Childhood Obesity, MMP-9 Levels, and Vitamin D

Keywords
Pediatric Obesity; Child; Adolescents; Cardiovascular Diseases; Overweight; Matrix Metaloproteinase 9

Dear Editor,

I have read the article entitled “MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese” by Andrade et al.¹, recently published in journal, with great interest. The investigators reported that obese children and adolescents present higher mean intima-media thickness (IMT), plasma matrix metalloproteinase (MMP)-9 and MMP-9/tissue inhibitor of metalloproteinase-1 ratio compared to the non-obese. Thus, these findings indicate that this group presents a risk profile for early atherosclerosis.¹

Childhood obesity is an international public health problem leading to an increased risk of adult obesity and associated with cardiovascular diseases such as hypertension, peripheral and coronary artery disease.² Vitamin D (vit D) may regulate adipose tissue mass, differentiation, and metabolism. Vit D deficiency might contribute with overweight and/or obesity, possibly by effects on lipogenesis and/or adipogenesis.³ Coussens et al.⁴ reported an inverse correlation between circulating vit D concentration and serum inflammatory biomarkers. Increased tumor necrosis factor-alpha (TNF-α) is associated with low vit D concentrations. Vit D down-regulates MMP-9 production by TNF-α and decreases production of MMP-9. Wang et al.⁵ reported that vit D derivatives could significantly inhibit TNF-α induced MMP-2 and MMP-9 secretion in nasal polyp-derived fibroblasts.

In this context, considering a close association among childhood obesity, serum MMP-9 and vit D levels, the correlation of this study’s result¹ with serum vit D levels might be beneficial.

References

• ¹
  Andrade C, Bosco A, Sandrim V, Silva F. MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese. Arq Bras Cardiol. 2017;108(3):198-203. doi: 10.5935/abc.20170025.
  » https://doi.org/10.5935/abc.20170025
• ²
  Saggese G, Vierucci F, Boot AM, Czech-Kowalska J, Weber G, Camargo CA Jr, et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr. 2015;174:565-76. doi: 10.1007/s00431-015-2524-6.
  » https://doi.org/10.1007/s00431-015-2524-6
• ³
  Cerit Z. Prediction of childhood obesity with or without vitamin D deficiency. Eur J Pediatr. 2017;176(4):557. doi: 10.1007/s00431-017-2860-9.
  » https://doi.org/10.1007/s00431-017-2860-9
• ⁴
  Coussens A, Timms PM, Boucher BJ, Venton TR, Ashcroft AT, Skolimowska KH, et al. A1alpha, 25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009;127:539-48. doi: 10.1111/j.1365-2567.2008.03024..
  » https://doi.org/10.1111/j.1365-2567.2008.03024.
• ⁵
  Wang LF, Tai CF, Chien CY, Chiang FY, Chen JY. Vitamin D decreases the secretion of matrix metalloproteinase-2 and matrix metalloproteinase-9 in fibroblasts derived from Taiwanese patients with chronic rhinosinusitis with nasal polyposis. Kaohsiung J Med Sci. 2015;31(5):235-40. doi: 10.1016/j.kjms.2015.02.001.
  » https://doi.org/10.1016/j.kjms.2015.02.001

Reply

We would like to thank you and agree with the considerations inserted in the letter about obesity and atherosclerosis. Indeed, we found a close association between obese children and adolescents with atherosclerosis, compared to non-obese ones.¹

Besides, many authors have cited the important role of Vitamin D in these situations. Certainly, there is an inverse association between Vitamin and obesity. In this point, the Vitamin should regulate the adipose tissue metabolism, although its real role is still unknown, that is, whether it is cause or consequence.²

Indeed, obesity and Vitamin D deficiency represent an important health concern in the United States among children and adults.²

Because of the association between cardiovascular risk in obese children and adolescents, Atabeck et al.³ suggest the prescription of Vitamin D as a way to prevent the premature onset of atherosclerosis. Gul at al.⁴ reported that Vitamin D deficiency could contribute with morbidities associated to childhood obesity, such as increasing cardiovascular cardiometabolic risks, atherogenic dyslipidemia and hypertension.

In short, we think it would be important to promote more studies in order to prevent and treat atherosclerosis in obesity, as well to considerer the other diseases.

Sincerely,

Claudio Andrade
Adriana Bosco
Valeria Sandrim
Francisco Silva

References

• ¹
  Andrade C, Bosco A, Sandrim V, Silva F. MMP-9 levels and IMT of Carotid Arteries are elevated in Obese Children and Adolescents Compared to Non-Obese. Arq Bras Cardiol. 2017;108(3):108-203. Doi:10.5935/abc.20170025
  » https://doi.org/10.5935/abc.20170025
• ²
  Peterson CA, Belenchia AM. Vitamin D deficiency and childhood obesity: a tale of two epidemics. Mo Med. 2014;111(1):49-53. PMID:24645299
• ³
  Atabeck ME, Eklioglu BS, Akyürek N, Alp H. Association between vitamin D level and cardiovascular risk in obese children and adolescents. J Pediatr Endocr Met. 2014;27(7-8):661-6. doi: 10.1515/jpem-2013-0379.
  » https://doi.org/10.1515/jpem-2013-0379
• ⁴
  Gul A, Ozer S, Yılmaz R, Sonmezgoz E, Kasap T, Takçı S, et al. Association between vitamin D levels and cardiovascular risk factors in obese children and adolescents. Nutr Hosp. 2017;34(2):323-9. doi: 10.20960/nh.412
  » https://doi.org/10.20960/nh.412

Carta-resposta

Agradecemos e concordamos com a consideração inserida na carta com relação à obesidade e à aterosclerose. De fato, encontramos uma associação entre crianças e adolescentes obesos com a aterosclerose, em comparação aos não-obesos.¹

Além disso, muitos autores mencionaram o importante papel da Vitamina D nessas situações. Certamente há uma associação inversa entre a vitamina e a obesidade. Neste ponto, a vitamina deveria regular o metabolismo do tecido adiposo, embora seu papel real ainda seja desconhecido - sendo causa ou consequência.²

De fato, a obesidade e a deficiência da vitamina D representam uma preocupação de saúde importante nos Estados Unidos entre crianças e adultos.²

Por causa da associação entre o risco cardiovascular em crianças e adolescentes obesos, Atabeck et al.,³ sugerem a prescrição da vitamina D como forma de prevenir o surgimento prematuro da aterosclerose. Gul et al.,⁴ relataram que a deficiência de vitamina D poderia contribuir com as morbidades associadas à obesidade infantil, como aumento dos riscos cardiovasculares ligados ao metabolismo, dislipidemia aterogênica e hipertensão.

Resumindo, consideramos a importância de promover mais estudos para prevenir e tratar a aterosclerose na obesidade, assim como considerar outras doenças.

Atenciosamente,

Claudio Andrade
Adriana Bosco
Valeria Sandrim
Francisco Silva

Publication Dates

• Publication in this collection
  Oct 2017

History

• Received
  20 Apr 2017
• Reviewed
  09 June 2017
• Accepted
  09 June 2017