Original Article

Differences in Cardiometabolic Biomarkers between Elementary School–Age Latinx Children with Obesity versus Healthy Weight

Authors: Allison J. McKay, MS, RD, Margaret T. Jones, PhD, Sina Gallo, PhD, MSc, RD

Abstract

Objectives: Low-income Latinx youth are disproportionately affected by obesity, which results in an increased risk of cardiometabolic abnormalities. Biomarker tracking may be useful for the early identification of obesity comorbidities in young Latinx children. Hence, we aimed to compare cardiometabolic biomarkers between age- and sex-matched pairs of elementary school-aged Latinx children with obesity versus healthy weight.

Methods: This case-control study compared cardiometabolic biomarkers between 13 pairs of age- and sex-matched elementary school–age (median 6.5 years) Latinx children with obesity (body mass index for age ≥ 95th percentile) as compared with their healthy weight (between the 5th and 85th percentiles) counterparts. Anthropometric measures and a fasted venous blood sample were taken for the analysis of lipids, glycemic, inflammatory, endocrine, and hepatic markers. Group differences were tested by the Mann-Whitney U or χ2 test.

Results: Cases had higher insulin (P = 0.003), hemoglobin A1c (P = 0.002), triglycerides (P = 0.023), and C-reactive protein (P < 0.001) and lower high-density lipoprotein (P = 0.002). Hepatic markers were similar, with alanine aminotransferase elevated among both groups.

Conclusions: The aforementioned biomarkers may be more sensitive to higher adiposity risk in this young Latinx population; however, elevated hepatic markers may indicate an ethnic/genetic predisposition to abnormal liver function. Research should be replicated in a larger group to confirm these findings.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief 2017;288:1–8.
 
2. Ogden CL, Flegal KM, Carroll MD, et al. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002; 288:1728–1732.
 
3. Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, et al. Hispanic health in the USA: a scoping review of the literature. Public Health Rev 2016;37:31.
 
4. Wells NM, Evans GW, Beavis A, et al. Early childhood poverty, cumulative risk exposure, and body mass index trajectories through young adulthood. Am J Public Health 2010;100:2507–2512.
 
5. Di Cesare M, Sorić M, Bovet P, et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med 2019;17:212.
 
6. Lopez-Jaramillo P, Herrera E, Garcia RG, et al. Inter-relationships between body mass index, C-reactive protein and blood pressure in a Hispanic pediatric population. Am J Hypertens 2008;21:527–532.
 
7. Parrinello CM, Rudolph BJ, Lazo M, et al. Associations of insulin resistance and glycemia with liver enzymes in Hispanic/Latino youths: results from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth). J Clin Gastroenterol 2019;53:e46–e53.
 
8. Kelsey MM, Zaepfel A, Bjornstad P, et al. Age-related consequences of childhood obesity. Gerontology 2014;60:222–228.
 
9. Godwill OC, Isaac N. Association of metabolic biomarkers of cardiovascular disease in overweight and obese children in Emohua local government area of river state, Nigeria. J Dent Med Sci 2012;1:40–46.
 
10. Kim J, Bhattacharjee R, Kheirandish-Gozal L, et al. Insulin sensitivity, serum lipids, and systemic inflammatory markers in school-aged obese and nonobese children. Int J Pediatr 2010;2010:846098.
 
11. Burris C, Ashwood E, Burns D, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. Philadelphia: Saunders; 2006.
 
12. Ezaizi Y, Kabbany MN, Conjeevaram Selvakumar PK, et al. Comparison between non-alcoholic fatty liver disease screening guidelines in children and adolescents. JHEP Rep 2019;1:259–264.
 
13. Schwimmer JB, Deutsch R, Kahen T, et al. Prevalence of fatty liver in children and adolescents. Pediatrics 2006;118:1388–1393.
 
14. Bonnet F, Ducluzeau P-H, Gastaldelli A, et al. Liver enzymes are associated with hepatic insulin resistance, insulin secretion, and glucagon concentration in healthy men and women. Diabetes 2011;60:1660–1667.
 
15. Qi Q, Hua S, Perreira KM, et al. Sex differences in associations of adiposity measures and insulin resistance in US Hispanic/Latino youth: the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth). J Clin Endocrinol Metab 2017;102:185–194.
 
16. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. 2017 poverty guidelines. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2017-poverty-guidelines. Published January 12, 2018. Accessed August 3, 2022.
 
17. US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. https://www.nhlbi.nih.gov/files/docs/resources/heart/hbp_ped.pdf. Revised May 2005. Accessed August 3, 2022.
 
18. Dakappagari N, Zhang H, Stephen L, et al. Recommendations for clinical biomarker specimen preservation and stability assessments. Bioanalysis 2017;9:643–653.
 
19. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419.
 
20. Melmed S, Polonsky KS, Larsen PR, et al, eds. Williams Textbook of Endocrinology, 13th ed. Philadelphia: Saunders; 2016.
 
21. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic & Laboratory Test Reference, 14th ed. St. Louis: Mosby; 2019.
 
22. Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity—assessment, treatment, and prevention: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017;102:709–757.
 
23. Abdellaoui A, Al-Khaffaf H. C-reactive potein (CRP) as a marker in peripheral vascular disease. Eur J Vasc Endovasc Surg 2007;34:18–22.
 
24. Licenziati MR, Valerio G, Vetrani I, et al. Altered thyroid function and structure in obese children. J Clin Endocrinol Metab 2019;104:2757–2765.
 
25. Fischbach FT, Fischbach MA, eds. Fischbach's A Manual of Laboratory and Diagnostic Tests, 10th ed. Philadelphia: Wolters Kluwer; 2018.
 
26. Melmed S, Polonsky KS, Larsen PR, et al. Williams' Textbook of Endocrinology, 12th ed. Philadelphia: Saunders; 2011, pp 348–414.
 
27. Lee JY, So T-Y, Thackray J. A review on vitamin D deficiency treatment in pediatric patients. J Pediatr Pharmacol Ther 2013;18:277–291.
 
28. Zakharova I, Klimov L, Kuryaninova V, et al. Vitamin D insufficiency in overweight and obese children and adolescents. Front Endocrinol 2019; 10:103.
 
29. MacDonald K, Godziuk K, Yap J, et al. Vitamin D status, cardiometabolic, liver, and mental health status in obese youth attending a pediatric weight management center. J Pediatr Gastroenterol Nutr 2017;65:462–466.
 
30. Rusconi RE, De Cosmi V, Gianluca G, et al. Vitamin D insufficiency in obese children and relation with lipid profile. Int J Food Sci Nutr 2015;66:132–134.
 
31. Peterson CA, Tosh AK, Belenchia AM. Vitamin D insufficiency and insulin resistance in obese adolescents. Ther Adv Endocrinol Metab 2014;5:166.
 
32. Ferreira AP, Oliveira CER, França NM. Metabolic syndrome and risk factors for cardiovascular disease in obese children: the relationship with insulin resistance (HOMA-IR). J Pediatr 2007;83:21–26.
 
33. Jamerson T, Sylvester R, Jiang Q, et al. Differences in cardiovascular disease risk factors and health behaviors between black and non-black students participating in a school-based health promotion program. Am J Health Promot 2017;31:318–324.
 
34. Zhu J, Xing G, Shen T, et al. Postprandial glucose levels are better associated with the risk factors for diabetes compared to fasting glucose and glycosylated hemoglobin (HbA1c) levels in elderly prediabetics: beneficial effects of polyherbal supplements—a randomized, double-blind, placebo-controlled trial. Evid Based Complementary Altern Med 2019;2019:1–13.
 
35. Arellano-Ruiz P, García-Hermoso A, García-Prieto JC, et al. Predictive ability of waist circumference and waist-to-height ratio for cardiometabolic risk screening among Spanish children. Nutrients 2020;12:415.
 
36. Yang HR, Chang EJ. Insulin resistance, body composition, and fat distribution in obese children with nonalcoholic fatty liver disease. Asia Pac J Clin Nutr 2016;25:126–133.
 
37. Kliethermes S, Ma M, Parutell C, et al. An assessment of racial differences in the upper limits of normal ALT levels in children and the effect of obesity on elevated values. Pediatr Obes 2017;12:363–372.
 
38. van Vliet M, von Rosenstiel I, Schindhelm R, et al. The association of elevated alanine aminotransferase and the metabolic syndrome in an overweight and obese pediatric population of multi-ethnic origin. Eur J Pediatr 2009;168:585–591.
 
39. Calcaterra V, Muratori T, Klersy C, et al. Early-onset metabolic syndrome in prepubertal obese children and the possible role of alanine aminotransferace as marker of metabolic syndrome. Ann Nutr Metab 2011;58:307–314.Pediatrics 2017;139:e20151175.
 
40. Kallwitz ER, Daviglus ML, Allison MA, et al. Prevalence of suspected nonalcoholic fatty liver disease in Hispanic/Latino individuals differs by heritage. Clin Gastroenterol Hepatol 2015;13:569–576.
 
41. Wiegand S, Keller K, Robi M, et al. Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16390 overweight or obese children and adolecents. Int J Pediatr 2010;34:1468–1474.
 
42. Martins C, Freitas I, Pizarro A, et al. Cardiorespiratory fitness, but not central obesity or C-reactive protein, is related to liver function in obese children. Pediatr Exerc Sci 2013;25:3–11.
 
43. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-2004. Gastroenterology 2007;133:1814–1820.
 
44. Lande MB, Pearson TA, Vermilion RP, et al. Elevated blood pressure, race/ ethnicity, and C-reactive protein levels in children and adolescents. Pediatrics 2008;122:1252–1257.
 
45. Ford E, Ajani U, Mokdad A. The metabolic syndrome and concentrations of C-reactive protein among U.S. youth. Diabetes Care 2005;284: 878–881.