Inflammation in metabolically healthy and metabolically abnormal adolescents: The HELENA study

Cadenas‐Sanchez, Cristina; Santabárbara, Javier; Bueno-Lozano, Gloria; Siani, Alfonso; Amaro-Gahete, Francisco J.; Rupérez, Azahara I.; Moreno, Luís A.; Henauw, Stefaan De; González‐Gross, Marcela; Gilbert, Chantal; Kafatos, Anthony; Libersa, Christian; Castello, S; Kersting, Mathilde; Sjöstróm, Michael; Dallongeville, Jean; Hall, Gunnar; Maes, Lea; Scalfi, Luca; Meléndez, P.; Fleta, Jesús; Casajús, José Antonio; Rodrı́guez, Gerardo; Tomás, Concepción; Mesana, M.I.; Vicente-Rodríguez, Germán; Villarroya, A.; Gil, Carlos Martínez; Ara, Ignacio; Alvira, J.F.; Bueno, Gloria; Lázaro, A.; Bueno, O.; León, J.F.; Garagorri, J. M.; Bueno, Manuel; Labayen, Idoia; Iglesia, Iris; Serrat, Silvia Bel; Marco, Luis A.; Mouratidou, Theodora; Santaliestra-Pasías, Alba M.; González-Gil, Esther M.; Miguel-Etayo, Pilar De; Julián-Almárcegui, Cristina; Miguel‐Berges, María L; Iguacel, Isabel; Marcos, Ascensión; Wärnberǵ, Julia; Nova, Esther; Gómez, Sonia; Díaz, L. E.; Romeo, Javier; Veses, Ana M.; Zapatera, Belén; Pozo, T.; Martínez, David; Béghin, Laurent; Gottrand, Frédéric; Iliescu, C.; Berlepsch, J. Von; Sichert-Hellert, Wolfgang; Koeppen, E.; Molnár, Denés; Erhardt, Éva; Csernus, Katalin; Török, Katalin; Bokor, Szilvia; Angster,; Nagy, Enikő; Kovács, Orsolya; Répasi, J.; Codrington, C.; Plada, María; Papadaki, Angeliki; Sarri, Katerina; Viskadourou, A.; Hatzis, Christos; Kiriakakis, Michael; Tsibinos, George; Vardavas, Constantine; Sbokos, Manolis; Protoyeraki, E.; Fasoulaki, Maria; Stehle, Peter; Pietrzik, Klaus; Breidenassel, Christina; Spinneker, André; Al-Tahan, Jasmin; Segoviano, Miriam; Berchtold, A.; Bierschbach, C.; Blatzheim, E.; Schuch, A.; Pickert, P.; Castillo, Manuel J.; Gutiérrez, Ángel; Ruiz, JR; Artero, Enrique G.; España, V.; Jiménez-Pavón, David; Chillón, Palma; Sánchez-Muñoz, Cristóbal; Cuenca, M.; Arcella, Davide; Azzini, Elena; Barrison, E.; Bevilacqua, Noemi; Buonocore, Pasquale; Catasta, Giovina; Censi, Laura; Ciarapica, Donatella; D'Acapito, P.; Ferrari, Marco; Galfo, Myriam; Donne, Cinzia Le; Leclercq, C.; Maiani, G.; Mauro, Béatrice; Mistura, Lorenza; Pasquali, A.; Piccinelli, Raffaela; Polito, Angela; Roccaldo, Romana; Spada, Raffaella; Sette, Stefania; Zaccaria, Maria; Vitaglione, Paola; Montagnese, Concetta; Bourdeaudhuij, I. De; Vriendt, Tineke De; Matthys, Christophe; Vereecken, Carine; Maeyer, Mieke De; Ottevaere, Charlene; Huybrechts, Inge; Widhalm, Kurt; Phillipp, K.; Dietrich, Sabine; Μanios, Yannis; Grammatikaki, Evangelia; Bouloubasi, Z.; Cook, Tina Louisa; Eleutheriou, S.; Consta, O.; Moschonis, George; Katsaroli, Ioanna; Kraniou, G.; Παπούτσου, Στάλω; Keke, D.; Petraki, Ioanna; Bellou, Elena; Tanagra, Sofia; Kallianoti, K.; Argyropoulou, Dionysia; Tsikrika, Stamatoula; Karaiskos, Christos; Meirhaeghe, Aline; Ortega, Francisco B.; Hagströmer, María; Wennlöf, Anita Hurtig; Hällström, Lena; Patterson, Emma; Kwak, Lydia; Rizzo, Nico; Sánchez-Molero, J.; Picó, E.; Navarro, María Á.; Viadel, Blanca; Carreres, J.; Merino, G.; Sanjuán, R.; Lorente, M.; Sánchez, María‐José; Thomas, Sarah A.; Allchurch, E.; Burgess, P.; Åström, Annika; Sverkén, A.; Broberg, A.; Masson, A.; Lehoux, Claire; Brabant, Pascal; Pate, P.; Fontaine, L.; Sebok, A.; Kuti, Tünde; Hegyi, Adrienn; Maldonado, Cristina A.; Llorente, Ana María Pinto; García, Emilio García; Fircks, H. von; Hallberg, Marianne Lilja; Messerer, Maria; Larsson, Mats; Fredriksson, Helena; Adamsson, Viola; Börjesson, I.; Fernández, Laura Fernández; Smillie, Laura; Wills, Josephine; Pedrero‐Chamizo, Raquel; Meléndez, Agustín; Valtueña, Jara; Albers, Ulrike; Benito, Pedro J.; Lorente, J.J. Gómez; Cañada, D.; Urzanqui, A.; Torres, Rosa María; Navarro, Paloma

doi:10.1016/j.numecd.2017.10.004

Cited by 29 publications

(17 citation statements)

References 30 publications

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“…Our findings also showed significant differences throughout weight status, but not for metabolic phenotypes in the same weight status category. These results are in agreement with a recent study that showed that adolescents with higher values of C-reactive protein had a higher probability of being in the MHO (obese/overweight) group than those from other categories [36].…”

Section: Discussionsupporting

confidence: 93%

Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents—A Multi-Cohort Study

et al. 2020

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Results from several studies show that only obese, unfit subjects, but not obese, fit subjects, are at higher mortality risk than are normal-weight fit subjects. The aim of the study was two-fold: (1) to examine the differences in C-reactive protein levels across different metabolic phenotypes (healthy and unhealthy) of weight status and (2) ascertain whether high levels of cardiorespiratory fitness (CRF) attenuate the association of C-reactive protein and metabolic phenotypes of weight status. This was a pooled study, which included data from three cross-sectional projects (1706 youth (921 girls) aged 12–18 years). We used a Shuttle run test to assess CRF. Adolescents were classified into six metabolic phenotypes (healthy and unhealthy) of weight status (non-overweight, overweight and obese), based on age- and sex-specific cutoff points for triglycerides, systolic blood pressure, HDL-cholesterol, glucose and body mass index. High-sensitivity assays were used to obtain the C-reactive protein as inflammatory biomarker. After adjustment for potential confounders (age, sex, pubertal stage and country), the analysis of covariance (ANCOVA) shows that C-reactive protein is directly associated with metabolic phenotypes of weight status. Subjects with obesity, regardless of their metabolic profile, had higher levels of C-reactive protein Z-score. In addition, (after adjustments for potential confounders) a two-way ANCOVA showed that high levels of CRF attenuated the associations of C-reactive protein levels in metabolic healthy non-overweight and in adolescents with obesity. In conclusion, higher CRF levels may attenuate the detrimental association between obesity and C-reactive protein independently of metabolic phenotype. Findings from this study are important for prevention, clinical practice on issues associated with adiposity and metabolic disorders.

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Section: Discussionsupporting

confidence: 93%

Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents—A Multi-Cohort Study

et al. 2020

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“…The greater prevalence of metabolic obesity biomarkers at higher BMI categories and ages, and their relative preponderance patterning conforms with the current understanding and guidelines [14][15][16]20,21,[26][27][28][29]. Our diagnosis of abnormal biomarkers was aligned with the internationally recommended cut-offs for identi cation of 5-19-year-old children with prediabetes or diabetes, and at risk of developing future cardiovascular disease [20,21].…”

Section: Discussionsupporting

confidence: 68%

“…The MONW phenotype, de ned as ≥1 metabolic obesity biomarker and BMI-for-age between -2Z and +1Z of WHO reference, occurred in 56% of normal-weight participants. This prevalence resonates with similar reports from national surveys in Iran (41% and 55% dyslipidemia in 2010 and 2015, respectively) and China (63% in 2002 among 12-18 years adolescents), urban schools in Chennai, India (65% in 2006 among 12-19 years adolescents), and 10 cities from 9 European countries (70% in 2006-2007 among adolescents), but is substantially higher than a national survey in Germany (3-13% individual lipid abnormalities in 2003-2006 among 0-18 years old) and a regional population-survey in Denmark (4.3% elevated fasting glucose in 2010-2015) [14][15][16][26][27][28][29]. However, these studies did not speci cally report on the paradoxical co-existence of anthropometric undernutrition (thinness or stunting) and metabolic obesity.…”

Section: Discussionmentioning

confidence: 99%

Intraindividual coexistence of anthropometric undernutrition and “metabolic obesity” in Indian Children: A paradox that needs action

Sachdev

Porwal

Sarna

et al. 2020

Preprint

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BackgroundIntraindividual coexistence of anthropometrically defined undernutrition and “metabolic obesity”, characterised by presence of at least one abnormal cardiometabolic risk factor, is rarely investigated in young children and adolescents, particularly in Low-and-Middle-Income-Countries undergoing rapid nutrition transition. MethodsPrevalence of biomarkers of metabolic obesity was related to anthropometric and socio-demographic characteristics in 5-19 years old participants from the population-based Comprehensive National Nutrition Survey in India (2016-2018). The biomarkers, serum lipid-profile (total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides), fasting glucose, and glycosylated hemoglobin (HbA1C), and all jointly were analysed in 22567, 23192, 25962 and 19143 participants, respectively.ResultsOverall (entire dataset), the prevalence of abnormalities was low (4.3-4.5%) for LDL and TC, intermediate for dysglycemia (10.9-16.1%), and high for HDL and triglycerides (21.7-25.8%). Proportions with ≥1 abnormal metabolic obesity biomarker(s) were 56.2% overall, 54.2% in thin (BMI-for-age <-2SD) and 59.3% in stunted (height-for-age <-2SD) participants. Comparable prevalence was evident in mild undernutrition (-1 to -2 SD). Clustering of two borderline abnormalities occurred in one-third, warranting active life-style interventions. Metabolic obesity prevalence increased with BMI-for-age. Among those with metabolic obesity, only 9% were overweight/obese (>1SD BMI-for-age). Among poor participants, triglyceride, glucose and HDL abnormalities were higher. ConclusionsA paradoxical, counter-intuitive prevalence of metabolic obesity biomarker(s) exists in over half of anthropometrically undernourished and normal-weight Indian children and adolescents. There is a crucial need for commensurate investments to address overnutrition along with undernutrition. Nutritional status should be characterized through additional reliable biomarkers, instead of anthropometry alone.

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“…This is regarded as the main acute phase protein synthesized by the liver and is regulated by proinflammatory cytokines, such as IL-6 and TNF- α [ 3 , 54 ]. The increase of CRP concentration occurs in chronic inflammatory situations, such as atherosclerosis, and its levels nearly triple in the presence of risk of peripheral vascular diseases [ 21 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Lifestyle and Body Composition on Risk Factors of Cardiometabolic Diseases and Biomarkers in Female Adolescents

Miranda

Amorim

Bastos

et al. 2020

Mediators of Inflammation

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Background. Female adolescents are considered a risk group for cardiometabolic disease due to their lifestyle (LS). Objective. To evaluate the association between LS classes and body composition groups with cardiometabolic disease risk factors and pro- and anti-inflammatory biomarkers in female adolescents. Methods. This cross-sectional study was carried out with female adolescents aged 14 to 19 years, from Viçosa-MG, Brazil. Latent class analysis assessed LS classes. Kinanthropometric measurements were taken together with the body fat percentage (BF%), being analyzed by the Dual Energy X-ray Absorptiometry (DEXA) equipment. Blood pressure and biochemical parameters were analyzed in the Health Division of the Federal University of Viçosa. The pro- and anti-inflammatory biomarkers were analyzed using Luminex technology. Associations with biomarkers were estimated by multiple linear regression. Results. 405 female adolescents were evaluated. The majority, 82.57%, 72.90%, and 65.31%, were classified as inactive by the number of steps, with high screen and cell phone time, respectively. Furthermore, 41.55% did meet the minimum of 60 minutes of moderate-to-vigorous physical activity (MVPA) and 54.69% had high values of BF% (DEXA). The “Sedentary & Inactive LS” class together with the high levels of weight and BF% were associated with increased levels of blood pressure, lipid profile, and uric acid. It was also found that “Inactive & Sedentary LS”, high BF%, insulin resistance, and ultra-sensitive C-reactive protein were associated with the concentrations of proinflammatory biomarkers of tumor necrosis factor-α, interleukin-6, and leptin. Conclusion. We concluded that female adolescents with overweight/obese and high BF% presented higher values of anthropometric indicators, levels of blood pressure, concentration of uric acid and hs-CRP, and lower concentration of HDL. Inactive and Sedentary lifestyle of these girls, along with excess body fat, insulin resistance, and higher concentrations of hs-CRP were associated with the higher concentration proinflammatory markers.

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Inflammation in metabolically healthy and metabolically abnormal adolescents: The HELENA study

Cited by 29 publications

References 30 publications

Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents—A Multi-Cohort Study

Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents—A Multi-Cohort Study

Intraindividual coexistence of anthropometric undernutrition and “metabolic obesity” in Indian Children: A paradox that needs action

Association of Lifestyle and Body Composition on Risk Factors of Cardiometabolic Diseases and Biomarkers in Female Adolescents

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