Elsevier

Metabolism

Volume 62, Issue 4, April 2013, Pages 527-531
Metabolism

Clinical Science
Increased circulating High-Sensitivity Troponin T concentrations in children and adolescents with obesity and the metabolic syndrome: A marker for early cardiac damage?

https://doi.org/10.1016/j.metabol.2012.09.012Get rights and content

Abstract

Objective

Childhood obesity is associated with an increased risk for atherosclerosis mediated by the pathogenetic mechanisms that lead to the development of the Metabolic Syndrome (MetS). High-Sensitivity Troponin T (hs-TnT) is a specific marker of ischemic myocardial damage, whereas a minimal elevation of this biomarker has been found in adults with a high-risk for cardiovascular disease. We hypothesized that hs-TnT might be altered in obese children with and/or without the Mets.

Materials and Methods

Fifty-seven (34 males) obese and 25 non-obese (6 males) children were assessed at the Childhood Obesity Clinic of our department. Obesity was defined using the IOTF criteria. Metabolic syndrome was defined with the IDF criteria. Hs-TnT was measured using an electrochemiluminescence-based assay.

Results

The entire group of obese children had significantly higher hs-TnT concentrations [4.1 ± 3.4 ng/L] (p=0.029) than the non-obese ones [3.0 ± 0.2 ng/L), however, in both groups the levels of the cardiac biomarker were within the normal range. Comparison of the obese children with or without the MetS and the non-obese, revealed that those with the MetS had significantly higher hs-TnT (6.7±7.1 ng/L) than the obese without MetS (3.7 ± 2.1 ng/L) [p=0.044], and the non-obese [p=0.014]. Hs-TnT did not differ between the obese without MetS and the non-obese.

Conclusions

Circulating concentrations of hs-TnT in obese children with the MetS are higher than those of the obese without the MetS and the non-obese, suggesting that it is obesity-related metabolic changes rather than obesity per se linked to increased hs-TnT in children.

Introduction

Childhood obesity is associated with an increased risk for atherosclerosis and cardiovascular disease (CVD) in later life, which is mediated by obesity-related pathophysiologic mechanisms, such as dyslipidemia, arterial hypertension and impaired glucose metabolism, parameters clustering in the diagnosis of Metabolic Syndrome (MetS) [1], [2]. Evidence, mainly from pathology studies, reveals that the atherosclerotic process begins in childhood [3], [4], [5], whereas in some children, this process develops rapidly and is mediated by the same risk factors as those of adults, including obesity and associated MetS manifestations [3], [4], [5]. In pathology studies of children who had died from other causes, fatty streaks and fibrous plaques were associated with previously measured Body Mass Index (BMI) [3], [5].

High-sensitivity Troponin T (hs-TnT) is a sensitive biomarker of cardiac dysfunction, and has been used for diagnostic and prognostic purposes in chronic and acute cardiac conditions in all ages [6], [7], [8]. This cardiocyte protein is released in response to myocardial damage, as a result of an acute coronary syndrome, and its measurement helps confirm the diagnosis of acute myocardial infarction [7]. In the general population, minimally increased TnT, especially when concentrations approach the lower detection limit, may be indicative of subclinical cardiac injury [9]. In adults, minimally increased troponin levels have been measured in individuals without typical ischemic chest pain. In the Dallas heart study [9], cardiac (c) TnT was undetectable among healthy subjects, and individuals with cTnT elevation had underlying CVD or a high-risk phenotype for CVD (including higher BMI).

We investigated circulating hs-TnT concentrations in obese children with and without the MetS and compared them to non-obese children. We hypothesized that obese children with MetS might have higher circulating hs-TnT concentrations than non-obese children.

Section snippets

Methods

The study was approved by the Ethics Committee of the “Aghia Sophia” Children's Hospital and was performed according to the Helsinki Declaration [10]. Written informed consent was obtained from the participants and their parents. Inclusion criteria were: children and adolescents 7–14 years old, fully assessed at the Obesity Clinic. The children visited this clinic either for weight problems or as a “healthy weight” preventive visit. Exclusion criteria were: 1) underlying chronic illnesses

Results

hs-TnT values in the entire population were within the “normal” or non-clinically important range (< 13) [16]. Obese children had higher hs-TnT concentrations (4.1 ± 3.4 ng/L) than the non-obese ones (3.0 ± 0.2 ng/L). When we subdivided the obese group into those with (N=8) or without the MetS (N=49), hs-TnT was significantly higher in the MetS than the obese non-MetS and the non-obese groups (Fig. 1). No differences were detected between the obese non-MetS and the non-obese group.

Μales had

Discussion

Our study revealed that obese children with the MetS had significantly higher circulating hs-TnT concentrations – although admittedly within the normal range – than obese children without the MetS and than the non-obese group. This finding implies an increased risk for CVD in obese children with the MetS. Furthermore, as subclinical atherosclerosis during childhood may progress more rapidly in obese children with the MetS, the small increase of hs-TnT observed might reflect subclinical cardiac

Conflict of Interest

The authors have nothing to declare. There is no conflict of interest.

Author Contributions

P.P. assessed clinically all the children, performed the statistical analysis and wrote the manuscript. A.A. conceived the research hypothesis, made the literature search, and advised in biochemical issues. D.B. contributed in the clinical assessment and performed the data entry. F.A. and I.P. performed the biochemical measurements. GC supervised and reviewed the manuscript.

Funding

None.

Acknowledgments

We thank all the families who participated in the study and Dr. G. Chouliaras for his statistical advise.

References (19)

There are more references available in the full text version of this article.

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