Supervisors info:
Ευαγγελία Χαρμανδάρη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Φλώρα Μπακοπούλου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Μαστοράκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
BACKGROUND: Thyroid hormones regulate metabolism and play a significant role in cardiovascular homeostasis. However, the association between thyreotropin (TSH), thyroid hormones and cardiometabolic risk factors has not been elucidated in children and adolescents with overweight and obesity.
AIM: To evaluate the relation of TSH and thyroid hormones with cardiometabolic parameters in obese, overweight and normal-weight children and adolescents before and after the implementation of a comprehensive, multidisciplinary, personalized life-style intervention program for 1 year.
METHODOLOGY: One thousand and three hundred eleven (n = 1.311) children and adolescents aged 2–18 years (mean age ± SD: 10.10 ± 2.92 years) were studied prospectively. Subjects were classified as obese (n = 727, 55.45%), overweight (n = 384, 29.29%) or with normal body mass index (BMI) (n = 200, 15.26%) according to the International Obesity Task Force cutoff points. All participants were evaluated by a multidisciplinary team at frequent intervals, received personalized guidance on diet and physical exercise and were studied prospectively for 1 year. Detailed clinical evaluation and laboratory investigations were performed at the beginning and at the end of the study.
RESULTS: Subjects with obesity had significantly higher systolic (SBP) and diastolic (DBP) blood pressure, waist circumference, hip circumference and waist-to-hip ratio than overweight and normal-BMI subjects on both assessments. In addition, they had significantly higher concentrations of fasting plasma glucose and serum insulin, HbA1C, triglycerides, LDL-cholesterol, uric acid and ApoB, and significantly lower concentrations of HDL-cholesterol, ApoA1 and Vitamin D than their overweight and normal-BMI counterparts. Baseline total T3 concentrations were positively associated with uric acid and HbA1C and negatively associated creatinin, while Free T4 concentrations were inversely associated with baseline insulin concentrations. No associations were found between baseline TSH concentrations and cardiometabolic risk parameters. Following the 1-year of multidisciplinary management interventions, some cardiometabolic indices, including lipids, HbA1C, ALT and γGT, improved significantly in all subjects. In all subjects, changes in Free T4 concentrations had a significant negative association with changes in cholesterol and insulin concentrations, while T3 changes had a significant positive association with changes in uric acid, glucose, HbA1C and TG and a significant negative association with changes in creatinine and HDL. Finally, TSH showed a significant positive association with changes in cholesterol, triglyceride and glucose concentrations.
CONCLUSIONS: In overweight and obese children and adolescents thyroid hormones are associated with indices conferring cardiometabolic risk. Changes in Free T4, T3 and TSH concentrations are also associated with changes in various cardiometabolic parameters, such as cholesterol, glucose, triglyceride and creatinine.
Keywords:
Obesity, Thyroid hormone, Cardiometabolic risk factors, Thyroid function, Overweight
