Association of metabolic syndrome with acanthosis nigricans in prepubertal children
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Abstract
Objective: Acanthosis nigricans is associated with hyperinsulinemia, which has pathophysiological role in metabolic syndrome. Given the prevalence of childhood obesity, acanthosis nigricans would be a good and easily accessible marker for the syndrome. This work aims to compare prepubertal children with and without acanthosis nigricans in relation to components of the metabolic syndrome, insulin resistance and leptin; evaluate association of these with acanthosis nigricans. Methods: Cross-sectional study comparing groups with and without acanthosis nigricans regarding: frequency of hypertriglyceridemia, low HDL, hyperinsulinemia, metabolic syndrome; average of age, Z-score of BMI, waist circumference, triglycerides, HOMA-IR, leptin, and median of systolic and diastolic blood pressure, HDL, insulin. The association of age, gender, waist circumference, HDL, triglycerides, HOMA-IR, and leptin with acanthosis nigricans was assessed by multivariate logistic regression. Results: It was studied 272 children (65 eutrophic, 43 overweight, 164 obese), age 93±17 months, 69 (25,4%) with acanthosis nigricans. There was statistically significant difference between the groups in relation to frequency of hypertriglyceridemia, low HDL, hyperinsulinemia, and metabolic syndrome. The groups differed in mean of age, Z-score of BMI, waist circumference, triglycerides, HOMA-IR, and leptin, and in the median of systolic and diastolic blood pressure, HDL, and insulin. Only waist circumference and HOMA-IR were associated with acanthosis nigricans, after adjusting for the other variables. Conclusions: Groups with and without acanthosis nigricans differ in relation to components of metabolic syndrome, and there was association between waist circumference and HOMA-IR with acanthosis, demonstrating that acanthosis nigricans is marker of the syndrome and of insulin resistance.
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References
1. Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol 1994; 31: 1-19.
2. Ten S, MacLaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab 2004; 89: 2526-39.
3. Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988; 37: 1595-607.
4. Madeira IR, Carvalho CNM, Gazolla FM, Pinto LW, Borges MA, Bordallo MAN. O impacto da obesidade sobre os componentes da síndrome metabólica e as adipocitoquinas em crianças pré-púberes. J Ped (Rio J) 2009; 85: 261-8.
5. Madeira IR, Carvalho CNM, Gazolla FM, Matos HJ, Borges MA, Bordallo MAN. Ponto de corte do índice homeostatic model assessment for insulin resistance (HOMA-IR) avaliado pela curva receiver operating characteristic (ROC) na detecção de síndrome metabólica em crianças pré-púberes com excesso de peso. Arq Bras Endocrinol Metab 2008; 52: 1466-73.
6. Negrão AB, Licino J. Leptina: o diálogo entre adipócitos e neurônios. Arq Bras Endocrinol Metab 2000; 44: 205-14.
7. Caro JF, Kolaczynski JW, Nyce MR, Ohannesian JP, Opentanova I, Goldman WH. Decreased cerebrospinal fluid /serum leptin ratio in obesity: a possible mechanism for leptin resistance. Lancet 1996; 348: 159-61.
8. Valle M, Martos R, Gascón F, Cañete R, Zafra MA, Morales R. Low-grade systemic inflamation, hypoadiponectinemia and a high concentration of leptin are present in very
young obese children, and correlate with metabolic syndrome. Diabetes Metab 2005; 21: 55-62.
9. Stein AD. Overweight in children: a growing problem. J Pediatr (Rio J) 2014; 90: 218-20.
10. Miura N, Ikesaki A, Iwama S, Matsuoka H, Ito K, Sugihara S. Genetic factors and clinical significance of acantosis nigricans in obese Japanese children and adolescents. Acta Paediatr 2006; 95: 170-5.
11. Yamazaki H, Ito S, Yoshida H. Acanthosis nigricans is a reliable cutaneous marker of insulin resistance in obese Japanese children. Pediatr Int 2003; 45: 701-5.
12. Kobaissi HA, Weigensberg MJ, Ball GDC, Cruz ML, Shaibi GQ, Goran MI. Relation between acanthosis nigricans and insulin sensitivity in overweight Hispanic children at risk for type 2 diabetes. Diabetes Care 2004;27:1412-6.
13. Copeland K, Pankratz K, Cathey V, Immohotichey P, Maddox J, Felton B, et al. Acanthosis nigricans, insulin resistance (HOMA) and dyslipidemia among native American children. J Okla State Med Assoc 2006; 99: 19-24.
14. Marchall WA, Tanner JM. Variations in the pattern of pubertal changes in girls and boys. Arch Dis Child 1969; 44: 291-303.
15. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145: 439-44.
16. Hoekelman RA. Exame físico de lactentes e crianças pressão arterial. In: Bickley LS, Hoekelman RA, editores. Bates Propedêutica Médica. 7a ed. Rio de Janeiro: Editora Guanabara Coogan; 1999, p. 617-20.
17. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull of the World Health Organization 2007; 85: 660-7.
18. Zimmet P. Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. The Lancet 2007; 369: 2059-61.
19. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555-76.
20. Giuliano ICB, Caramelli B, Pellanda L, Duncan B, Mattos S, Fonseca FH. Sociedade Brasileira de Cardiologia. I Diretriz de Prevenção da Aterosclerose na Infância e na Adolescência. Arq Bras Cardiol 2005; 85(supl VI): 1-36.
21. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and ß-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-9.
22. Nguyen T T, Keil M F, Russell DL, Pathomvanich A, Uwaifo GI, Sebring NG et al. Relation of acanthosis nigricans to hyperinsulinemia and insulin sensitivity in overweight African American and white children. J Pediatr 2001; 138: 474-80.
23. Lemieux I, Pascot A, Coulliard C, Lamarche B, Tchernof A, Almeras N, et al. Hypertriglyceridemic waist: a mark of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprtein B; small dense LDH). Circulation 2000; 102: 179-84.
24. Despres JP, Lamarche B, Mauriege P, Cantin B, Dagenais GR, Moorjani S, et al. Hyperinsulinemia as an independent risk factor for ischemic Herat disease. N Engl J Med 1996; 334: 952-7.
25. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006; 148: 188-94.
26. Almeida CAN, Pinho AP, Ricco RG, Elias CP. Abdominal circumference as an indicator of clinical and laboratory parameters associated with obesity in children and adolescents: comparison between two reference tables. J Pediatr (Rio J) 2007; 83: 181-5.
27. Moreira SR, Ferreira AP, Lima RM, Arsa G, Campbell CSG, Simões HB, et al. Predicting insulin resistance in children: anthropometric and metabolic indicators. J Pediatr (Rio J) 2008; 84: 47-52.
28. Orrego JPC, Mancilla CAB, Galarza RAR. Los niños com sobrepeso y acantosis nigricans presentan mayor riesgo de tener elevada la pressión arterial. Evid Pediatr 2007; 3: 7-9.
29. Urrutia-Rojas X, Egbuchunam CU, Bae S, Menchaca J, Bayona, Rivers PA, et al. High blood pressure in school children: prevalence and risk factors. BMC Pediatr 2006; 6: 32-7.
30. Hardin DS. Screening for type 2 diabetes in children with acanthosis nigricans. The Diabetes Educator 2006; 32: 574-82.