THE USE OF ROUTINE BIOMARKERS FOR IMMUNOMETABOLIC ASSESSMENT IN OVERWEIGHT AND OBESE CHILDREN
DOI:
https://doi.org/10.56238/revgeov17n6-113Keywords:
Childhood Obesity, Insulin Resistance, Diabetes Mellitus, BiomarkersAbstract
In 41 years, the number of overweight and/or obese people in the world has tripled, this obesity epidemic has evolved into the biggest public health threats worldwide due to its potential to develop several chronic diseases associated with it, such as heart disease, liver disease and type 2 diabetes. In 2025, the WHO estimate is that about 2.3 billion people around the world will be overweight, of which 70 million will be children. Knowing that obese children are 5 times more likely to be obese adults, it is essential to monitor the metabolic health of these children in order to identify early changes that will affect chronic diseases in their adult life. Therefore, the aim of this article is to describe the applicability of low-cost biochemical and hematological biomarkers in the early identification of metabolic changes and inflammation in overweight children. For this, a search was performed in the PUBMED database with the associated terms "Obesity", "Childhood obesity", "Insulin resistance", "Heart disease" and "Biomarkers". In all, 60 articles were chosen for reading and indicated that the use of routine laboratory biomarkers, such as hematological, hepatic, glucose and lipid profiles, are efficient in assessing the metabolic and inflammatory impact of excess weight, either through their direct analysis or through their relationships. Based on the analysis of these biomarkers, it is possible to screen patients who are at increased risk for the future development of chronic diseases resulting from obesity.
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1. Organização Mundial da Saúde - OMS. Obesity. 2016. Disponível em: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. IBGE- Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde: 2019 : Atenção primária à saúde e informações antropométricas. Em: IBGE, organizador. 1o ed Rio de Janeiro; 2020. p. 1–57.
3. Greydanus DE, Agana M, Kamboj MK, Shebrain S, Soares N, Eke R, et al. Pediatric obesity: Current concepts. Disease-a-Month. 1o de abril de 2018;64(4):98–156.
4. ABESO – Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica. Mapa da Obesidade. 2022.
5. Simmonds M, Burch J, Llewellyn A, Griffiths C, Yang H, Owen C, et al. The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis. Health Technol Assess (Rockv) [Internet]. junho de 2015;19(43):1–336. Disponível em: https://www.journalslibrary.nihr.ac.uk/hta/hta19430/
6. Ighbariya A, Weiss R. Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know? J Clin Res Pediatr Endocrinol. 15 de janeiro de 2018;
7. DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 23 de julho de 2015;1.
8. Piché ME, Tchernof A, Després JP. Obesity Phenotypes, Diabetes, and Cardiovascular Diseases. Circ Res. 2020;1477–500.
9. Sociedade Brasileira de Diabetes. Diretrizes-Sociedade-Brasileira-de-Diabetes-2019-2020. Vol. 1. 2019.
10. Abdel-Moneim A, Mahmoud B, Sultan EA, Mahmoud R. Relationship of leukocytes, platelet indices and adipocytokines in metabolic syndrome patients. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 1o de janeiro de 2019;13(1):874–80.
11. Kyle TK, Dhurandhar EJ, Allison DB. Regarding Obesity as a Disease: Evolving Policies and Their Implications. Vol. 45, Endocrinology and Metabolism Clinics of North America. W.B. Saunders; 2016. p. 511–20.
12. Belfort-DeAguiar R, Seo D. Food Cues and Obesity: Overpowering Hormones and Energy Balance Regulation. Curr Obes Rep. 1o de junho de 2018;7(2):122–9.
13. Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. New England Journal of Medicine. 19 de janeiro de 2017;376(3):254–66.
14. De Lorenzo A, Romano L, Di Renzo L, Di Lorenzo N, Cenname G, Gualtieri P. Obesity: A preventable, treatable, but relapsing disease. Vol. 71, Nutrition. Elsevier Inc.; 2020.
15. Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases. Vol. 61, Progress in Cardiovascular Diseases. W.B. Saunders; 2018. p. 142–50.
16. Elagizi A, Kachur S, Carbone S, Lavie CJ, Blair SN. A Review of Obesity, Physical Activity, and Cardiovascular Disease. Vol. 9, Current Obesity Reports. Springer; 2020. p. 571–81.
17. Tyson N, Frank M. Childhood and adolescent obesity definitions as related to BMI, evaluation and management options. Best Pract Res Clin Obstet Gynaecol. 1o de abril de 2018;48:158–64.
18. Morales Camacho WJ, Molina; Díaz JM, Plata Ortiz S, Plata Ortiz JE, Morales Camacho MA, Calderón BP. Childhood obesity: Aetiology, comorbidities, and treatment. Diabetes Metab Res Rev. 1o de novembro de 2019;35(8).
19. Kohut T, Robbins J, Panganiban J. Update on childhood/adolescent obesity and its sequela. Curr Opin Pediatr. 1o de outubro de 2019;31(5):645–53.
20. Daniels SR, Hassink SG. The Role of the Pediatrician in Primary Prevention of Obesity. Pediatrics. 1o de julho de 2015;136(1).
21. Morrison JA, Glueck CJ, Wang P. Childhood risk factors predict cardiovascular disease, impaired fasting glucose plus type 2 diabetes mellitus, and high blood pressure 26 years later at a mean age of 38 years: the Princeton–lipid research clinics follow-up study. Metabolism. abril de 2012;61(4).
22. Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA. Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults. New England Journal of Medicine. 4 de junho de 1998;338(23):1650–6.
23. Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Vol. 1411, Annals of the New York Academy of Sciences. Blackwell Publishing Inc.; 2018. p. 166–83.
24. McGill HC, McMahan CA, Zieske AW, Sloop GD, Walcott J V., Troxclair DA, et al. Associations of Coronary Heart Disease Risk Factors With the Intermediate Lesion of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. agosto de 2000;20(8):1998–2004.
25. Saydah S, Bullard KM, Imperatore G, Geiss L, Gregg EW. Cardiometabolic Risk Factors Among US Adolescents and Young Adults and Risk of Early Mortality. Pediatrics. 1o de março de 2013;131(3):e679–86.
26. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, et al. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. New England Journal of Medicine. 23 de junho de 2016;374(25):2430–40.
27. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. junho de 2017;128.
28. Hall JE (John E. Guyton and Hall Tratado de Fisiologia Médica. 13o ed. Rio de Janeiro: Elsevier; 2017. 1–1176 p.
29. Yaribeygi H, Farrokhi FR, Butler AE, Sahebkar A. Insulin resistance: Review of the underlying molecular mechanisms. J Cell Physiol. 1o de junho de 2019;234(6):8152–61.
30. Tagi VM, Chiarelli F. Obesity and insulin resistance in children. Curr Opin Pediatr. 1o de agosto de 2020;32(4):582–8.
31. Amin MN, Hussain MS, Sarwar MS, Rahman Moghal MM, Das A, Hossain MZ, et al. How the association between obesity and inflammation may lead to insulin resistance and cancer. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 1o de março de 2019;13(2):1213–24.
32. Lauterbach MAR, Wunderlich FT. Macrophage function in obesity-induced inflammation and insulin resistance. Vol. 469, Pflugers Archiv European Journal of Physiology. Springer Verlag; 2017. p. 385–96.
33. Wu H, Ballantyne CM. Metabolic Inflammation and Insulin Resistance in Obesity. Circ Res. 2020;1549–64.
34. Cifarelli V, Beeman SC, Smith GI, Yoshino J, Morozov D, Beals JW, et al. Decreased adipose tissue oxygenation associates with insulin resistance in individuals with obesity. Journal of Clinical Investigation. 1o de dezembro de 2020;130(12):6688–99.
35. Shimobayashi M, Albert V, Woelnerhanssen B, Frei IC, Weissenberger D, Meyer-Gerspach AC, et al. Insulin resistance causes inflammation in adipose tissue. Journal of Clinical Investigation. 2 de abril de 2018;128(4):1538–50.
36. Watanabe Y, Nagai Y, Honda H, Okamoto N, Yanagibashi T, Ogasawara M, et al. Bidirectional crosstalk between neutrophils and adipocytes promotes adipose tissue inflammation. FASEB Journal. 1o de novembro de 2019;33(11):11821–35.
37. Lebiedowska A, Hartman-Petrycka M, Błońska-Fajfrowska B. How reliable is BMI? Bioimpedance analysis of body composition in underweight, normal weight, overweight, and obese women. Ir J Med Sci. 1o de agosto de 2021;190(3):993–8.
38. Ng CD, Elliott MR, Riosmena F, Cunningham SA. Beyond recent BMI: BMI exposure metrics and their relationship to health. SSM Popul Health. 1o de agosto de 2020;11.
39. Munusamy J, Yadav J, Kumar R, Bhalla A, Dayal D. Metabolic complications of childhood obesity. J Family Med Prim Care. 2021;10(6):2325–30.
40. Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, et al. Screening for obesity in children and adolescents us preventive services task force recommendation statement. JAMA - Journal of the American Medical Association. 20 de junho de 2017;317(23):2417–26.
41. Christian Flemming GM, Bussler S, Körner A, Kiess W. Definition and early diagnosis of metabolic syndrome in children. Journal of Pediatric Endocrinology and Metabolism. 1o de julho de 2020;33(7):821–33.
42. Higgins V, Adeli K. Pediatric Metabolic Syndrome: pathophysiology and laboratory assessment. The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine. 8 de março de 2017;25–42.
43. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric obesity-assessment, treatment, and prevention: An endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 1o de março de 2017;102(3):709–57.
44. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 1o de dezembro de 2008;6(4):299–304.
45. Vieira-Ribeiro SA, Fonseca PCA, Andreoli CS, Ribeiro AQ, Hermsdorff HHM, Pereira PF, et al. Answer to the letter “TyG in insulin resistance prediction”. J Pediatr (Rio J). janeiro de 2020;96(1):133–4.
46. Alizargar J, Hsieh NC, Wu SFV. The correct formula to calculate triglyceride-glucose index (TyG). Journal of Pediatric Endocrinology and Metabolism. 28 de julho de 2020;33(7):945–6.
47. Vieira-Ribeiro SA, Fonseca PCA, Andreoli CS, Ribeiro AQ, Hermsdorff HHM, Pereira PF, et al. The TyG index cutoff point and its association with body adiposity and lifestyle in children. J Pediatr (Rio J). 1o de março de 2019;95(2):217–23.
48. Locateli JC, Lopes WA, Simões CF, De Oliveira GH, Oltramari K, Bim RH, et al. Triglyceride/glucose index is a reliable alternative marker for insulin resistance in South American overweight and obese children and adolescents. Journal of Pediatric Endocrinology and Metabolism. 2019;
49. Simental-Mendía LE, César &, Ortega-Pacheco J, García-Guerrero E, María &, Sicsik-Aragón A, et al. The triglycerides and glucose index is strongly associated with hepatic steatosis in children with overweight or obesity. Eur J Pediatr [Internet]. 25 de janeiro de 2021;1755–60. Disponível em: https://doi.org/10.1007/s00431-021-03951-1
50. Yoon JS, Shim YS, Lee HS, Hwang IT, Hwang JS. A population-based study of TyG index distribution and its relationship to cardiometabolic risk factors in children and adolescents. Sci Rep. 1o de dezembro de 2021;11(1).
51. Brito ADM de, Hermsdorff HHM, Filgueiras MDS, Suhett LG, Vieira-Ribeiro SA, Franceschini S do CC, et al. Predictive capacity of triglyceride-glucose (TyG) index for insulin resistance and cardiometabolic risk in children and adolescents: a systematic review. Crit Rev Food Sci Nutr. 2021;61(16):2783–92.
52. Lim J, Kim J, Koo SH, Kwon GC. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: An analysis of the 2007-2010 Korean national health and nutrition examination survey. PLoS One. 1o de março de 2019;14(3).
53. Chang M, Shao Z, Shen G. Association between triglyceride glucose-related markers and the risk of metabolic-associated fatty liver disease: a cross-sectional study in healthy Chinese participants. BMJ Open. 2 de maio de 2023;13(5).
54. Behiry EG, El Nady NM, AbdEl Haie OM, Mattar MK, Magdy A. Evaluation of TG-HDL Ratio Instead of HOMA Ratio as Insulin Resistance Marker in Overweight and Children with Obesity. Endocr Metab Immune Disord Drug Targets. 2 de julho de 2019;19(5):676–82.
55. Liang J, Fu J, Jiang Y, Dong G, Wang X, Wu W. TriGlycerides and high-density lipoprotein cholesterol ratio compared with homeostasis model assessment insulin resistance indexes in screening for metabolic syndrome in the chinese obese children: A cross section study. BMC Pediatr. 28 de setembro de 2015;15(1).
56. Mǎrginean CO, Meliţ LE, Ghiga DV, Mǎrginean MO. Early inflammatory status related to pediatric obesity. Front Pediatr. 2019;7(JUN).
57. Yang XJ, Tian S, Ma QH, Sun HP, Xu Y, Pan CW. Leukocyte-related parameters in older adults with metabolic syndrome. Endocrine. 1o de maio de 2020;68(2):312–9.
58. KARAKAYA S, ALTAY M, KAPLAN EFE F, KARADAĞ İ, ÜNSAL O, BULUR O, et al. The Neutrophil-Lymphocyte Ratio and its Relationship with Insulin Resistance in Obesity. Turk J Med Sci [Internet]. 17 de janeiro de 2019;49(1):245–8. Disponível em: https://journals.tubitak.gov.tr/medical/vol49/iss1/36
59. Aydın M. Neutrophil lymphocyte ratio in obese adolescents. North Clin Istanb. 2015;
60. Eren C, Cecen S. The relationship between childhood obesity with inflammatory mediators. J Pak Med Assoc. 1o de outubro de 2020;70(10):1737–41.
61. Akboga MK, Canpolat U, Yuksel M, Yayla C, Yilmaz S, Turak O, et al. Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: A single center large-scale study. Platelets [Internet]. 17 de fevereiro de 2016;27(2):178–83. Disponível em: http://www.tandfonline.com/doi/full/10.3109/09537104.2015.1064518
62. Vahit D, Mehmet KA, Samet Y, Hüseyin E. Assessment of monocyte to high density lipoprotein cholesterol ratio and lymphocyte-to-monocyte ratio in patients with metabolic syndrome. Biomark Med. 1o de julho de 2017;11(7):535–40.
63. Riyahi N, Tohit ERM, Thambiah SC, Ibrahim Z. Platelet-related cytokines among normal body mass index, overweight, and obese Malaysians. Asia Pac J Clin Nutr. 1o de janeiro de 2018;27(1):182–8.
64. Arslan N, Makay B. Mean Platelet Volume in Obese Adolescents with Nonalcoholic Fatty Liver Disease. Vol. 23, London Journal of Pediatric Endocrinology & Metabolism. 2010.
65. Güçlü E, Kocayiğit H, Okan HD, Erkorkmaz U, Yürümez Y, Yaylacı S, et al. Effect of COVID-19 on platelet count and its indices. Rev Assoc Med Bras. agosto de 2020;66(8):1122–7.
