Association of hypertriglyceridemic-waist phenotype with liver enzymes and cardiometabolic risk factors in adolescents: the CASPIAN-III study

Kelishadi, Roya; Jamshidi, Fahimeh; Qorbani, Mostafa; Motlagh, Mohammad Esmaeil; Heshmat, Ramin; Ardalan, Gelayol; Hovsepian, Silva

doi:10.1016/j.jped.2015.12.009

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Original articles • J. Pediatr. (Rio J.) 92 (5) • Sep/Oct 2016 • https://doi.org/10.1016/j.jped.2015.12.009 linkcopy

Association of hypertriglyceridemic-waist phenotype with liver enzymes and cardiometabolic risk factors in adolescents: the CASPIAN-III study^☆

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective This study aims to investigate the role of metabolic syndrome (MetS) and the hypertriglyceridemic-waist (HW) phenotype in determining cardiometabolic risk factors and elevated liver enzymes in a national sample of Iranian pediatric population.

Method This nationwide study was conducted in the framework of the third survey of a surveillance program. Students, aged 10-18 years, were recruited from 27 provinces in Iran. The prevalence of cardiometabolic risk factors was compared in students with and without HW and MetS. The association of HW with different cardiometabolic risk factors was determined.

Results The mean age of studied population was 14.73 ± 2.41 years. Prevalence of HW and MetS was 3.3% and 4%, respectively. Sixty-nine (71.1%) participants with HW had MetS. The prevalence of obesity, elevated systolic blood pressure, hypercholesterolemia, and elevated alanine aminotransaminase (ALT) was significantly higher in subjects with HW phenotype and MetS than in their peers (p < 0.05). A significant association was observed between HW and elevated levels of cholesterol and ALT, as well as between obesity and low HDL-C (p < 0.05).

Conclusions The current findings serve as complementary evidence to previous studies, which have been mainly conducted among adults, suggesting that the HW phenotype is associated with cardiometabolic risk factors, especially with elevated cholesterol and ALT. The authors propose that, in primary care settings and in large epidemiological studies, the measurement of all MetS components can be replaced by studying HW as a screening tool for identifying children at high risk for cardiometabolic disorders.

KEYWORDS
Hypertriglyceridemic waist; Metabolic syndrome; Children and adolescent; Lipid profile; Liver function test

Variables	Males	Females	p-value
Abdominal obesity a	415 (14.7)	471 (16.9)	0.02
Overweight a	265 (9.4)	186(6.6)	<0.001
Obesity a	286 (10.1)	215 (7.7)	<0.001
High FBG a	278 (12.2)	409 (18.6)	<0.001

High blood pressure a
Systolic	72 (2.7)	123 (4.8)	0.82
Diastolic	60 (2.2)	114 (4.3)	0.74
Systolic/diastolic	110 (4.2)	190 (7.6)	<0.001

Dyslipidemia a
High TC	153 (6.4)	116 (5)	0.03
High TG	188 (8.1)	179 (7.9)	0.82
Low HDL	105 (6.2)	85 (5.3)	0.26
High LDL	667 (33.4)	317 (36.9)	0.02

High liver enzymes a
ALT	68 (3.5)	76 (3.8)	0.45
AST	136 (6.7)	159 (7.8)	0.11

HW	71 (3.0)	80 (3.5)	0.35
MetS	54(3.0)	87(5.1)	0.02

	Males			Males			Females			Females
	HW+	HW-	p -value	MetS+	MetS-	p -value	HW+	HW-	p -value	MetS+	MetS-	p -value
10-13.9 years
Overweight a	6 (17.6)	105 (10)	0.14	3 (12)	90 (10.8)	0.85	3 (10.3)	63 (6.2)	0.37	5 (22.7)	45 (5.9)	<0.001
Obesity a	24 (70.6)	106 (10.1)	<0.001	17 (68)	90 (10.8)	<0.001	18 (62.1)	64 (6.3)	<0.001	10 (45.5)	49 (66.5)	<0.001
High FBG	3 (10.3)	132 (12.7)	0.70	7 (28)	86 (10.3)	<0.001	8 (30.8)	169 (17.1)	0.07	13 (59.1)	96 (12.7)	<0.001

High blood pressure a
Systolic	3 (8.8)	18 (1.8)	<0.001	5 (20)	13 (1.6)	<0.001	1 (3.6)	15 (1.6)	0.43	1 (4.5)	12 (1.6)	0.28
Diastolic	2 (5.9)	15 (1.5)	0.04	3 (12)	11 (1.3)	<0.001	0 (0)	23 (2.4)	0.41	2 (9.1)	16 (2.1)	0.03

Dyslipidemia a
High TC	7 (20.6)	58 (5.5)	<0.001	4 (16)	38 (4.6)	<0.001	2 (6.9)	72 (7.1)	0.96	4 (18.2)	47 (6.2)	0.02
Low HDL	13 (54.2)	289 (31.9)	0.02	20 (80)	269 (32.3)	<0.001	12 (48)	259 (29.6)	0.04	19 (86.4)	224 (29.6)	<0.001
High LDL	2 (12.5)	41 (5.5)	0.23	1 (6.2)	39 (5.5)	0.94	1 (5.3)	57 (8.2)	0.64	4 (25)	46 (7.7)	0.01

High liver enzymes a
ALT	6 (22.2)	36 (4)	<0.001	5 (21.7)	34 (4.6)	<0.001	2 (8)	28 (3.2)	0.19	1 (6.2)	24 (3.5)	0.56
AST	4 (15.4)	70 (7.5)	0.13	3 (13)	56(7.3)	0.30	0 (0)	84 (9.6)	0.11	1 (6.2)	54 (7.9)	0.80

14-18 years
Overweight a	7 (18.9)	104 (8.6)	0.03	6 (20.7)	84 (9.4)	0.04	7 (13.7)	71 (6.1)	0.02	17 (26.2)	47 (5.5)	<0.001
Obesity a	19 (51.4)	94 (7.8)	<0.001	9 (31)	9 (8.8)	<0.001	29 (44.6)	36 (70.6)	<0.001	42 (4.9)	62 (5.3)	<0.001
High FBG	2 (6.5)	140 (12)	0.34	11 (37.9)	77 (8.6)	<0.001	12 (27.9)	208 (18.6)	0.12	35 (53.8)	121 (14.2)	<0.001

High blood pressure a
Systolic	3 (8.8)	33 (3)	0.05	8 (27.6)	22 (2.5)	<0.001	12 (26.1)	73 (6.7)	<0.001	27 (41.5)	42 (4.9)	<0.001
Diastolic	1 (2.9)	26 (2.3)	0.79	3 (10.3)	17 (1.9)	<0.001	7 (15.2)	68 (6.1)	0.01	19 (29.2)	48 (5.6)	<0.001

Dyslipidemia a
High TC	8 (21.6)	79 (6.6)	<0.001	6 (20.7)	53 (5.9)	<0.001	9 (17.6)	31 (2.7)	<0.001	9 (13.8)	16 (1.9)	<0.001
Low HDL	13 (54.2)	60 (6.8)	0.82	5 (20)	45 (6.2)	<0.001	20 (44.4)	434 (43.1)	0.85	51 (78.5)	361 (42.2)	<0.001
High LDL	2 (8)	349 (34)	0.04	28 (96.6)	304 (33.9)	<0.001	2 (6.5)	23 (2.8)	0.23	3 (5.5)	20 (2.5)	0.27

High liver enzymes a
ALT	1 (4.3)	25 (2.4)	0.54	1 (3.8)	24 (3)	0.79	8 (17.8)	35 (3.3)	<0.001	10 (16.14)	26 (3.3)	<0.001
AST	1 (4.3)	61 (5.7)	0.75	2 (7.4)	47 (5.7)	0.70	3 (6.4)	71 (6.7)	0.83	3 (5)	48 (6)	0.74

10-18 years
Overweight a	13 (18.3)	409 (18.1)	0.01	9 (16.7)	174 (10.1)	0.11	10 (12.5)	134 (6.1)	0.02	22 (24.4)	92 (5.6)	<0.001
Obesity a	43 (60.6)	200 (8.9)	<0.001	26 (48.1)	169 (9.8)	<0.001	54 (67.5)	126 (5.8)	<0.001	52 (25.7)	111 (36.2)	<0.001
High FBG	5 (8.3)	272 (12.3)	0.35	18 (33.3)	163 (9.4)	<0.001	20 (29)	377 (17.9)	0.01	48 (55.2)	217 (13.5)	<0.001

High blood pressure a
Systolic	6 (8.8)	51 (2.4)	<0.001	13 (24.1)	35 (2)	<0.001	13 (17.6)	88 (4.4)	<0.001	28 (32.2)	24 (3.2)	<0.001
Diastolic	3 (4.4)	41 (1.9)	0.14	6 (11.1)	28 (1.6)	<0.001	7 (9.6)	91 (6.4)	0.03	21 (24.1)	64 (4)	<0.001

Dyslipidemia a
High TC	15 (21)	137 (6.1)	<0.001	10 (18.5)	91 (5.3)	<0.001	11 (13.8)	103 (4.7)	<0.001	13 (14.9)	63 (3.9)	<0.001
Low HDL	26 (54.2)	638 (33)	<0.001	48 (88.9)	73 (33.1)	<0.001	32 (45.7)	693 (36.8)	0.12	70 (80.5)	585 (36.3)	<0.001
High LDL	4 (9.8)	101 (6.2)	0.35	6 (14.6)	84 (6)	0.02	3 (6)	80 (5.2)	0.81	7 (9.9)	66 (5.1)	0.07

High liver enzymes a
ALT	7 (14)	61 (3.1)	<0.001	6 (12.2)	58 (3.7)	<0.001	10 (14.3)	63 (3.3)	<0.001	11 (14.3)	50 (3.4)	<0.001
AST	5 (10)	131 (6.5)	0.32	5 (10)	103 (6.5)	0.32	3 (4.2)	155 (8)	0.24	4 (5.3)	102 (6.9)	0.58

Cardiometabolic risk factors a	HW
	Crude model OR (95%CI)	Adjusted model b OR (95%CI)
MetS	113.46 (68.99-186.57) c	64.24 (30.55-135.06)
Obesity	22.66 (15.94-32.20) c	23.11 (14.84-35.98) c
Overweight	2.14 (1.35-3.39) c	1.57 (0.84-2.93)
High TC	3.62 (2.32-5.63) c	2.17 (1.11-4.21) c
High LDL	1.36 (0.62-2.99)	0.83 (0.23-3.00)
High ALT	4.99 (2.9-8.59) c	0.88 (0.28-2.70)
High AST	0.90 (0.43-1.87)	0.56 (0.18-1.69)
High blood pressure	3.09 (1.90-5.02) c	1.21 (0.60-2.46)
High FBG	1.35 (0.86-2.11)	1.12 (0.60-2.08)

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[TFN6] CASPIAN, childhood and adolescence surveillance and prevention of adult non-communicable disease; BMI, body mass index; FBG, fasting blood glucose; HW, hypertriglyceridemic waist; MetS, metabolic syndrome.

[TFN1] ^a
Abdominal obesity: waist circumference above the age- and gender-specific 90th percentile; overweight: 85th < BMI < 95th percentile; obesity: BMI ≥ 95th percentile; high FBG ≥ 100 mg/dL; dyslipidemia, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglycerides (TG), higher than the level corresponding to the age- and gender-specific 95th percentile, and/or high-density lipoprotein cholesterol (HDL-C) lower than the age- and gender-specific 5th percentile; high blood pressure, systolic and diastolic blood pressure above the 90th percentile for that age and gender; high liver enzyme, alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) above the 90th percentile value for Iranian children and adolescents.

Association of hypertriglyceridemic-waist phenotype with liver enzymes and cardiometabolic risk factors in adolescents: the CASPIAN-III study☆

Abstract

Association of hypertriglyceridemic-waist phenotype with liver enzymes and cardiometabolic risk factors in adolescents: the CASPIAN-III study^☆