The Evaluation of a Cardiac Index Derived from Anthropometric and Biochemical Parameters in Pediatric Morbid Obesity and Metabolic Syndrome

Authors: Mustafa M. Donma

Abstract:

Metabolic syndrome (MetS) components are noteworthy among children with obesity and morbid obesity, because they point out the cases with MetS, which have the great tendency to severe health problems such as cardiovascular diseases both in childhood and adulthood. In clinical practice, considerable efforts are being observed to bring into the open the striking differences between morbid obese cases and those with MetS findings. The most privileged aspect is concerning cardiometabolic features. The aim of this study was to derive an index, which behaves different in children with and without MetS from the cardiac point of view. For the purpose, aspartate transaminase (AST), a cardiac enzyme still being used independently to predict cardiac-related problems was used. 124 children were recruited from the outpatient clinic of Department of Pediatrics in Tekirdag Namik Kemal University, Faculty of Medicine. 43 children with normal body mass index, 41 and 40 morbid obese (MO) children with MetS and without the characteristic features of MetS, respectively, were included in the study. Weight, height, waist circumference (WC), hip circumference (HC), head circumference (HdC), neck circumference (NC), systolic and diastolic blood pressure values were measured and recorded. Body mass index and anthropometric ratios were calculated. Fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein cholesterol (HDL-C) analyses were performed. The values for AST, alanine transaminase (ALT) and AST/ALT were obtained. Advanced Donma cardiac index (ADCI) values were calculated. Statistical evaluations including correlation analysis were done by a statistical package program. The statistical significance degree was accepted as p < 0.05. The index, ADCI, was developed from both anthropometric and biochemical parameters. All anthropometric measurements except weight were included in the equation. Besides all biochemical parameters concerning MetS components were also added. This index was tested in each of three groups. Its performance was compared with the performance of cardiometabolic index (CMI). It was also checked whether it was compatible with AST activity. The performance of ADCI was better than that of CMI. Instead of double increase, the increase of three times was observed in children with MetS compared to MO children. The index was correlated with AST in MO group and with AST/ALT in MetS group. In conclusion, this index was superior in discovering cardiac problems in MO and in diagnosing MetS in MetS groups. It was also arbiter to point out cardiovascular and MetS aspects among the groups.

Keywords: Aspartate transaminase, cardiac index, metabolic syndrome, obesity.

References:

[1] S. M. Grundy, “Obesity, metabolic syndrome and cardiovascular disease,” J. Clin. Endocrinol. Metabol., vol.89, no.6, pp.2595-2600, Jun 2004.
[2] C. D. Bendor, A. Bardugo, O. Pinhas-Hamiel, A Afek and G. Twig, “Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity,” Cardiovasc. Diabetol., vol.19, no.1 pp. 79, Jun 2020.
[3] B. A. Aulinger, T. To Viet, E. Waldmann and K. G. Parhofer, “Prevalence of the metabolic syndrome in severely obese patients presenting for bariatric surgery,” Dig. Dis., vol.39, no.4, pp. 334-340, 2021.
[4] P. Piqueras, A. Ballester, J. V. Durá-Gil, S. Martinez-Hervas, J. Redón and J. T. Real, “Anthropometric indicators as a tool for diagnosis of obesity and other health risk factors: A literature review,” Front. Psychol., vol.12, pp.631179, Jul. 2021.
[5] B. Bourgeois, K. Watts, D. M. Thomas, O. Carmichael, F. B. Hu, M. Heo, J. E. Hall and S. B. Heymsfield, “Associations between height and blood pressure in the United States population,” Medicine (Baltimore), vol.96, no.50, pp.e9233, Dec. 2017.
[6] J. H. Page, K. M. Rexrode, F. Hu, C. M. Albert, C. U. Chae, and J. E. Manson, “Waist-height ratio as a predictor of coronary heart disease among women,” Epidemiology, vol.20, no.3, pp.361-366, May 2009.
[7] M. Mahdavi-Roshan, A. Rezazadeh, F. Joukar, M. Naghipour, S. Hassanipour, and F. Mansour-Ghanaei, “Comparison of anthropometric indices as predictors of the risk factors for cardiovascular disease in Iran: The PERSIAN Guilan Cohort Study,” Anatol. J. Cardiol., vol.25, no.2, pp.120-128, Feb. 2021.
[8] S. E. Kahn, R. L. Hull and K. M. Utzschneider, “Mechanisms linking obesity to insulin resistance and type 2 diabetes,” Nature, vol.444, no.7121, pp.840-846, Dec. 2006.
[9] M. Laakso and J. Kuusisto, “Insulin resistance and hyperglycaemia in cardiovascular disease development,” Nat. Rev. Endocrinol., vol.10, no.5, pp.293-302, May 2014.
[10] P. Zimmet, K. G. AlbertiG, F. Kaufman, N. Tajima, M. Silink, S. Arslanian, G. Wong, P. Bennet, 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, 2007.
[11] M. Donma, S. Kacmaz, A. Yilmaz, S. Guzel, and O. Donma, “The evaluation of new generation cardiovascular risk markers in childhood obesity,” Int. J. Med. Health Sci., vol.15, no.12, pp.308–314, 2021.
[12] S. Thupakula, S. S. R. Nimmala, H. Ravula, S. Chekuri, and R. Padiya, “Emerging biomarkers for the detection of cardiovascular diseases,” Egypt Heart J., vol.74, no.1, pp. 77, 2022.
[13] P. Deepa and N. Sasivathanam, “A study of AST/ ALT ratio in metabolic syndrome,” Int. J. Contemp. Med. Res., vol.4, no.1, pp.28-30, 2017.
[14] S. Lin, L. Tang, R. Jiang, Y. Chen, S. Yang, L. Li and Li P, “The relationship between aspartate aminotransferase to alanine aminotransferase ratio and metabolic syndrome in adolescents in Northeast China,” Diabetes Metab. Syndr. Obes., vol.12, pp.2387-2394, Nov. 2019.
[15] F. Yan, G. Nie, N. Zhou, M. Zhang, and W. Peng, “Combining fat-to-muscle ratio and alanine aminotransferase/aspartate aminotransferase ratio in the prediction of cardiometabolic risk: A cross-sectional study,” Diabetes Metab. Syndr. Obes., vol.16, pp.795–806, 2023.
[16] H. Liu, C. Ding, L. Hu, M. Li, W. Zhou, T. Wang, L. Zhu, H. Bao and X. Cheng, “The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension,” Medicine (Baltimore), vol.100, no.31, pp.e26693, Aug. 2021.
[17] I. Wakabayashi and T. Daimon, “The "cardiometabolic index" as a new marker determined by adiposity and blood lipids for discrimination of diabetes mellitus,” Clin. Chim. Acta, vol.438, pp.274-278, Jan 2015.
[18] S. Duan, D. Yang, H. Xia, Z. Ren, J. Chen and S. Yao, “Cardiometabolic index: A new predictor for metabolic associated fatty liver disease in Chinese adults,” Front. Endocrinol. (Lausanne), vol.13, pp.1004855, Sep. 2022.
[19] I. Soldatovic, R. Vukovic, D. Culafic, M. Gajic, and V. Dimitrijevic-Sreckovic, “siMS score: Simple method for quantifying metabolic syndrome,” PLoS One, vol.11, no.1, pp. e0146143, Jan. 2016.
[20] M. M. Donma and O. Donma, “A new index for the differential diagnosis of morbid obese children with and without metabolic syndrome,” Int. J. Med. Health Sci., vol.17, no.2, pp.1, 2023.
[21] WHO World Health Organization. The WHO Child Growth Standards. Available at: http://www.who.int/childgrowth/en/ Accessed on June 10, 2016.
[22] S. Patibandla, K. Gupta and K. Alsayouri, “Cardiac Enzymes,” Aug. 2022. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2023 Jan–.
[23] J. S. Ladue, F. Wroblewski and A. Karmen, “Serum glutamic oxaloacetic transaminase activity in human acute transmural myocardial infarction,” Science, vol.120, no.3117, pp.497-499, Sep. 1954.
[24] G. Ndrepepa, “Aspartate aminotransferase and cardiovascular disease—a narrative review,” J. Lab. Precis. Med., vol.6, pp.6, 2021.
[25] W. Liu, C. Chen, X. Gu, L. Zhang, X. Mao, Z. Chen and L. Tao, “AM1241 alleviates myocardial myocardial ischemia-reperfusion injury in rats by enhancing Pink1/Parkin- mediated autophagy,” Life Sci., vol.272, pp.119228, May 2021.
[26] A. Sikandar, K. Farhat, A. Afzal, K. Ajmal, M. Laeeq and A. Khokhar, “Protective effects of Trimetazidine against Doxorubicin-induced cardiotoxicity and hepatotoxicity in mice,” J. Ayub. Med. Coll. Abbottabad, vol.32, no.3, pp.304-309, Jul-Sep. 2020.
[27] K. A. Olofinsan, R. A. Ajala-Lawal and T. O. Ajiboye, “Loperamide-induced cardiotoxicity in rats: Evidence from cardiac and oxidative stress biomarkers,” J. Biochem. Mol. Toxicol., vol.33, no.4, pp.e22278, Apr. 2019.
[28] A. S. Mandour, R. F. Elsayed, A. O. Ali, A. E. Mahmoud, H. Samir, A. A. Dessouki, K. Matsuura, I. Watanabe, K. Sasaki, S. Al-Rejaie, T. Yoshida, K. Shimada, R. Tanaka and G. Watanabe, “The utility of electrocardiography and echocardiography in copper deficiency- induced cardiac damage in goats,” Environ. Sci. Pollut. Res. Int., vol.28, no.7, pp.7815-7827, Feb. 2021.
[29] P. Liu and Q. Pan, “Butein inhibits oxidative stress injury in rats with chronic heart failure via ERK/Nrf2 signaling,” Cardiovasc. Ther., vol.2022, pp.8684014, Jan. 2022.
[30] G. Ndrepepa, S. Holdenrieder, S. Cassese, E. Xhepa, M. Fusaro, K. L. Laugwitz, H. Schunkert and A. Kastrati, “Aspartate aminotransferase and mortality in patients with ischemic heart disease,” Nutr. Metab. Cardiovasc. Dis., vol.30, no.12, pp. 2335-2342, Nov. 2020.
[31] S. Lazzer, M. D’Alleva, M. Isola, M. De Martino, D. Caroli, A. Bondesan, A. Marra and A. Sartorio, “Cardiometabolic index (CMI) and visceral adiposity index (VAI) highlight a higher risk of metabolic syndrome in women with severe obesity,” J. Clin. Med., vol.12, no.9, pp.3055, 2023.
[32] X. Cai, J. Hu, W. Wen, J. Wang, M. Wang, S. Liu, Q. Zhu, J. Hong, Y. Dang, X. Yao, L. Sun, D. Zhang, Q Luo and N. Li, “Associations of the cardiometabolic index with the risk of cardiovascular disease in patients with hypertension and obstructive sleep apnea: Results of a longitudinal cohort study,” Oxid. Med. Cell Longev., vol.2022, pp.4914791, Jun. 2022.