Endothelial dysfunction is related to insulin resistance and inflammatory biomarker levels in obese prepubertal children

BACKGROUND: The metabolic syndrome (MS) is associated with insulin resistance (IR), a systemic low-grade inflammatory state and endothelial dysfunction. These disorders may arise at a very early age in obese children. This study aimed to investigate the relationship between endothelial dysfunction and both IR and inflammation in prepubertal obese children. METHODS AND RESULTS: Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) levels were measured in 46 obese prepubertal children aged 6-9, and in 46 non-obese, age-and sex-matched controls; the possible association of these levels with MS, various inflammatory biomarkers and plasminogen activator inhibitor-1 (PAI-1) was analyzed. Obese children displayed significantly elevated values for sICAM-1 (P=0.008), vWF (P=0.034), insulin (P=0.006), homeostasis model assessment for IR (HOMA-IR; P=0.003), C-reactive protein (CRP) (P<0.001), PAI-1 (P=0.002) and leptin (P<0.001). Nonsignificant differences were found in interleukin 6 (IL-6) levels. In the obese group, sICAM-1 showed a positive correlation with insulin (P=0.013), HOMA-IR (P=0.015), CRP (P=0.020), IL-6 (P=0.023) and PAI-1 (P=0.015). Corrected for age and sex, insulin, HOMA-IR, IL-6 and CPR were found to be independent predictive factors for sICAM-1. CONCLUSIONS: Prepubertal obese children displayed alterations indicative of endothelial dysfunction as well as disorders typical of MS. An association was established between endothelial dysfunction, IR, inflammation and inappropriate fibrinolysis in the children studied.