RESEARCH ARTICLE
Anthropometric features as predictors of atherogenic dyslipidemia and cardiovascular risk in a large population of school-aged children Jose´ M. Furtado1,2*, Sı´lvia M. Almeida1,2, Paulo Mascarenhas1,2, Maria E. Ferraz1, Jose´ C. Ferreira1,3, Manuel Vilanova4,5, Mariana P. Monteiro6, Fernando P. Ferraz1,2
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1 Centro de Gene´tica Me´dica e Nutric¸ão Pedia´trica Egas Moniz, Campus Universita´rio, Monte da Caparica, Portugal, 2 Instituto Universita´rio Egas Moniz, Campus Universita´rio, Monte da Caparica, Portugal, 3 Department of Obstetrics and Gynecology of University of Medicine of Warsaw, Warsaw, Poland, 4 Instituto de Investigac¸ão e Inovac¸ão em Sau´de, and IBMC–Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal, 5 Instituto de Ciências Biome´dicas de Abel Salazar, Universidade do Porto, Porto, Portugal, 6 Clinical and Experimental Endocrinology Group, Unit for Multidisciplinary Research in Biomedicine UMIB, ICBAS, University of Porto, Porto, Portugal *
[email protected]
OPEN ACCESS Citation: Furtado JM, Almeida SM, Mascarenhas P, Ferraz ME, Ferreira JC, Vilanova M, et al. (2018) Anthropometric features as predictors of atherogenic dyslipidemia and cardiovascular risk in a large population of school-aged children. PLoS ONE 13(6): e0197922. https://doi.org/10.1371/ journal.pone.0197922 Editor: Antonio Palazo´n-Bru, Universidad Miguel Hernandez de Elche, SPAIN Received: July 7, 2017 Accepted: May 10, 2018 Published: June 1, 2018 Copyright: © 2018 Furtado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was funded by the Directorate General of Health - Ministry of Health and, in part, by Egas Moniz Higher Education Cooperative, grant number 27-2008 (Martins dos Santos). An informatics platform was funded by Rui Nabeiro (Nabeiro Group). There was no additional external funding received for this study.
Abstract Background Autopsy studies reveal that atherosclerosis lesions can be found as early as two years of age. To slow the development of this early pathology, obesity and dyslipidemia prevention should start from childhood making it urgent to explore new ways to evaluate dyslipidemia risk in children that can be applied widely, such as the non-invasive anthropometric evaluation.
Objective Assess the metabolic profile of a pediatric population at a specific age to describe the association between anthropometric and biochemical cardiovascular disease risk factors; and evaluate selected anthropometric variables as potential predictors for dyslipidemic cardiovascular risk.
Design and methods Anthropometric features, bioimpedance parameters and fasting clinical profile were assessed in Lisbon and the Tagus Valley region pre-pubertal nine-year-old children (n = 1.496) from 2009–2013 in a descriptive, cross-sectional study. Anthropometric variables predictive power was evaluated through regression analysis.
Results At least one abnormal lipid parameter was found in 65% of “normal weight”, 73% of “overweight” and 81% of “obese” children according to the International Obesity Task Force
PLOS ONE | https://doi.org/10.1371/journal.pone.0197922 June 1, 2018
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Anthropometric predictors of cardiovascular risk factors
Competing interests: The authors declared no conflicts of interest.
(IOTF) standards. Dyslipidemia was present in 67.8% of children. Waist-hip ratio (WHR) explained 0.4% of total cholesterol (TC) variance. Waist circumference (WC) explained 2.8% of apolipoprotein (APO) A1 variance. Waist-circumference-to-height-ratio (WHtR) explained 2.7%, 2.8% and 1.9% of low-density lipoprotein cholesterol (LDL-c), APO B, and N_HDL-c variance, respectively. Children with abnormally high WHR levels had an increase in risk of 4.49, 3.40 and 5.30 times, respectively, for developing cardiovascular disease risk factors measured as high-risk levels of TC, LDL-c and non-HDL-c (N_HDL-c) (p170 mg/dl, LDL-c >110 mg/dl, and N_HDL-c 120 mg/dl, as defined by the American Academy of Pediatrics, [26] and HDL-c 75 mg/dl, APO A1 0.9 g/L, as defined by the Laboratories of the Mayo Clinic [27]. Serum samples were also tested for glucose (Glucose oxidase method), creatinine (Jaffe´ method), total proteins (Biuret method), and ferritin (immunoassay method); normal values were defined as follows: glucose
