Elevated remnant lipoproteins may increase subclinical CVD risk in pre-pubertal children with obesity: a case-control study

• Published in: Pediatric obesity 2013-10, Vol.8 (5), p.376-384
• Main Authors: Wang, Y., Pendlebury, C., Dodd, M. M. U., Maximova, K., Vine, D. F., Jetha, M. M, Ball, G. D. C., Proctor, S. D.
• Format: Article
• Language: English
• Subjects: Apolipoprotein B-48 - blood; Apolipoprotein B48; Biomarkers - blood; Canada - epidemiology; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Case-Control Studies; Child; Childrens health; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - prevention & control; Female; Humans; Lipoproteins; Male; Obesity; paediatrics; Pediatric Obesity - blood; Pediatric Obesity - epidemiology; Pediatric Obesity - prevention & control; Pediatrics; Practice Guidelines as Topic; Risk Factors; Triglycerides - blood
• ISSN: 2047-6302; 2047-6310
• DOI: 10.1111/j.2047-6310.2012.00116.x

Summary What is already known about this subject Childhood obesity plays a fundamental role in the development of cardiovascular disease (CVD) and type 2 diabetes in adulthood. Clinical guidelines for the early management of CVD in children are poorly defined. Traditional cholesterol biomarkers such as low‐density lipoprotein cholesterol usually fall within the normal range in pre‐pubertal children with obesity. Remnant lipoproteins are overproduced by the intestine during obesity and type‐2 diabetes in adults and are an independent risk factor for CVD. What this study adds Pre‐pubertal children with obesity have elevated (3‐fold) remnant lipoprotein concentration (assessed as apolipoprotein B48) relative to non‐obese controls, suggesting impaired metabolism of these atherogenic lipoproteins and potential increased CVD risk. Fasting apolipoprotein B48 is positively and significantly correlated with lipid biomarkers including triglyceride, total cholesterol and total cholesterol/high‐density lipoprotein cholesterol in pre‐pubertal children with obesity. Objectives Current clinical guidelines to assess paediatric cardiovascular disease (CVD) risk heavily rely on cholesterol parameters that are generally normal for obese children. Remnant lipoproteins have emerged as a critical CVD risk factor particularly in adults with normolipidemia. We assessed remnant lipoprotein concentration (measured by apolipoprotein [apo] B48) and its relationship with other traditional CVD risk biomarkers in pre‐pubertal children with obesity. Methods Pre‐pubertal children (n = 78) with obesity (n = 39, 9.9 ± 0.3 years old) as well as sex‐matched normal‐weight controls (n = 39, 9.8 ± 0.3 years) were assessed for anthropometry, blood pressure and fasting plasma biochemical parameters for remnant lipoprotein, lipid and glucose/insulin metabolism, and inflammatory status. Results Children with obesity had striking 2‐fold higher apoB48‐containing remnant lipoproteins concentrations relative to normal‐weight peers; the magnitude of elevation in the remnant lipoproteins is comparable to the levels previously reported for adults with established CVD and type‐2 diabetes. Fasting apoB48 was positively correlated with fasting triglyceride concentration in children with obesity (r = 0.51, P