ESPE Abstracts

Background: In early-onset obesity, metabolic and cardiovascular problems like insulin resistance, hypertension, dyslipidemia, and metabolic syndrome start early in life. Our study aimed to investigate the relationship between metabolic and microvascular abnormalities in children with early-onset severe obesity using a non-invasive method, nailfold video capillaroscopy (NVC).

Methods: In this cross-sectional study, 27 patients (F/M:18/9) with non-syndromic, early-onset severe obesity and 36 age- and sex-matched healthy controls (F/M:18/18) were included. Clinical, laboratory and genetic evaluation results were recorded from the files. All patients underwent NVC to evaluate morphological and structural changes in the vessels, and findings were compared with healthy peers. Except for the thumbs, all fingers were examined two times from each finger, with a total of 16 images taken from each child.

Results: The mean age of the obesity and control groups were 13.0±3.5 and 13.1±3.3 years, respectively, and similar in terms of age and gender (P >0.05). In obese group, BMI and waist circumference SDS was 3.5±0.7 and 4.4±0.9, respectively. Genetic analysis revealed at least one gene variant in 63% (n = 17) of the patients, with homozygous variants in LEPR (n = 4), heterozygous variants PCSK1 (n = 6), MC4R (n = 3), UCP3 (n = 1), NTRK2 (n = 1), NCOA1 (n = 1), and POMC (n = 1). Metabolic problems included elevated blood pressure/hypertension in77.8% and dyslipidemia in44.4% of the patients. Among 24patients, 37% (n = 9) had impaired glucose tolerance and hyperinsulinemia, and 54% (n = 13) had hyperinsulinemia on OGTT. One patient was diagnosed with type 2 diabetes. The prevalence of metabolic syndrome was31.8% in patients >10 years. Hepatosteatosis was present in 79% of the cases. Morphological evaluation of capillaries showed abnormalities in all obese children, while nonspecific changes were observed in only27.8% of the control group (P <0.001). Obese children showed significantly more capillary cross (P <0.001), capillary tortuosity (P <0.001), abnormal vessels (P <0.001), dilatation (P = 0.007), and microhemorrhages (P <0.001). In addition, capillary density was significantly lower (P <0.001) in obese group when compared with healthy volunteers. There was a positive correlation between the number of microhemorrhages and total insulin level in OGTT (r =0.522, P = 0.09), and HOMA-IR (r =0.482, P = 0.011). Additionally, there was a positive correlation between the number of abnormal capillaries and total insulin level in OGTT (r =0.483, P = 0.017).

Conclusion: Microvascular abnormalities appear early in life in children with non-syndromic severe obesity and may predict cardiovascular and metabolic risk later in life. NVC appears to be a simple and non-invasive tool for assessing early microvascular involvement in severe obesity.

Keywords: Early-onset severe obesity, Nailfold capillaroscopy, Metabolic syndrome, Insulin resistance