Serum amyloid A in children and adolescents: association with overweight and carotid intima-media thickness

Barbosa, Maria Vitória Mareschi; Faria, João Carlos Pina; Coelho, Stephanie Ramos; Fonseca, Fernando Luiz Affonso; Haddad, Andrea Paula Kafejian; Souza, Fabíola Isabel Suano de; Sarni, Roseli Oselka Saccardo

doi:10.31744/einstein_journal/2023AO0251

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ORIGINAL ARTICLE • einstein (São Paulo) 21 • 2023 • https://doi.org/10.31744/einstein_journal/2023AO0251 copy

Serum amyloid A in children and adolescents: association with overweight and carotid intima-media thickness

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To compare serum amyloid A concentrations between overweight and eutrophic children and adolescents and to relate it to lipid profiles, glucose tolerance, and carotid intima-media thickness.

Methods

One hundred children and adolescents (mean age: 10.8±3.16 years) were included and divided into two groups: overweight and non-overweight. The following were evaluated: Z-score body mass index, carotid intima-media thickness, lipid metabolism biomarkers (lipid profile and apolipoproteins A1 and B), inflammatory biomarkers (ultra-sensitive C-reactive protein and serum amyloid A), and glucose homeostasis model assessment of insulin resistance.

Results

The groups were homogeneous in age, sex, and pubertal stage. Higher levels of triglycerides, apolipoprotein B, homeostasis model assessment of insulin resistance, ultrasensitive C-reactive protein, serum amyloid A, and carotid intima-media thickness were observed in the overweight group. In the multivariate analysis, age (OR=1.73; 95%CI: 1.16-2.60, p=0.007), Z-score body mass index (OR=3.76; 95%CI: 1.64-8.59, p=0.002), apolipoprotein-B (OR=1.1; 95%CI: 1.01-1.2, p=0.030), and carotid intima-media thickness (OR=5.00; 95%CI: 1.38-18.04, p=0.014) were independently associated with serum amyloid A levels above the fourth quartile of the studied sample (>9.4mg/dL).

Conclusion

Overweight children and adolescents had higher serum amyloid A concentrations than eutrophic children. There was an independent association between higher concentrations of serum amyloid A and Z-score, body mass index, apolipoprotein B, and carotid intima-media thickness, indicating the importance of this inflammatory biomarker in identifying the early risk of atherosclerosis.

Serum amyloid A protein; Carotid intima-media thickness; Apolipoproteins; Pediatric obesity; Overweight; Child

Highlights

■ Serum amyloid A is an acute phase inflammatory protein.

■ Excess weight causes meta-inflammation with a consequent increase in the synthesis of C-reactive protein and serum amyloid A.

■ Carotid intima-media thickness measurement evaluates atherosclerosis before atheromatous plaque formation.

Variables		Overweight	Non-overweight	p value*
Sex	Male	25 (50)	25 (50)	0.579
Age	<10 years	21 (42.0)	21 (42.0)	0.580
Waist-to-height ratio	>0.5	40 (80.0)	5 (10.0)	<0.001
Pubertal development	Prepubescent	22 (44.0)	24 (48.0)	0.841
Total cholesterol	>170mg/dL	11 (22.0)	14 (28.0)	0.645
LDL-C	>110mg/dL	9 (18.0)	9 (18.0)	0.602
HDL-C	<45mg/dL	28 (56.0)	21 (42.0)	0.230
Non-HDL-C	>120mg/dL	13 (26.0)	13 (26.0)	0.590
Triglycerides	>90mg/dL	22 (44.0)	13 (26.0)	0.093
Apolipoprotein-B	>90mg/dL	21 (42.0)	9 (18.0)	0.016
Apolipoprotein-A1	<120mg/dL	18 (36.0)	10 (20.0)	0.118

Variables	Overweight	Non-overweight	p value*
Age (years)	10.8±3.2	10.8±3.1	0.924^†
Body mass index, Z-score	2.7±1.0	-0.05±0.65	<0.001^†
Waist-to-height ratio, cm	0.56±0.06	0.45±0.04	<0.001^†
Total cholesterol	154.4±27.3	153.5±25.6	0.807^†
LDL-C, mg/dL	93.1±26.8	90.2±22.8	0.562^†
HDL-C, mg/dL	43.4±8.6	49.0±10.3	0.004^†
Non-HDL-C, mg/dL	111.0±27.4	104.6±24.7	0.218^†
Triglycerides, mg/dL	79.1 (62.7-107.4)	63.3 (49.9-87.9)	0.008^‡
Apolipoprotein-B, mg/dL	85.9±22.2	73.7±19.8	0.005^†
Apolipoprotein-A1, mg/dL	126.9±20.7	139.9±21.5	0.003^†
Total cholesterol / HDL, mg/dL	3.68±0.88	3.23±0.72	0.007^†
Triglycerides / HDL	1.80 (1.37-2.71)	1.36 (0.98-2.07)	0.005^‡
LDL / Apolipoprotein -B, mg/dL	1.10±0.20	1.19±0.14	0.010^†
Apolipoprotein-B / A1, mg/dL	1.58±0.50	1.93±0.46	0.001^†
Insulin, uU/mL	11.7 (7.3-14.7)	5.3 (3.1-9.5)	0.001^‡
Glucose, mg/dL	81.6±7.7	78.0±8.2	0.028^†
HOMA-IR	2.26 (1.51-2.87)	1.01 (0.57-2.00)	0.025^‡
us-CRP, mg/L	1.0 (0.6-2.4)	0.3 (0.2-0.9)	0.001^‡
Serum amyloid A, mg/L	9.4 (3.4-15.5)	2.8 (1.7-3.7)	0.001^‡
CIMT, mm	0.284±0.087	0.252±0.050	0.029^†

	OR	95%CI		p value
Model I
Age	1.739	1.163	2.602	0.007
Body mass index Z-score	3.759	1.643	8.598	0.002
Apolipoprotein-A I	0.971	0.920	1.024	0.274
Apolipoprotein-B	1.102	1.010	1.203	0.030
HOMA-IR	1.239	0.785	1.956	0.357
us-CRP	1.521	0.912	2.537	0.108
CIMT	5.004	1.387	18.048	0.014
Dependent variable: serum amyloid A (>fourth quartile >9.4mg/dL)
Model II
Age	0.186	0.984	1.474	0.072
Body mass index Z-score	0.253	0.906	1.832	0.159
Apolipoprotein-A1	-0.001	0.974	1.025	0.930
Apolipoprotein-B	-0.027	0.942	1.005	0.099
HOMA-IR	0.062	0.843	1.344	0.601
us-CRP	0.028	0.847	1.250	0.774
Serum amyloid A	0.052	0.988	1.123	0.114
Dependent variable: carotid intima-media thickness (>fourth quartile >0.3mm)

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[1] Corresponding author: João Carlos Pina Faria Avenida Lauro Gomes, 2.000 - Vila Sacadura Cabral Zip code: 09060-870 - Santo André, SP, Brazil Phone: (55 11) 4993-5400 E-mail: jocapf79@gmail.com