol.76, no. 1, pp. 58-63, Feb. 2017.
 A. Zachurzok, G. Deja, A. Gawlik, A. Drosdzol-Cop, K. Klimek, and E. Malecka-Tendera, “Lipid profile in adolescent girls with type I diabetes mellitus and hyperandrogenemia,”Int. J. Endocrinol.,vol. 2016, no. 9473158, 2016.
 M. Rodriguez-Moran, F. Guerrero-Romero, C. Aradillas-Garcia, and C. Bermudez-Pena, “Atherogenic indices and prehypertension in obese and non-obese children,”Diab. Vasc. Dis. Res., vol. 10, no. 1, pp. 17-24, Jan.2013.
 G. Mulé, E. Nardi, G. Geraci, M. K. Schillaci, and S. Cottone, “The relationship between lipid ratios and arterial stiffness,” J. Clin. Hypertens (Greenwich), vol. 19(8), pp. 777–779, Aug 2017.
 E. M. Urbina, P. R. Khoury, C. E. McCoy, L. M. Dolan, S. R. Daniels, and T. R. Kimball, “Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults,” Pediatrics, vol. 131, no. 4, pp. e1082-e1090, Apr. 2013.
 M. R. Salazar, H. A. Carbajal, W. G. Espeche, M. Aizpurua, C. A. Dulbecco, and G. M. Reaven, “Comparison of two surrogate estimates of insulin resistance to predict cardiovascular disease in apparently healthy individuals, Nutr. Metab. Cardiovasc. Dis., vol. 27, no. 4, pp. 366-373, Apr. 2017.
 O. Turak, B. Afsar , F. Ozcan, F. Oksuz, M. A. Mendi, C. Yayla, A. Covic, N. Bertelsen, and M. Kanbay, “The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict new cardiovascular events in essential hypertensive patients,” J. Clin. Hypertens. (Greenwich), vol. 18, no. 8, pp. 772-777, Aug.2016.
 J. H. Wen, Y. Y. Zhong, C. Kuang, J. Liao, Z. Chen, and Q. Yang, “Lipoprotein ratios are better than conventional lipid parameters in predicting arterial stiffness in young men. J. Clin. Hypertens. (Greenwich), vol. 19, no.8, pp.771-776, Aug.2017.
 World Health Organization (WHO). The WHO Child Growth Standarts. Available at: http://www.who.int/childgrowth/en/ Accessed on June 10, 2016.
 P. Zimmet, K. G. Alberti, F. Kaufman, N. Tajima, M. Silink, S. Arslanian, G. Wong, P. Bennett, J. Shaw, S. Caprio, and IDF consensus group, “The metabolic syndrome in children and adolescents-an IDF consensus report”, Pediatr. Diabetes, vol: 8, no.5, pp. 299-306, Oct. 2007.
 O. Donma, M. M. Donma, M. Demirkol, M. Aydın, T. Gokkus, B. Nalbanoglu, A. Nalbantoglu, and B. Topcu, “Laboratory indices in late childhood obesity: The importance of DONMA indices,” Int J Med Health Biomed Bioeng Pharmaceutical Eng, vol. 10, no. 5, pp. 280-286, May 2016.
 T. Kim, A. Y. Park, Y. Baek, and S. Cha, “Genome-Wide Association Study Reveals Four Loci for Lipid Ratios in the Korean Population and the Constitutional Subgroup,” PLoS One, vol. 12, no. 1, pp. 0168137, Jan. 2017.
 F. Essiarab, H. Taki, H. Lebrazi, M. Sabri, and R. Saïle, 2014]. “Usefulness of lipid ratios and atherogenic index of plasma in obese Moroccan women with or without metabolic syndrome,” Ethn. Dis., vol. 24, no. 2, pp. 207-212, Spring 2014.
 H. Wang H, X. Guo, Y. Chen, Z. Li, J. Xu, and Y. Sun, “Relation of four nontraditional lipid profiles to diabetes in rural Chinese H-type hypertension population,”Lipids Health Dis.,vol. 16, no. 1, pp. 199, Oct. 2017.
 M. Abbasian, M. Delvarianzadeh, H. Ebrahimi, and F. Khosravi F, “Lipid ratio as a suitable tool to identify individuals with MetS risk: A case-control study,” Diabetes Metab. Syndr., vol.11, no. Suppl 1, pp. S15-S19, Nov. 2017.
 L. Zhang, S. Chen, A. Deng, X. Liu, Y. Liang, X. Shao, M. Sun, and L. Zou, “Association between lipid ratios and insulin resistance in a Chinese population,” PLoS One, vol. 10, no. 1, pp. e0116110, Jan 2015.
 H. von Bibra, S. Saha, A. Hapfelmeier, G. Müller, and P. E. H. Schwarz, “Impact of the triglyceride/high-density lipoprotein cholesterol ratio and the hypertriglyceremic-waist phenotype to predict the metabolic syndrome and insulin resistance,” Horm. Metab. Res.,vol. 49, no. 7, pp. 542-549,Jul. 2017.
 D. Gasevic, J. Frohlich, G. J. Mancini, and S. A. Lear, “Clinical usefulness of lipid ratios to identify men and women with metabolic syndrome: a cross-sectional study,” Lipids Health Dis., vol. 13, pp.159, Oct. 2014.
 T. Du, G. Yuan, M. Zhang, X. Zhou, X. Sun, and X. Yu, “Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance,” Cardiovasc. Diabetol., vol. 20, no. 13, pp. 146, Oct. 2014.
 M. A. Olamoyegun, R. Oluyombo, and S. O. Asaolu, “Evaluation of dyslipidemia, lipid ratios, and atherogenic index as cardiovascular risk factors among semi-urban dwellers in Nigeria,” Ann. Afr. Med., vol. 15, no. 4, pp.194-199, Oct-Dec. 2016.
 T. E. Toms, V. F. Panoulas, K. M. Douglas, P. Nightingale, J. P. Smith, H. Griffiths, N. Sattar, D. P. Symmons, and G. D. Kitas, “Are lipid ratios less susceptible to change with systemic inflammation than individual lipid components in patients with rheumatoid arthritis?,” Angiology,vol. 62, no. 2, pp. 167-175, Feb. 2011.
 B. Goswami, M. Rajappa, B. Chakraborty, S. K. Patra, S. Kumar, and V. Mallika, “Comparison of the various lipid ratios and indices for risk assessment in patients of myocardial infarction,” Clin. Biochem., vol. 45, no. 6, pp. 445-449, Apr. 2012.
 M. K. Arora, S. Seth, S. Dayal, A. S. Trehan, and M. Seth, “Serum lipid profile in female patients with severe acne vulgaris,” Clin. Lab., vol. 60, no. 7, pp. 1201-1205, 2014.
 X. M. Shi, Y. B. Lyu, Z. X. Yin, L. Q. Su, J. Zhang, J. F. Cai, and J. S. Luo,“Follow-up study on the effects of lipid ratios on all-cause mortality among elderly adults in longevity areas of China,” ZhonghuaYu Fang Yi XueZaZhi., vol. 50, no. 7, pp. 594-599, Jul. 2016.
 I. Riaño-Galán, A. Fernández-Somoano, C. Rodríguez-Dehli, D. Valvi, M. Vrijheid, and A. Tardón, “Proatherogenic lipid profile in early childhood: Association with weight status at 4 years and parental obesity,” J. Pediatr., vol. 187, pp. 153-157, Aug. 2017.