European Journal of Pediatrics

, Volume 170, Issue 7, pp 879–886

Insulin resistance is associated with at least threefold increased risk for prothrombotic state in severely obese youngsters

  • Assimina Galli-Tsinopoulou
  • Ioannis Kyrgios
  • Ioanna Maggana
  • Eleni Z. Giannopoulou
  • Eleni P. Kotanidou
  • Charilaos Stylianou
  • Emmanouil Papadakis
  • Ioannis Korantzis
  • George Varlamis
Original Paper

DOI: 10.1007/s00431-010-1370-9

Cite this article as:
Galli-Tsinopoulou, A., Kyrgios, I., Maggana, I. et al. Eur J Pediatr (2011) 170: 879. doi:10.1007/s00431-010-1370-9

Abstract

Obesity in childhood increases the risk for early adult cardiovascular disease. However, the underlying mechanism is not fully known. The aims of this study were to measure levels of prothrombotic factors and examine their possible association with obesity and insulin resistance in obese children and adolescents. A total of 313 obese children and adolescents were recruited. In a cross-sectional design, we measured anthropometric parameters, plasminogen activator inhibitor-1-antigen (PAI-1-Ag), von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids, fasting glucose, and insulin (FI) levels. Insulin resistance was estimated using the homeostasis model assessment for insulin resistance (HOMA-IR) index. Boys presented significantly higher PAI-1-Ag levels than girls (82.6 vs. 71.3 ng/ml, p = 0.01). Higher levels of PAI-1-Ag (96.8 vs. 69 ng/ml, p < 0.001), vWF-Ag (123.5 vs. 107.6%, p = 0.004) but not FB (353.1 vs. 337.6 mg/dl, p = 0.137) were found in insulin-resistant (IR) participants after adjusted for age, gender, and pubertal stage. IR patients were at 2.98 (CI: 1.084–8.193) and 4.86 (CI: 1.119–15.606) times greater risk for high PAI-1-Ag and vWF-Ag levels, respectively. All three prothrombotic factors were positively correlated with body mass index (BMI) and FI levels (p < 0.05), but only PAI-1-Ag and vWF-Ag were significantly correlated with HOMA-IR index (p ≤ 0.001). After adjustment for confounding factors, both BMI and HOMA-IR indices remained significantly associated with PAI-1-Ag (r2 = 0.225, p < 0.001) and vWF-Ag levels (r2 = 0.077, p = 0.003). Conclusion: This study shows that obesity in youngsters, when accompanied with insulin resistance, is associated with at least threefold increased risk for elevated levels of prothrombotic factors, contributing to the early development of atherothrombosis. This impaired prothrombotic state may partially explain the increased risk for developing cardiovascular disease later in adulthood.

Keywords

ObesityInsulin resistancePlasminogen activator inhibitor 1von Willebrand factorFibrinogenChildren and adolescents

Abbreviations

BMI

Body mass index

CI

Confidence interval

FG

Fasting glucose

FI

Fasting insulin

FB

Fibrinogen

HDL-c

High-density lipoprotein cholesterol

HOMA-IR

Homeostasis model assessment for insulin resistance

IGT

Impaired glucose tolerance

IR

Insulin-resistant

LDL-c

Low-density lipoprotein cholesterol

MS

Metabolic syndrome

NIR

Non insulin-resistant

OR

Odds ratio

PAI-1-Ag

Plasminogen activator inhibitor-1-antigen

SD

Standard deviation

TC

Total cholesterol

TG

Triglycerides

vWF-Ag

von Willebrand factor-antigen

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Assimina Galli-Tsinopoulou
    • 1
  • Ioannis Kyrgios
    • 1
  • Ioanna Maggana
    • 1
  • Eleni Z. Giannopoulou
    • 1
  • Eleni P. Kotanidou
    • 1
  • Charilaos Stylianou
    • 1
  • Emmanouil Papadakis
    • 2
  • Ioannis Korantzis
    • 2
  • George Varlamis
    • 1
  1. 1.4th Department of Pediatrics, Medical SchoolAristotle University of Thessaloniki, Papageorgiou General HospitalThessalonikiGreece
  2. 2.Haemostasis Unit, Department of HaematologyPapageorgiou General HospitalThessalonikiGreece