Increased ApoB/ApoA1 ratio is associated with excess weight, body adiposity, and altered lipid profile in children

Castro, Ana Paula Pereira; Hermsdorff, Helen Hermana Miranda; Milagres, Luana Cupertino; Albuquerque, Fernanda Martins de; Filgueiras, Mariana de Santis; Rocha, Naruna Pereira; Novaes, Juliana Farias de

doi:10.1016/j.jped.2017.12.008

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Original articles • J. Pediatr. (Rio J.) 95 (2) • Mar-Apr 2019 • https://doi.org/10.1016/j.jped.2017.12.008 copy

Increased ApoB/ApoA1 ratio is associated with excess weight, body adiposity, and altered lipid profile in children^☆ ☆ Please cite this article as: Castro AP, Hermsdorff HH, Milagres LC, Albuquerque FM, Filgueiras MS, Rocha NP, et al. Increased ApoB/ApoA1 ratio is associated with excess weight, body adiposity, and altered lipid profile in children. J Pediatr. 2019;95:238-46.

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Abstract

Objective:

To investigate ApoB/ApoA1 ratio and its association with cardiovascular risk factors in children.

Methods:

Cross-sectional study with 258 children aged 8 and 9 years old, enrolled in all urban schools in the city of Viçosa-MG. Anthropometric and body composition assessment, as well as biochemical profile of the children was performed. Socioeconomic variables and sedentary lifestyle were evaluated through a semi-structured questionnaire.

Results:

Many children had excess weight (35.2%), abdominal adiposity (10.5%), and body fat (15.6%), as well as increased ApoB/ApoA1 ratio (14.7%), total cholesterol (51.8%), and triglycerides (19.8%). Children with excess weight and total and central fat had a higher prevalence of having a higher ApoB/ApoA1 ratio, as well as those with atherogenic lipid profile (increased LDL-c and triglycerides and low HDL-c). A direct association was found between the number of cardiovascular risk factors and the ApoB/ApoA1 ratio (p = 0.001), regardless of age and income.

Conclusion:

The increased ApoB/ApoA1 ratio was associated with excess weight, body adiposity (total and central), and altered lipid profile in children. Children with a higher number of cardiovascular risk factors had higher ApoB/ApoA1 ratio, in both genders.

KEYWORDS
Children; Dyslipidemias; Adiposity; Apolipoproteins

Variables	Boys, n (%)	Girls, n (%)	p-value
Age
8 years	60 (53.6)	65 (44.5)	0.149
9 years	52 (46.4)	81 (55.5)	0.149
TPA
Active (>300 min/week)	78 (69.6)	117 (80.1)	0.052
Inactive (≤300 min/week)	34 (30.4)	29 (19.9)	0.052
Waist/height ratio
≤0.5	18 (16.1)	30 (20.5)	0.360
>0.5	94 (83.9)	116 (79.5)	0.360
Excess weight
No (z-score ≥-2 and <1)	74 (66.1)	93 (63.7)	0.693
Yes (z-score ≥1)	38 (33.9)	53 (36.3)	0.693
Neck circumference (cm)
Normal	97 (86.6)	121 (82.9)	0.412
Increased	15 (13.4)	25 (17.1)	0.412
Waist circumference (cm)
<90th percentile	100 (89.3)	131 (89.7)	0.909
≥90th percentile	12 (10.7)	15 (10.3)	0.909
Body fat (%)
<85th percentile	96 (85.7)	121 (82.9)	0.537
≥85th percentile	16 (14.3)	25 (17.1)	0.537
GF/AF (%)
<85th percentile	95 (84.8)	123 (84.2)	0.899
≥85th percentile	17 (15.2)	23 (15.8)	0.899
SBP (mmHg)
Normal	105 (93.8)	136 (93.8)	0.989
Increased	7 (6.2)	9 (6.2)	0.989
DBP (mmHg) ^a a Fisher's exact test.
Normal	108 (96.4)	143 (98.6)	0.408
Increased	4 (3.6)	2 (1.4)	0.408
ApoB (mg/dL)
<85th percentile	99 (88.4)	122 (83.6)	0.272
≥85th percentile	13 (11.6)	24 (16.4)	0.272
ApoA1 (mg/dL)
<85th percentile	24 (21.4)	14 (9.6)	0.008
≥85th percentile	88 (78.6)	132 (90.4)	0.008
ApoB/ApoA1
<85th percentile	99 (88.4)	121 (82.9)	0.215
≥85th percentile	13 (11.6)	25 (17.1)	0.215
Total cholesterol (mg/dL)
<150	54 (48.2)	70 (48.3)	0.992
≥150	58 (51.8)	75 (51.7)	0.992
Triglycerides (mg/dL)
<100	98 (87.5)	108 (74.5)	0.009
≥100	14 (12.5)	37 (25.5)	0.009
LDL-c (mg/dL)
<100	80 (72.1)	104 (71.2)	0.883
≥100	31 (27.9)	42 (28.8)	0.883
HDL-c (mg/dL)
<45	87 (77.7)	94 (64.8)	0.025
≥45	25 (22.3)	51 (32.5)	0.025
Non-HDL-c (mg/dL) ^a a Fisher's exact test.
<130	110 (98.2)	143 (97.9)	1.00
≥130	2 (1.8)	3 (2.1)	1.00
Ultrasensitive CRP (mg/L)
<85th percentile	100 (89.3)	135 (92.5)	0.374
≥85th percentile	12 (10.7)	11 (7.5)	0.374
Leptin (ng/mL)
<85th percentile	99 (89.2)	107 (76.4)	0.009
≥85th percentile	12 (10.8)	33 (23.6)	0.009
Homocysteine (ng/mL)
<85th percentile	83 (74.1)	113 (77.4)	0.540
≥85th percentile	29 (25.9)	33 (22.6)	0.540

Variables	ApoB/ApoA1, <85th percentile, n (%)	ApoB/ApoA1, ≥85th percentile, n (%)	p-value
TPA
Active (>300 min/week)	172 (78.2)	23 (60.5)	0.019
Inactive (≤ 300 min/week)	48 (21.8)	15 (39.5)	0.019
Waist/height ratio
≤ 0.5	185 (84.1)	25 (65.8)	0.007
>0.5	35 (15.9)	13 (34.2)	0.007
Excess weight
No (z-score ≥-2 and <1)	150 (68.2)	17 (44.7)	0.005
Yes (z-score ≥1)	70 (31.8)	21 (55.3)	0.005
Neck circumference (cm)
Normal	188 (85.5)	30 (78.9)	0.306
Increased	32 (14.5)	8 (21.1)	0.306
Waist circumference (cm) ^a a Fisher's exact test.
≤90th percentile	22 (10.0)	5 (13.2)	0.567
>90th percentile	198 (90.0)	33 (86.8)	0.567
Body fat (%)
<85th percentile	188 (85.5)	29 (76.3)	0.155
≥85th percentile	32 (14.5)	9 (23.7)	0.155
GF/AF (%)
<85th percentile	190 (86.4)	28 (73.7)	0.046
≥85th percentile	30 (13.6)	10 (26.3)	0.046
Total cholesterol (mg/dL)
<150	116 (53.0)	8 (21.1)	<0.001
≥150	103 (47.0)	30 (78.9)	<0.001
Triglycerides (mg/dL)
<100	186 (84.9)	20 (52.6)	<0.001
≥100	33 (15.1)	18 (47.4)	<0.001
LDL-c (mg/dL)
<100	171 (78.1)	13 (34.2)	<0.001
≥100	48 (21.9)	25 (65.8)	<0.001
HDL-c (mg/dL)
<45	165 (75.3)	16 (42.1)	<0.001
≥45	54 (24.7)	22 (57.9)	<0.001
Non-HDL-c (mg/dL)
<130	196 (89.1)	21 (55.3)	<0.001
≥130	24 (10.9)	17 (44.7)	<0.001
Leptin (ng/mL)
<85th percentile	178 (83.2)	28 (75.7)	0.272
≥85th percentile	36 (16.8)	9 (24.3)	0.272
PCR (mg/L)
<85th percentile	187 (85)	30 (78.9)	0.346
≥85th percentile	33 (15)	8 (21.1)	0.346
Homocysteine (ng/mL)
<85th percentile	168 (76.4)	28 (73.7)	0.686
≥85th percentile	52 (23.6)	10 (26.3)	0.686

Variables	ApoB/ApoA1 (≥85th percentile)
	PR	95% CI	p-value
TPA ^a a Adjustment by gender, age, and income.
Active (≥ 300 minutes/week)	1	-
Inactive (<300 minutes/week)	1.31	0.63-2.75	0.432
Nutritional status ^b b Adjustment by gender, age, income, and physical activity.
Normal weight	1	-
Excess weight	2.14	1.20-3.80	0.001
Waist/height ratio ^b b Adjustment by gender, age, income, and physical activity.
<0.5	1	-
≥0.5	2.21	1.24-3.94	0.004
Waist circumference ^b b Adjustment by gender, age, income, and physical activity.
<90th percentile	1	-
≥90th percentile	1.82	1.02-3.25	0.003
Body fat ^b b Adjustment by gender, age, income, and physical activity.
Boy < 20%, girl < 25%	1	-
Boy ≥ 20%, girl ≥ 25%	1.92	1.02-3.61	0.009
AF/GF^b b Adjustment by gender, age, income, and physical activity.
<85th percentile	1	-
≥85th percentile	1.80	0.93-3.47	0.003
Total cholesterol ^c c Adjustment by gender, age, income, and body fat.
<150 mg/dL	1	-
≥150 mg/dL	3.39	1.61-7.12	<0.001
HDL-c^c c Adjustment by gender, age, income, and body fat.
>45 mg/dL	1	-
<45 mg/dL	2.98	1.62-5.49	<0.001
LDL-c^c c Adjustment by gender, age, income, and body fat.	1	-
<100 mg/dL
≥100 mg/dL	4.66	2.55-8.54	<0.001
Non-HDL-c^c c Adjustment by gender, age, income, and body fat.
<130 mg/dL	1	-
≥130 mg/dL	3.49	1.39-8.77	<0.001
Triglycerides
<100 mg/dL	1	-
≥100 mg/dL	3.59	2.06-6.25	<0.001

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[1] * Corresponding author. E-mail:anaenut@gmail.com (A.P. Castro).