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Metabolic risk-factor clustering estimation in obese children

Estimación de la agregación de factores de riesgo metabólico en niños obesos

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Abstract

The purpose of this study was to apply the new approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) score in a group of Spanish obese children and adolescents and to describe its relationship with other metabolic risk factors. 153 children with simple obesity were studied: 79 males and 74 females, mean age 11.2±2.2. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MIRACLE score included: family history (early cardiovascular disease, type 2 diabetes, and hypertension), individual history (small for gestational age and ethnic origin), clinical features (BMI, waist circumference >90th percentile and blood pressure >95th percentile) and metabolic abnormalities (glucose intolerance or type 2 diabetes). It was assigned a value of 1 to “presence” and 0 to “absence” in every patient. The children were considered as having metabolic risk when at least 5 items were present. Triglycerides, HDL-cholesterol, apolipoprotein B, apolipoprotein A1, glucose and HOMA index, were measured too. The most frequent clinical features of MIRACLE score were: excess waist circumference (95.4%) and hypertension (41.8%). Family history criteria were frequent (55.3% for type 2 diabetes, 39,1% for hypertension and 31.3% for early cardiovascular disease). Individual risk factors were not frequent. Glucose intolerance was detected in 22.2% of the obese patients. A MIRACLE score ≥5 was found in 37.4% of the children studied, being associated with a significant risk of dyslipidemia (triglycerides, p=0.040; HDL-cholesterol, p=0.006; LDL-cholesterol p=0.038; apolipoprotein B, p=0.008) only in females. In conclusion, the MIRACLE score is useful in order to detect metabolic risk in obese children but it seems necessary to improve the score, by including other features of the metabolic syndrome like lipid profile or indirect indicators of insulin resistance.

Resumen

El objetivo de este estudio ha sido aplicar la puntuación MIRACLE, un nuevo enfoque clínico del riesgo metabólico, a un grupo de niños y adolescentes obesos españoles y establecer la relación existente entre dicha puntuación y otros factores de riesgo. Se han estudiado 153 niños: 79 varones y 74 mujeres, de edad media 11,2±2,2 años, todos ellos con obesidad exógena. Como criterio de obesidad se ha seguido el valor del índice de masa corporal (IMC) mayor o igual a 30 Kg/m2 para edad y sexo. La puntuación MIRACLE incluyó historia familiar (enfermedad cardiovascular precoz, diabetes tipo 2 y/o hipertensión), historia personal (recién nacido de bajo peso y/o etnia de riesgo), datos clínicos (IMC, perímetro de cintura >percentil 90 y/o tensión arterial >percentil 95) y anomalías metabólicas (intolerancia a la glucosa o diabetes tipo 2). Se asignó un valor de 1 a la “presencia” y un valor de 0 a la “ausencia” de cada uno de estos 10 factores. El paciente presentaba riesgo metabólico cuando al menos 5 de los anteriores datos eran positivos. Se valoraron también: triglicéridos, HDL-colesterol, colesterol total, apolipoproteínas A1 y B, glucosa e índice HOMA. Los datos clínicos más frecuentemente encontrados fueron: perímetro de cintura >percentil 90 (95,4%) e hipertensión (41,8%). Una historia familiar positiva fue un hallazgo frecuente (55,3% de diabetes tipo 2, 39,1% de hipertensión y 31,3% de enfermedad cardiovascular precoz). Los datos relativos a historia personal no fueron frecuentes. El 22,2% de los obesos presentaron intolerancia hidrocarbonada. Puntuación MIRACLE ≥5 se encontró en el 37,4% de los niños estudiados. Una puntuación MIRACLE ≥5 se asoció, tan sólo en el sexo femenino, con riesgo significativo de dislipemia (triglicéridos p=0,040, HDL-colesterol p=0,006, colesterol p=0,038, apolipoproteína B p=0,008). De estos resultados se deduce que la puntuación MIRACLE es útil para detectar riesgo metabólico, pero podría ser mejorada si se incluyeran datos relativos al perfil lipídico y a indicadores indirectors de resistencia a la insulina.

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Authors and Affiliations

  1. Departamento de Pediatría, Universidad de Zaragoza, C/ Domingo Miral s/n, 50009, Zaragoza, Spain

    G. Bueno, O. Bueno, J. Morales, T. Pérez-Roche, J. M. Garagorri & M. Bueno

  2. Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, C/ Domingo Miral s/n, 50009, Zaragoza, Spain

    L. A. Moreno

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  1. G. Bueno
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  2. L. A. Moreno
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  6. J. M. Garagorri
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  7. M. Bueno
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Correspondence to L. A. Moreno.

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Bueno, G., Moreno, L.A., Bueno, O. et al. Metabolic risk-factor clustering estimation in obese children. J. Physiol. Biochem. 63, 347–355 (2007). https://doi.org/10.1007/BF03165766

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  • DOI: https://doi.org/10.1007/BF03165766

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