Affiliation:
1. Division of Endocrinology and Diabetes, School of Medicine and Health Sciences, The George Washington University and Clinical and Translational Science Institute at Children’s National, Children’s Research Institute, Children’s National Health System, Washington, District of Columbia; Divisions of
2. Gastroenterology, Hepatology, and Nutrition,
3. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; and
4. Developmental Behavioral Pediatrics, and
5. Familial Hypercholesterolemia Foundation, Pasadena, California
6. Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;
Abstract
BACKGROUND AND OBJECTIVES:
Whether BMI captures adiposity and cardiometabolic risk in Down syndrome (DS), a condition associated with obesity, short stature, and altered body proportions, is not known. We compared cardiometabolic risk measures in youth with DS and typically developing matched controls.
METHODS:
Youth with (n = 150) and without (n = 103) DS of comparable age (10–20 years), sex, race, ethnicity, and BMI percentile underwent whole-body dual-energy X-ray absorptiometry, fasting glucose, insulin, lipids, lipoprotein particles, inflammatory factors, and when BMI percentile ≥85, an oral glucose tolerance test.
RESULTS:
Sixty-four percent of youth with DS had BMI percentile ≥85. Among these, no difference in glucose, insulin, or insulin resistance was detected, but prediabetes was more prevalent with DS (26.4% vs 10.3%; P = .025) after adjustment for demographics, pubertal status, and BMI z score (odds ratio = 3.2; P = .026). Among all participants, those with DS had higher low-density lipoprotein cholesterol (median 107 [interquartile range 89–128] vs 88.5 [79–103] mg/dL; P < .00005), triglycerides (89.5 [73–133] vs 71.5 [56–104] mg/dL; P < .00005), non–high-density lipoprotein cholesterol (non-HDL-C; 128 [104–153] vs 107 [92–123] mg/dL; P < .00005), and triglycerides/HDL-C (2.2 [1.6–3.4] vs 1.7 [1.1–2.5] mg/dL; P = .0003) and lower levels of HDL-C (41 [36.5–47] vs 45 [37–53] mg/dL; P = .012). DS youth had higher high-sensitivity C-reactive protein, interleukin-6, small low-density lipoprotein particles (LDL-P), and total LDL-P, but similar LDL-P size. Youth with DS had less visceral fat (VFAT), fat mass, and lean mass for BMI z score, but greater VFAT at higher fat mass. However, VFAT did not fully explain the increased prevalence of dyslipidemia or prediabetes in youth with DS.
CONCLUSIONS:
Despite similar insulin resistance, youth with DS had greater prevalence of dyslipidemia and prediabetes than typically developing youth, which was not fully explained by VFAT.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Cited by
25 articles.
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