RESUMO
Objective: The aim: to identify subgroups by cluster analysis according parameters: original homeostatic model of insulin resistance (HOMA-1 IR), updated computer model of insulin resistance (HOMA-2 IR), ß-cell function (%B) and insulin sensitivity (%S) for the prognosis of different variants of metabolic syndrome in children for more individualized treatment selection. Patients and methods: The observational cross-sectional study on 75 children aged from 10 to 17 with metabolic syndrome according to the International Diabetes Federation criteria was conducted at the Cardiology Department of Children's Clinical Hospital No.6 in Kyiv. HOMA-1 IR was calculated as follows: fasting insulin (µIU/ml) × fasting glucose (mmol/L)/22.5. HOMA-2 IR with %B and %S were calculated according to the computer model in [http://www.dtu.ox.ac.uk]. All biochemical analysis were carried out using Cobas 6000 analyzer and Roche Diagnostics (Switzerland). The statistical analysis was performed using STATISTICA 7.0 and Easy R. The hierarchical method Ward was used for cluster analysis according the parameters: HOMA-1 IR, HOMA-2 IR, %B and %S. Results: Four clusters were identified from the dendrogram, which could predict four variants in the course of metabolic syndrome such that children in cluster 1 would have the worst values of the studied parameters and those in cluster 4 - the best. It was found that HOMA-1 IR was much higher in cluster 1 (6.32 ± 0.66) than in cluster 4 (2.19 ± 0.13). HOMA-2 IR was also much higher in cluster 1 (3.80 ± 0.34) than in cluster 4 (1.31 ± 0.06). By the analysis of variance using Scheffe's multiple comparison method, a statistically significant difference was obtained between the laboratory parameters among the subgroups: HOMA-1 IR (p < 0,001), glucose (p < 0.001), insulin (p < 0,001), HOMA-2 IR (p < 0.001), %B (p < 0.001), %S (p < 0.001), TG ( p = 0.005) and VLDL-C (p = 0.002). Conclusions: A cluster analysis revealed that the first two subgroups of children had the worst insulin resistance and lipid profile parameters. It was found positive correlation between HOMA-1 IR, HOMA-2 IR, %B and %S with lipid metabolism parameters TG and VLDL-C and negative correlation between %B and HDL-C in children with metabolic syndrome (MetS).The risk of getting a high TG result in the blood analysis in children with MetS was significantly dependent with the HOMA-2 IR >2.26.
RESUMO
OBJECTIVE: The aim: To compare lipid metabolism and leptin levels among the children with and without hypertension to identify associated risk factors for the course of metabolic syndrome in children. PATIENTS AND METHODS: Materials and methods: This observational, cross-sectional study recruited children from the Rheumocardiology Department of Children's Clinical Hospital No 6 in Kyiv, with metabolic syndrome, identification of waist-to-height ratio, leptin level, homeostasis model assessment of insulin resistance and lipid profile. The main group included 41 children with metabolic syndrome and hypertension and the control group included 40 children with metabolic syndrome without hypertension. Statistical data analysis was performed using the MedStat 2.6.2. package. RESULTS: Results: A total of 81 children aged 10 to 17 with metabolic syndrome were examined. The group of children with hypertension had significantly lower high-density lipoprotein cholesterol (0.85±0.04) than children without hypertension (0.94±0.03), with p < 0.05. Leptin resistance was detected in 65.2% of children with hypertension and 35.3% of children with normal blood pressure (p < 0.01). CONCLUSION: Conclusions: Children with metabolic syndrome and hypertension had a significantly higher body mass index and waist circumference as opposed to children with normal blood pressure. In the lipid profile high-density lipoprotein cholesterol was significantly lower in hypertensive children. There was no reliable difference in other lipid profile indicators between the two groups, but there was an upward trend of them in group with hypertension. Leptin resistance is also significantly higher in hypertensive children.
