ESPE Abstracts

Introduction: Dyslipidemia secondary to obesity is a risk factor related to cardiovascular disease events, however a pathological conventional lipid profile (CLP) is infrequently found in obese children. The objective of our study is to evaluate the advanced lipoprotein profile (ALP) and its relationship with cardiac changes, metabolic syndrome and inflammatory markers in a population of morbidly obese adolescents with normal CLP and without type 2 diabetes mellitus, the most common scenario in obese adolescents.

Methods: Prospective case-control research of 42 morbidly obese adolescents and 25 normal-weight adolescents, whose left ventricle (LV) morphology and function had been assessed. The ALP was obtained by proton nuclear magnetic resonance spectroscopy, and the results were compared according to the degree of cardiac involvement – normal heart, mild LV changes, and severe LV changes (specifically LV remodeling and systolic dysfunction) – and related to inflammation markers (highly-sensitive C-reactive protein and glycoprotein A [GlycA]) and insulin-resistance (homeostatic model assessment for insulin-resistance [HOMA-IR]). A second analysis was performed to compare our results with the predominant ALP when only body mass index and metabolic syndrome criteria were considered.

Results: The three cardiac involvement groups showed significant differences in HOMA-IR and inflammatory markers (P<0.01). A significant increase was also observed in the ratio LDL-P/HDL-P (40.0 vs 43.9 vs 47.1, p0.01), while when the mild and severe LV changes groups were compared, an elevation in the small LDL-P and decrease in VLDL size were identified. The multivariable model (AUC: 0.91 [95%CI: 0.74-1]) to differentiate normal heart subjects from those with severe cardiac changes included: body mass index, HOMA-IR, blood pressure, GlycA, small VLDL-P, small LDL-P and ratio HDL-TG/HDL-C. In the second analysis, an atherosclerotic ALP was detected in morbidly obese subjects, characterized by a significant increase in large VLDL-P, small LDL-P, ratio LDL-P/HDL-P and ratio HDL-TG/HDL-C. Subjects that meet the criteria for metabolic syndrome presented overall worse ALP and remnant cholesterol values.

Conclusions: The overage of VLDL-P and LDL-P compared to HDL-P and, particularly, the increase in small LDL-P and ratio HDL-TG/HDL-C, appear to be key ALP’s parameters involved in LV changes. Morbidly obese adolescents without pathological CLP show an atherosclerotic ALP.