Nutrición Hospitalaria ISSN: 0212-1611 info@nutriciónhospitalaria.com Grupo Aula Médica España Gomes Domingos, Ana Luiza; Machado-Coelho, George Luiz Lins; Pinheiro Volp, Ana Carolina; Pereira de Oliveira, Fernando Luiz; Santana Caldas, Ivo; Nascimento de Freitas, Silvia Association between nutritional status, C-reactive protein, adiponectin and HOMA-AD in Brazilian children Nutrición Hospitalaria, vol. 30, núm. 1, julio-, 2014, pp. 66-74 Grupo Aula Médica Madrid, España Available in: http://www.redalyc.org/articulo.oa?id=309231672009 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative 09. ASSOCIATION_01. Interacción 05/08/14 08:49 Página 66 Nutr Hosp. 2014;30(1):66-74 ISSN 0212-1611 • CODEN NUHOEQ S.V.R. 318 Original / Pediatría Association between nutritional status, C-reactive protein, adiponectin and HOMA-AD in Brazilian children Ana Luiza Gomes Domingos1, George Luiz Lins Machado-Coelho PhD2, Ana Carolina Pinheiro Volp PhD3, Fernando Luiz Pereira de Oliveira PhD4, Ivo Santana Caldas PhD5 and Silvia Nascimento de Freitas PhD3 1Graduate Program in Health and Nutrition. School of Nutrition. 2School of Medicine. 3Department of Social and Clinical Nutrition. School of Nutrition. 4Department of Statistics. 5Research Center in Biological Sciences. Federal University of Ouro Preto (UFOP). Ouro Preto. Minas Gerais. Brazil. Abstract ASOCIACIÓN ENTRE ESTADO NUTRICIONAL, PROTEÍNA C REACTIVA, ADIPONECTINA Y HOMA-AD Introduction: In children, the presence of obesity is a major EN NIÑOS BRASILEÑOS risk factor for the occurrence of cardiovascular diseases on the adulthood. Resumen Objective: To evaluate the association of anthropometry, body composition, clinical variables and biochemical profile Introducción: En niños, la obesidad es um factor de riesgo pa- with C-reactive protein and adiponectin levels, and insulin ra enfermedades cardiovasculares en la edad adulta. resistance in children in the municipality of Nova Era, Brazil. Objetivos: Asociaciar la antropometría, composición corpo- Methods: Nested case-control study following a cross- ral, variables clínicas y bioquímicas con la proteína C reactiva sectional study. We evaluated 178 children, 57 of them classified (PCR), adiponectina y resistencia a la insulina en niños de Nova as obese and 121 as normal-weight from a population of 1024 Era, Brasil. schoolchildren 6 to 10 years old: Blood samples were collected Métodos: Estudio de casos y controles anidado en un trans- after 12-hour fast to obtain serum and plasma. We collected versal. Se evaluaron 178 niños, 57 obesos y 121 eutróficos en una anthropometric and body composition measures, systolic and población de 1.024 escolares de 6 a 10 años. Las muestras de san- diastolic blood pressure data. Sexual maturation was assessed gre se recogieron después de 12 horas de ayuno. Recogimos las according to the stage of sexual development. We performed medidas antropométricas, de composición corporal y presión Student’s t-test, Mann-Whitney U test, Pearson’s correlation, arterial. La madurez sexual fue evaluada de acuerdo con el de- Spearman’s test and multiple linear regression analysis. Inde- sarrollo sexual. Se realizo las pruebas t de Student y U de Mann- pendent variables with p < 0.05 were included in the multiple Whitney, las correlaciones de Pearson y Spearman y el análisis regression model. Residual analysis was performed to assess de regresión lineal múltiple. Se incluyeron en el modelo de re- model validity. gresión, las variables independientes con p < 0,05. Se realizo el Results: Among obese children, C-reactive protein levels análisis residual para evaluar la validez del modelo. were associated with triacylglycerol levels and body fat percen- Resultados: Entre los niños obesos, los niveles de PCR se aso- tage estimated by skinfold thickness (R2 = 27.6%, p < ciaron con los triglicéridos y el porcentaje de grasa corporal adjusted (%GC) estimada por los pliegues cutáneos (R2 = 27,6%, p < 0.001). Adiponectin was associated with HOMA-IR, HOMA- ajustado AD and body fat percentage estimated by skinfold thickness 0,001). La adiponectina se asoció con HOMA-IR, HOMA-AD y % GC estimada por los pliegues cutáneos (R2 = 75,5%, p < (R2 = 75.5%, p < 0.001). HOMA-AD index was associated ajustado adjusted 0,001). El HOMA-AD se asoció con HOMA-IR, adiponectina, with HOMA-IR, adiponectin, systolic blood pressure and 2 2 presión arterial sistólica y peso (R ajustado = 90,7%, p < 0,001). weight (R adjusted = 90.7%, p < 0.001). Conclusion: Significant associations were found between Conclusiones: Se encontraron asociaciones entre la composi- body composition, anthropometry, clinical variables, bioche- ción corporal, antropometría, variables clínicas, perfil bioquí- mical profile and adiponectin and C-reactive protein levels and mico, adiponectina, PCR y la resistencia a la insulina en niños insulin resistance in obese and normal-weight children. obesos y eutróficos. (Nutr Hosp. 2014;30:66-74) (Nutr Hosp. 2014;30:66-74) DOI:10.3305/nh.2014.30.1.7322 DOI:10.3305/nh.2014.30.1.7322 Key words: Inflammation. Child. Insulin resistance. Obesity. Palabras clave: Inflamación. Niño. Resistencia a la insulina. Biological markers. Obesidad. Marcadores biológicos. Correspondence: Silvia Nascimento de Freitas PhD. Federal University of Ouro Preto School of Nutrition. Department of Social and Clinical Nutrition. Campus Universitario. Morro do Cruzeiro. 35400-000 Ouro Preto. Minas Gerais. Brazil. E-mail: [email protected] Recibido: 5-II-2014. 1.ª Revisión: 17-II-2014. Aceptado: 30-IV-2014. 66 09. ASSOCIATION_01. Interacción 05/08/14 08:49 Página 67 Abbreviations Even a low-grade inflammatory process is probably related to CRP levels in overweight or obese children8. BF: Body Fat. Among adipokines, adiponectin stands out as one of BIA: Bioelectrical Impedance Analysis. the most abundant hormones secreted by adipocytes, BMI: Body Mass Index. and its expression decreases as adipose tissue increa - BP: Blood Pressure. ses. In addition, adiponectin levels are inversely pro- C INDEX: Conicity Index. portional to insulin resistance, type 2 diabetes, cardio- CRP: C-Reactive Protein. vascular diseases, hypertension, atherosclerosis and DP: Standard Deviation. triglycerides, and directly proportional to HDL choles- HDL-C: High-Density Lipoprotein Cholesterol. terol levels9. HOMA-AD: Homeostatic Model Assessment- Adiponectin has antiatherogenic, anti-inflammatory Adiponectin. and insulin sensitizer properties. Thus, this hormone HOMA-IR: Homeostatic Model Assessment for In- protects vascular endothelium against processes in- sulin Resistance. volved in the pathogenesis of atherosclerosis and dia- IL-1: Interleukin 1. betes10. In addition, hypoadiponectinemia may be con- IL-10: Interleukin10. sidered an independent biomarker of metabolic IL-6: Interleukin 6. syndrome and atherosclerosis even in overweight LDL-C: Low-Density Lipoprotein Cholesterol. young people11. MUAC: Mid-Upper Arm Circumference. As nutritional status is correlated with inflammatory ND: Not Detected. markers, studies indicate that weight reduction in chil- SBP: Systolic Blood Pressure. dren can decrease CRP and increase adiponectin le- SST: Subscapular Skinfold Thickness. vels12. TBIA: Tetrapolar Bioelectrical Impedance. Since insulin resistance plays a major role in obesity TC: Total Cholesterol. complications, it should also be investigated for being TFM: Trunk Fat Mass. associated with central adiposity, lipid profile and TNF-α: Tumor Necrosis Fator-alpha blood pressure in various age groups13. TST: Triceps Skinfold Thickness. From the assumptions mentioned above, this study VIF: Variance Inflation Factor. evaluated associations of body composition, anthro- WC: Waist Circumference. pometry, clinical and biochemical variables with adiponectin and C-reactive protein levels and insulin resistance in children aged 6 to 10 years old. Introduction Obesity is a chronic multifactorial and complex di - Materials and methods sease, a low-grade chronic inflammatory state resulting from altered secretion of cytokines, chemokines and Study design and subjects hormones1. Studies show that prevalence of over- weight and obesity in children has increased signifi- In 2009 we conducted a nested case-control study cantly in many countries, including Brazil2. following a cross-sectional study with 1024 children Importantly, excess body fat is a possible risk mark- aged 6 to 10 years old from public municipal schools in er for cardiovascular disease, metabolic syndrome, in- Nova Era, state of Minas Gerais, Brazil. In the first sulin resistance, and dyslipidemia. It is noteworthy that stage of the study we found a prevalence of 2.3% un- atherosclerotic process arising from the combination of derweight, 11.2% overweight and 6.4% obesity by cal- endothelial dysfunction and inflammation may begin culating z-score of body mass index for age (BMI-for with the development of fatty streaks in childhood3. age)14 (fig. 1). It is essential to analyze obesity as an inflammatory In the second stage we selected two normal-weight state, as research proves its direct association with children (n = 130) for each obese child (n = 65) making markers of angiogenesis and inflammation even in a total sample of 195 students. children and adolescents4. Children with acute, chronic, degenerative diseases, Thus,