Insulin resistance is associated with at least threefold increased risk for prothrombotic state in severely obese youngsters |
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Authors: | Assimina Galli-Tsinopoulou Ioannis Kyrgios Ioanna Maggana Eleni Z Giannopoulou Eleni P Kotanidou Charilaos Stylianou Emmanouil Papadakis Ioannis Korantzis George Varlamis |
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Institution: | (1) 4th Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 564 03 Thessaloniki, Greece;(2) Haemostasis Unit, Department of Haematology, Papageorgiou General Hospital, Thessaloniki, Greece |
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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
(r
2 = 0.225, p < 0.001) and vWF-Ag levels (r
2 = 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. |
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