Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study.

Lipid ratios to estimate atherosclerotic disease risk in overweight/obese children are receiving great attention. We aimed to compare the performance of non-high-density lipoprotein-cholesterol (HDL-C) versus triglycerides-to-HDL-C ratio (Tg/HDL-C) in identifying cardiometabolic risk factors (CMRFs) or preclinical signs of organ damage in outpatient Italian overweight/obese children. In this retrospective, cross-sectional study, 5505 children (age 5-18 years) were recruited from 10 Italian centers for the care of obesity, of which 4417 (78%) showed obesity or morbid obesity. Anthropometric, biochemical, and blood pressure variables were analyzed in all children. Liver ultrasound scan, carotid artery ultrasound, and echocardiography were performed in 1257, 601, and 252 children, respectively. The entire cohort was divided based on the 75th percentile of non-HDL-C (≥130 mg/dl) or Tg/HDL-C ratio (≥2.2). The odds ratio for insulin resistance, high blood pressure, metabolic syndrome, presence of liver steatosis, increased levels of carotid intima-media thickness (cIMT) and concentric left ventricular hypertrophy (cLVH) was higher in children with high levels of Tg/HDL-C with respect to children with high levels of non-HDL-C. In an outpatient setting of overweight/obese children, Tg/HDL-C ratio discriminated better than non-HDL-C children with CMRFs or preclinical signs of liver steatosis, and increased cIMT and cLVH.

Di Bonito P ，Valerio G ，Grugni G ，Licenziati MR ，Maffeis C ，Manco M ，Miraglia del Giudice E ，Pacifico L ，Pellegrin MC ，Tomat M ，Baroni MG ，CARdiometabolic risk factors in overweight and obese children in ITALY (CARITALY) Study Group ... -  《-》

Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents.

The triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio has been reported as a useful marker of atherogenic lipid abnormalities, insulin resistance, and cardiovascular disease. We evaluated in a large sample of children and adolescents the association of TG/HDL-C ratio with early signs of morphological vascular changes and cardiometabolic risk factors including nonalcoholic fatty liver disease (NAFLD). The study population, including 548 children (aged 6-16 years), of whom 157 were normal-weight, 118 overweight, and 273 obese, had anthropometric, laboratory, liver and carotid ultrasonography (carotid artery intima-media thickness-cIMT) data collected. Subjects were stratified into tertiles of TG/HDL-C. There was a progressive increase in body mass index (BMI), BMI-SD score (SDS), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and cIMT values across TG/HDL-C tertiles. The odds ratios for central obesity, insulin resistance, high hsCRP, NAFLD, metabolic syndrome, and elevated cIMT increased significantly with the increasing tertile of TG/HDL-C ratio, after adjustment for age, gender, pubertal status, and BMI-SDS. In a stepwise multivariate logistic regression analysis, increased cIMT was associated with high TG/HDL-C ratio [OR, 1.81 (95% CI, 1.08-3.04); P < 0.05], elevated BP [5.13 (95% CI, 1.03-15.08); P < 0.05], insulin resistance [2.16 (95% CI, 1.30-3.39); P < 0.01], and NAFLD [2.70 (95% CI, 1.62-4.56); P < 0.01]. TG/HDL-C ratio may help identify children and adolescents at high risk for structural vascular changes and metabolic derangement.

Pacifico L ，Bonci E ，Andreoli G ，Romaggioli S ，Di Miscio R ，Lombardo CV ，Chiesa C ... -  《-》

White blood cell count may identify abnormal cardiometabolic phenotype and preclinical organ damage in overweight/obese children.

Subclinical inflammation is a central component of cardiometabolic disease risk in obese subjects. The aim of the study was to evaluate whether the white blood cell count (WBCc) may help to identify an abnormal cardiometabolic phenotype in overweight (Ow) or obese (Ob) children. A cross-sectional sample of 2835 Ow/Ob children and adolescents (age 6-18 years) was recruited from 10 Italian centers for the care of obesity. Anthropometric and biochemical variables were assessed in the overall sample. Waist to height ratio (WhtR), alanine aminotransferase (ALT), lipids, 2 h post-load plasma glucose (2hPG), left ventricular (LV) geometry and carotid intima-media thickness (cIMT) were assessed in 2128, 2300, 1834, 535 and 315 children, respectively. Insulin resistance and whole body insulin sensitivity index (WBISI) were analyzed using homeostatic model assessment (HOMA-IR) and Matsuda's test. Groups divided in quartiles of WBCc significantly differed for body mass index, WhtR, 2hPG, HOMA-IR, WBISI, lipids, ALT, cIMT, LV mass and relative wall thickness. Children with high WBCc (≥8700 cell/mm(3)) showed a 1.3-2.5 fold increased probability of having high normal 2hPG, high ALT, high cIMT, or LV remodeling/concentric LV hypertrophy, after adjustment for age, gender, pubertal status, BMI and centers. This study shows that WBCc is associated with early derangements of glucose metabolism and preclinical signs of liver, vascular and cardiac damage. The WBCc may be an effective and low-cost tool for identifying Ow and Ob children at the greatest risk of potential complications.

Di Bonito P ，Pacifico L ，Chiesa C ，Invitti C ，Miraglia Del Giudice E ，Baroni MG ，Moio N ，Pellegrin MC ，Tomat M ，Licenziati MR ，Manco M ，Maffeis C ，Valerio G ，“CARdiometabolic risk factors in overweight and obese children in ITALY” (CARITALY) Study Group ... -  《-》

Comparison of lipoprotein derived indices for evaluating cardio-metabolic risk factors and subclinical organ damage in middle-aged Chinese adults.

High-density lipoprotein cholesterol (HDL-C) and related lipoprotein ratios were used to assess lipid atherogenesis or insulin resistance. However, which of these indices is superior remains controversial and could differ across ethnic groups. We evaluated the efficacy of HDL-C, and related lipoprotein ratios in identifying cardio-metabolic risk factors (CMRs) or preclinical organ damage among a health check-ups population in China. We conducted a cross-sectional study of 17,596 Chinese adults aged 40-64years, who participated in annual health checkups in China. Anthropometric, biochemical, liver ultrasound scan, brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT) were analyzed. Partial spearman correlations, receiver operating characteristic (ROC) curves were used for statistical analyses. In both gender, the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio consistently had the highest correlation with various CMRs and subclinical organ damage. Overall, the area under the curve (AUC) of TG/HDL-C ratio was significantly greater than that of the rest lipid variables/ratios in the prediction of abdominal obese, high blood pressure, impaired fasting glucose, metabolic syndrome, and preclinical signs of organ damage (all P<0.001). In both gender with a normal TG and HDL-C concentration, those with an increased TG/HDL-C, had higher concentrations of various CMRs and higher presence of subclinical organ damage (despite no significant differences were found between different TG/HDL-C for part of CMRs indicators). In this population, TG/HDL-C ratio of ≥1.255 in men and ≥0.865 in women can identify individuals with cardio-metabolic risk, despite TG/HDL-C ratio, TC/HDL-C ratio, and LDL-C/HDL-C ratio seem comparable in their association with CMRs and subclinical signs of organ damage.

Cao X ，Wang D ，Zhou J ，Chen Z ... -  《-》

Relationship between childhood obesity cut-offs and metabolic and vascular comorbidities: comparative analysis of three growth standards.

To compare the association between metabolic and vascular comorbidities and the body mass (BMI)-for-age cut-off criteria from three growth standards [Centers for Disease Control and Prevention (CDC), 2000; World Health Organization (WHO), 2007; Spanish Reference Criteria (Carrascosa Lezcano et al., 2008)] that are used to define being overweight and obese in childhood. A prospective study was conducted in 137 children (aged 8-16 years). Based on BMI-for-age Z-scores according to WHO cut-offs, 59 participants were obese, 35 were overweight and 43 were normal-weight. All participating children were subsequently reclassified applying the CDC and Spanish Reference Criteria. Blood pressure (BP), biochemical variables and vascular parameters (stiffness and intima-media thickness) were analysed. According to WHO and CDC references, 48% and 43% of the children, respectively, were categorised as obese, whereas 16% were considered as obese using the Spanish Reference Criteria. Applying WHO criteria, obese children showed significantly higher levels of insulin, homeostasis model assessment index and most vascular parameters, as well as lower high-density lipoprotein (HDL)-cholesterol than overweight children. Moreover, overweight children showed higher BP, insulin and uric acid, and lower HDL-cholesterol than normal weight children. The CDC criteria yielded similar results, although with fewer differences between obese and overweight children. Applying Spanish criteria, the differences between obese and overweight children disappeared. WHO and CDC BMI-for-age references and cut-offs are useful for defining obesity and being overweight in children because they clearly identify metabolic and vascular comorbidities. The Spanish Reference Criteria underdiagnose obesity because overweight children show comorbidities typical of the obese.

Martínez-Costa C ，Núñez F ，Montal A ，Brines J ... -  《-》