Receptor soluble para productos finales de glicación avanzada y perfil lipídico como marcadores de riesgo cardiovascular en niños con obesidad / Soluble receptor for advanced glycation end products and lipid profile ratio as cardiovascular risk markers in children with obesity

Resumen Introducción: Se ha mostrado que la obesidad está asociada a niveles bajos de la forma soluble del receptor para productos finales de glicación avanzada (sRAGE). Objetivo: Evaluar los niveles de sRAGE y su asociación con el índice lipídico en niños con obesidad. Métodos: Estudio transversal de niños de seis a 11 años de edad con obesidad. Se evaluaron medidas antropométricas, glucosa, perfil lipídico, insulina y sRAGE; también se calculó índice de masa corporal, colesterol total/C-HDL, triglicéridos/glucosa, triglicéridos/C-HDL y HOMA-IR.] Resultados: Se estudiaron 80 niños, 50 % hombres y 50 % mujeres. Las mujeres presentaron mayor perímetro de cintura, HOMA-IR, triglicéridos/C-HDL y triglicéridos/glucosa. No se encontraron diferencias significativas en sRAGE. Al comparar las variables conforme a los terciles de la relación triglicéridos/C-HDL, en el tercil superior se encontraron mayores valores de colesterol total/HDL, triglicéridos/glucosa y sRAGE. Se observó correlación significativa entre sRAGE y HOMA-IR (p < 0.03) en los hombres y entre sRAGE, triglicéridos/C-HDL (p < 0.01) y triglicéridos/glucosa (p < 0.008) en las mujeres. Conclusiones: El sexo femenino mostró más factores de riesgo cardiovascular y mayor sRAGE en el tercil superior de triglicéridos/C-HDL. Se requieren más estudios para probar el posible efecto predictor de mayor riesgo para desarrollar complicaciones metabólicas y cardiovasculares.

Abstract Introduction: Obesity has been shown to be associated with low levels of soluble receptor for advanced glycation end products (sRAGE). Objective: To evaluate the levels of sRAGE and its association with the lipid index in children with obesity. Methods: Cross-sectional study of children with obesity aged between six and 11 years. Anthropometric measurements, glucose, lipid profile, insulin and sRAGE were evaluated; body mass index, total cholesterol/high-density cholesterol (TC/HDL-C), triglycerides/glucose (TG/glucose), and triglycerides/HDL-C (TG-HDL-C) ratios and HOMA-IR were also calculated. Results: Eighty children were studied, among which 50% were males and 50% females. Females had higher values for waist circumference, HOMA-IR, and TG/HDL-C and TG/glucose ratios. No significant differences were found for sRAGE. When the variables were compared according to TG/HDL-C ratio tertiles, higher TC/HDL, TG/glucose, and sRAGE values were found at upper tertile. A significant correlation was observed between sRAGE and HOMA-IR (p < 0.03) in males, and between sRAGE and TG/HDL-C (p < 0.01) and TG/glucose ratios (p < 0.008) in females. Conclusions: The female gender showed more cardiovascular risk factors and higher sRAGE at TG/HDL-C upper tertile. Further studies are required to test the possible predictive effect of higher risk for developing metabolic and cardiovascular complications.

Trigliceridos/colesterol HDL: utilidad en la deteccion de sujetos obesos con riesgo para diabetes mellitus tipo 2 y enfermedad cardiovascular / Triglycerides/HDL cholesterol: utility for the detection of obese subjects with risk for diabetes mellitus type 2 and cardiovascular diseases / Triglicerideos/colesterol HDL: utilidade na deteccao de sujeitos obesos com risco para a diabetes mellitus tipo 2 e doenca cardiovascular

En la Republica Argentina, la prevalencia de obesidad se ha incrementado considerablemente y la de diabetes mellitus tipo 2 (DMT2) alcanza 12,7%. La obesidad presenta heterogeneidad y el aumento de la grasa abdominal puede incluir hipertrigliceridemia, hiperglucemia, disminucion de C-HDL, aumentos de apolipoproteina B (Apo B), aumento de lipoproteinas LDL pequenas y densas, hiperinsulinemia, insulino-resistencia (IR), estado inflamatorio cronico, estado protrombotico y otras alteraciones metabolicas, que se han reunido en el llamado sindrome metabolico con prevalencia del 20 al 40%. La resistencia a la insulina (IR) esta presente en 10 al 25% de la poblacion y se asocia con esas alteraciones. La determinacion de IR es compleja, necesita de internacion en clinicas y debe ser realizada por especialistas. En el laboratorio se puede estimar a traves del dosaje de insulina, pero no esta estandarizado, por lo que es necesario disponer de tecnicas sencillas y accesibles. La relacion trigliceridos (TG)/colesterol HDL (C-HDL) puede ser una opcion utilizando como valores de corte TG/C-HDL ≥2,5 en mujeres y ≥3,5 en varones. Se asocia significativamente con IR y enfermedad cardiovascular (ECV), tiene buena especificidad aunque bajo poder discriminador por lo cual cuando esta presente y existe riesgo de DMT2 o ECV deberia complementarse con el calculo del colesterol-no-HDL o Apo B y el colesterol remanente. Teniendo en cuenta la pandemia de obesidad y DMT2 y la elevada frecuencia de ECV, la relacion TG/C-HDL podria ser un marcador que deberia ser informado por el laboratorio bioquimico-clinico.

In Argentina, the prevalence of obesity has increased considerably and type 2 diabetes mellitus (DMT2) reaches 12.7%. Obesity presents heterogeneity and the increase in abdominal fat may include hypertriglyceridemia, hyperglycemia, decrease in HDL-C, increases in apolipoprotein B (Apo B), increase in small and dense LDL lipoproteins, hyperinsulinemia, insulin resistance (IR), chronic inflammatory state, prothrombotic state and other metabolic alterations, which have been included in the so-called metabolic syndrome with 20 to 40% prevalence. Insulin resistance is present in 10 to 25% of the population and is associated with these alterations. The determination of IR is complex; it needs hospitalization and must be performed by specialists. In the laboratory, it can be estimated through insulin dosing, but it is not standardized, so it is necessary to have simple and accessible techniques. The triglycerides (TG)/HDL cholesterol (HDL-C) ratio can be an option using TG/C-HDL cutoff values ≥2.5 in women and ≥3.5 in men. It is significantly associated with IR and CVD and has good specificity but low discriminating power. So when it is present and there is a risk of T2DM or cardiovascular disease, CVD should be complemented with the calculation of non-HDL cholesterol or Apo B and the remaining cholesterol. Considering the pandemic of obesity and DMT2 and the high frequency of CVD, the TG/C-HDL ratio marker should be reported by the biochemical-clinical laboratory.

Na Republica Argentina, a prevalencia de obesidade aumentou em forma consideravel e a de diabetes mellitus tipo 2 (DMT2) atinge 12,7%. A obesidade apresenta heterogeneidade e o aumento da gordura abdominal pode incluir hipertrigliceridemia, hiperglicemia, diminuicao do HDL-C, aumentos da apolipoproteina B (Apo B), aumento das lipoproteinas LDL pequenas e densas, hiperinsulinemia, resistencia a insulina, estado inflamatorio cronico, estado pro-trombotico e outras alteracoes metabolicas, que se encontraram na chamada sindrome metabolica, com prevalencia de 20 a 40%. A resistencia a insulina (RI) esta presente em 10 a 25% da populacao e esta associada a essas alteracoes. A determinacao da RI e complexa, precisa da hospitalizacao em clinicas e deve ser realizada por especialistas. No laboratorio, isso pode ser estimado atraves da dosagem de insulina, mas nao e padronizado, portanto e necessario ter tecnicas simples e acessiveis. A relacao triglicerideos (TG)/colesterol HDL (C-HDL) pode ser uma opcao usando como valores de corte TG/C-HDL ≥2,5 em mulheres e ≥3,5 em homens. Esta significativamente associado a RI e a doenca cardiovascular (DCV), possui boa especificidade, embora apresente baixo poder discriminador; portanto, quando esta presente e ha risco de DMT2 ou DCV, deveria ser complementado com o calculo do colesterol nao-HDL ou Apo B e o restante colesterol. Considerando a pandemia de obesidade e DMT2 e a alta frequencia de DCV, a relacao TG/C-HDL poderia ser um marcador que deveria ser relatado pelo laboratorio bioquimico-clinico.

Interrelación de índices de resistencia y sensibilidad a la insulina con variables antropométricas y metabólicas de mujeres del tercer trimestre de embarazo y recién nacido a término / Relationship between insulin resistance and sensibility indexes with anthropometrics and metabolic parameters in third trimester of pregnant women and normal term newborns

Objetivo: Evaluar la interrelación de índices de resistencia y sensibilidad a la insulina con variables antropométricas y metabólicas de mujeres del tercer trimestre de embarazo y RN a término. Métodos: Este estudio transversal evaluó 52 mujeres sanas en el tercer trimestre del embarazo y 52 reciénnacidos (RN) a término. Se evaluaron peso corporal pregestacional y ganancia durante el embarazo (Δpeso). Se estimó el peso fetal (PFE), circunferencia abdominal fetal (CAF) y grosor placentario por ultrasonido. Se registró peso, talla y circunferencia abdominal (CA) del RN y peso placentario. Se realizó lipidograma, glucosa e insulina en ayunas en el suero de la madre y cordón umbilical. Se calcularon los índices lipídicos y de resistencia y sensibilidad a la insulina. Resultados: El Δpeso materno se correlacionó positivamente con PFE y peso del RN (r=0,32, p<0,02; r=0,32, p<0,05). El HOMA-R del RN se relacionó positivamente con CT (r=0,46; p<0,01) y TG (r=0,52; p<0,0001). El índice TG/C-HDL del RN se correlacionó positivamente con índices HOMA-R y TG/C-HDLmat (r=0,31, p=0,03; r=0,35, p=0,01). El peso pregestacional, materno final, placentario y TG maternos fueron significativamente más altos en los RN de mayor peso. Los índices TG/C-HDLmat y HOMA-Rmat se relacionaron inversamente con los índices QUICKImat y HOMA-Smat (p<0,01). Conclusiones: La cuantificación de los índices TG/C-HDL, HOMA-R, HOMA-S y QUICKI en el tercer trimestre del embarazo, puede tener utilidad potencial para identificar mujeres con riesgo alto para desarrollar complicaciones metabólicas en el embarazo.

Objective: To evaluate the relationship between insulin resistance and sensibility indexes with anthropometrics and metabolic parameters in third trimester of pregnant women and normal term newborns. Methods: In this cross-sectional study, 52 normal pregnant women in third trimester and 52 term born were assessed. Pre-gestational body weight, blood pressure and pregnancy weight gain (Δ-weight) were registered. Estimated fetal weight (EFW) and abdominal circumference (AFC) and placental gross were evaluated by ultrasound. Placental and newborn body weight, height and abdominal circumference were registered. Serum lipids, glucose and insulin concentrations were measured in fasting women and cord blood. Placental weight was registered. Lipids and insulin resistance and sensibility indexes were calculated. Results: Δ-weight was significant and positively correlated with EFW and newborn body weight (r=0,32, p<0,02; r=0,32; p<0,05). Newborn HOMA-R was positively correlated with total cholesterol (TC) (r=0,46; p<0,01) and triglycerides serum concentration (r=0,52; p<0,0001). TG/C-HDL index was positively correlated with HOMA-R and maternal TG/C-HDL(r=0,31, p=0,03; r=0,35, p=0,01). Pre-gestational weight, term weight, placental and serum maternal triglycerides were significantly higher in newborns with higher body weight group. Maternal TG/C-HDL and HOMA-R were negatively related with maternal QUICKI and HOMA-S (p<0,01). Conclusions: The quantification of TG/C-HDL, HOMA-R, HOMA-S QUICKI indexes in pregnant women during third trimester could be potentially useful to identify pregnant women at high risk of developing metabolic complications during pregnancy.

Evaluation of variation in the lipid profile and risk for coronary artery disease in healthy male individuals with respect to age.

Background: Coronary Artery Disease (CAD) is one of the commonest causes of death affecting both sexes worldwide. It is the leading cause of mortality in developed countries. The measurement of lipids, lipoproteins and apolipoproteins has long been recognized as necessary for the diagnosis and clinical management of disorders of lipoprotein metabolism. On the basis of this, the present study was performed to compare the serum lipid profile in males of different age groups. Methods: The present cross-sectional study was conducted after the institutional ethical clearance. The male subjects between the ages of 20-59 were included in the study. Blood was collected from the subjects after an overnight fast of 12 hours who were also advised to refrain from non-vegetarian food for 3 days. Estimation of serum total cholesterol was done by using the cholesterol kit which uses modified Allain’s method for estimating serum cholesterol. Serum triglyceride was estimated using the triglyceride kit which is based on GPO-POD method. Estimation of serum HDL cholesterol was done using cholesterol kit which uses modified Allain’s method. Serum LDL cholesterol level was calculated using the Friedewald’s formula, LDL cholesterol = Total cholesterol - (HDL-C + TG/5). Estimation of fasting blood sugar was done using GOD-POD method. The lipid levels with risk for CAD were performed based on Framingham heart study. Statistical analysis was done by unpaired t-test for group wise comparison and P value <0.05 was considered statistically significant. Results: The lipid levels on comparison in 2 successive age groups of males, that is 20-29 and 30-39 years; and 30-39 and 40-49years; 40-49 and 50-59 years, it was found that the mean values of total cholesterol, triglyceride, LDL-C and the ratio of TC/HDL-C and LDL-C/HDL-C are increased while HDL-C is decreased in the older age group. Conclusion: From the present study it is understood that as age advances total cholesterol, LDL-C & triglyceride increases; ratios between TC/HDL-C and LDL-C/HDL-C also increases. But HDL-C shows a decrease in males. The risk for CAD with respect to lipid values is higher in older age groups.

Evaluación de los métodos directo, precipitado y Friedewald para la cuantificación de colesterol LDL y HDL en pollos de engorde / Assessment of the Direct, Precipitated and Friedewald Methods for Quantifying LDL and HDL Cholesterol in Broilers

El objetivo fue evaluar los métodos directo y precipitado para el colesterol de las lipoproteínasde alta densidad y los métodos directo, precipitado y Friedewald para el colesterol de las lipoproteínas de baja densidad en pollos de engorde. Se obtuvo suero de 30 pollos de engorde de 36 días de edad, en ayunas, de la línea Cobb 500, se determinaron los niveles de triglicéridos y colesterol total usando un kit enzimático-colorimétrico. El colesterol, tanto de las lipoproteínasde alta densidad como de las de baja densidad, se midió por el método de precipitación y el método directo, y la estimación del colesterol de la lipoproteína de baja densidad se determinó usando la fórmula de Friedewald. Las medias ± desviación estándar para los niveles de colesterol de las lipoproteínas de alta densidad, por los métodos directo y precipitado, en mg/dl, fueron de: 92,8 ± 16,7; 92,2 ± 16,3, respectivamente. El valor P del test F es mayor a 0,05, por lo cual no hay diferencia estadísticamente significativa, con un índice de confianza de 95 % entre métodos, y para los niveles de colesterol de la lipoproteínas de baja densidad por los métodos directo, precipitado y Friedewald, en mg/dl, fueron: 51,8 ± 9,4; 21,9 ± 12,6y 26,1 ± 12,9, respectivamente. El valor P del test F es inferior a 0,05 evidenciando diferencia estadísticamente significativa, con un índice de confianza de 95 % entre métodos. Se concluye que en los pollos de engorde se puede cuantificar el colesterol de la lipoproteína de alta densidad con los dos métodos evaluados (directo y precipitado), sin embargo, para calcular el colesterol de la lipoproteína de baja densidad solo se recomienda utilizar el método directo ya que los métodos de precipitado y de Friedewald dieron resultados mucho menores en dicha especie...

The objective was to evaluate the direct and precipitated methods for cholesterol from highdensitylipoprotein, and the direct, precipitated and Friedewald methods for cholesterolfrom low-density lipoprotein in broilers. Serum was obtained from thirty 36-day old fastingbroilers from the Cobb 500 line; triglyceride and total cholesterol levels were determinedusing an enzymatic-colorimetric kit. Cholesterol, both of high and low density lipoprotein,was measured by the precipitation method and the direct method, and the estimation ofthe low density lipoprotein cholesterol was determined using the Friedewald formula. Themean ± standard deviation for cholesterol levels of high density lipoprotein by the direct and precipitated methods in mg/dl, were: 92.8 ± 16.7, 92.2 ± 16.3, respectively. The f-testp-value is higher than 0.05, and therefore there is no statistically significant difference, witha confidence index of 95 % between methods, and for the cholesterol levels of low densitylipoprotein by the direct, precipitated and Friedewald methods, in mg/dl, they were: 51.8 ±9.4; 21.9 ± 12.6 and 26.1 ± 12.9 respectively. The f-test p-value is less than 0.05, demonstratinga statistically significant difference, with a confidence index of 95 % between methods.It is concluded that, in broilers, high-density lipoprotein cholesterol can be quantified bymeans of both of the evaluated methods (direct and precipitated); however, only the directmethod is recommended to calculate low density lipoprotein cholesterol, as the precipitatedand Friedewald methods gave much lower results in that species...

O objetivo foi avaliar os métodos direto e precipitado para o colesterol das lipoproteínas dealta densidade e os métodos direto, precipitado e Friedewald para o colesterol das lipoproteínasde baixa densidade em frangos de engorde. Obteve-se soro de 30 frangos de engordede 36 dias de idade, em jejum, da linha Cobb 500, determinaram-se os níveis de triglicéridese colesterol total usando um kit enzimático-colorimétrico. O colesterol, tanto das lipoproteínasde alta densidade como das de baixa densidade, foi medido pelo método de precipitaçãoe o método direto, e a estimativa do colesterol da lipoproteína de baixa densidadedeterminou-se usando a fórmula de Friedewald. As médias ± desvio padrão para os níveis decolesterol das lipoproteínas de alta densidade, pelos métodos direto e precipitado, em mg/dl,foram de: 92,8 ± 16,7; 92,2 ± 16,3, respectivamente. O valor P do teste F é maior a 0,05,pelo qual não há diferença estadisticamente significativa, com um índice de confiança de95 % entre métodos, e para os níveis de colesterol das lipoproteínas de baixa densidade pelosmétodos direto, precipitado e Friedewald, em mg/dl, foram: 51,8 ± 9,4; 21,9 ± 12,6 e 26,1 ±12,9, respectivamente. O valor P do teste F é inferior a 0,05 evidenciando diferença estatisticamentesignificativa, com um índice de confiança de 95 % entre métodos. Conclui-se quenos frangos de engorde se pode quantificar o colesterol da lipoproteína de alta densidadecom os dois métodos avaliados (direto e precipitado), porém, para calcular o colesterol dalipoproteína de baixa densidade só se recomenda utilizar o método direto já que os métodosde precipitado e de Friedewald deram resultados muito menores nessa espécie...

Dislipidemias y riesgo cardiovascular: ¿Tiempo para un nuevo enfoque en lípidos? / Dyslipidemias and cardiovascular risk: time for a new appoach to lipid disorders?

La enfermedad coronaria es una entidad con causas múltiples, la primera causa de mortalidad en el mundo actual y, para el año 2025, la primera causa de morbilidad mundial. Dado su origen multicausal, el enfoque debe ser también múltiple; con revisión a todos los factores. Uno de los factores de riesgo, la dislipidemia, tiene varios aspectos que necesitan atención y control, aunque ésta se haya centrado tradicionalmente en el c-LDL, sin prestar mayor cuidado a las otras subfracciones. Los estudios clásicos en lípidos, principalmente con estatinas, han dirigido su atención, al c-LDL y se encuentran estudios en los que hay reducción en c-LDL sin cambios (o con muy pocos) en c-HDL. Aunque hay disminución en el riesgo de eventos y mortalidad, pueden apreciarse riesgos residuales significativos. Un estudio con fibratos tuvo los resultados opuestos, un aumento significativo en el c-HDL sin cambio en el c-LDL, y se observó una reducción interesante en el riesgo, pero con un riesgo similar al observado en los estudios con estatinas. Los estudios con intervenciones múltiples que impactan todas las subfracciones lipídicas, han mostrado cambios significativamente mejores en riesgo. La adición de niacina de liberación extendida al armamentario terapéutico ha permitido, en combinación con estatinas, obtener un mejor control de todas las subfracciones lipídicas, así como reducciones significativas en riesgo y en crecimiento de placa. Los efectos de la niacida de liberación extendida son reducción de c-LDL y triglicéridos, aumento en c-HDL y también reducción en LP(a), así como cambios benéficos en apoA y apoB. Las reacciones adversas, como el enrojecimiento, pueden controlarse y en muchos casos evitarse, y han mostrado ser pasajeras y disminuir hasta desaparecer con el tiempo.

Coronary artery disease is an entity with multiple causes. It is the first cause of mortality in the world, and for the year 2025, will be the first cause of morbidity. Given its multi-causal origin, the approach must also be multiple and all factors should be controlled. Dyslipidemia, one of the main risk factors, has several aspects that need attention and control, although the attention has traditionally been focused on LDL-c, disregarding other lipidic subfractions. Classical lipid studies mainly those with statins, have directed their attention to LDL-c, and there are studies in which there is a LDL-c reduction without little or no change in HDL-C. Even though events and mortality risks decrease, significant residual risks can be appreciated. A study with fibrates had the opposite results, showing significant increase in HDL-c without any change in LDL-c, and an interesting decrease in risk but also with a similar risk to that found in previous studies with statins was observed. Studies with multiple interventions that impact all lipidic sub-fractions have shown better significant changes in risk. Addition of niacin extended release to the pool of drugs in combination witn statins, has allowed to achieve a better control of all the lipidic subfractions as well as significant reductions in risk and plaque growth. The effects of the niacin extended release are reduction of LDL-c and triglycerides, increase in HDL-c and also LP(a) reduction, as well as beneficial changes in ApoA and ApoB. Adverse reactions, such as flushing, can be controlled and in many cases avoided, and have shown to be transient and to decrease and even disappear with time.

Plasma LDL Particle Sizes Affect the Blood Lipid Profile and Dietary Intakes among Korean Adults / 대한지역사회영양학회지

The purpose of this research was to examine the relationship between the plasma LDL particle size and blood lipid profile, dietary factors and anthropometric values (body mass index, waist circumference and waist/hip ratio). The subjects were 173 adults aged 23 to 81 years, selected from the Outpatient Clinic and Cardiovascular Department of the Seoul Municipal Hospital. Dietary data were obtained using a 3-day food record and analyzed using Korean and US nutrient databases. The subjects were divided into three groups by LDL particle size:type A (large buoyant LDL, > 25.5 nm, n = 96), type I (Intermediate LDL, 25.2 < or = - < or = 25.5 nm, n = 18), and type B (small dense LDL, < 25.2 nm, n = 59) groups. The type B group had higher age, waist circumference, and waist/hip ratio (WHR) than the type A and type I groups. Serum concentration of triglyceride, Apo B, LDL/HDL cholesterol ratio and atherogenic index were significantly higher in the type B group as compared to those in the other two groups. HDL cholesterol level and Apo A-I/Apo B ratio were significantly lower in the type B group than the other two groups. The plasma LDL particle size was highly correlated with triglyceride (r = -0.450), Apo B (r = -0.402) and HDL cholesterol (r = 0.418). However, there was no correlation between plasma LDL particle size and dietary intakes. This study showed that small dense LDL was an important biochemical risk factor that was associated with other risk factors.