Adropin, asymmetric dimethyl arginine, symmetric dimethyl arginine and N-monomethyl-l-arginine levels as early cardiovascular risk markers in obese children

Introduction and Objective: Obesity is an important health problem that occurs as a result of excessive accumulation of adipose tissue in the body and its frequency is gradually increasing. It is known that 1/3 of obese children and 2/3 of obese adolescents remain obese when they reach adulthood. Nowadays, increasing childhood obesity and related complications are becoming more and more important. Obesity is an independent major risk factor for the development of CVD. Therefore, early diagnosis of obesity, prevention of its progression and treatment are important in terms of preventing permanent pathologies that may occur in adulthood. For this purpose, many hemodynamic, metabolic and inflammatory markers are used. However, the fact that existing markers are affected by many factors such as age, nutritional status, growth and hormonal change in childhood causes problems regarding their reliability and standardization. For this reason, determining CVD risk in childhood obesity is still one of the most interesting topics. In our study, we aimed to investigate adropin, ADMA, SDMA and L-NMMA levels as potential early CVD risk markers in obese children. Materials and Methods: In the study, 98 obese patients diagnosed with obesity with a BMI SDS > + 2 percentile and 78 healthy controls with a BMI SDS <+1 percentile were included. Sociodemographic and anthropometric characteristics, metabolic, inflammatory, and echocardiographic parameters, as well as adropin, ADMA, SDMA and L-NMMA levels were compared between the groups. The relationships of adropin, ADMA, SDMA and L-NMMA with other CVD markers were investigated. Results: Lifestyle and family history of heart disease were found to be similar in both groups. Anthropometric measurements, metabolic parameters, hs-CRP, ECD,LVMI and CIMT were found to be significantly higher in the obese group compared to the control group. Serum adropin levels were found to be significantly lower in the obese group compared to the control group. Serum ADMA, SDMA, L-NMMA levels were found to be similar in both groups. In the study group, a negative correlation was found between adropin and BMI SDS, WC, WC/HC, DAP, insulin, HOMA-IR, TG, ALT, hs-CRP, ECD, LVMI and CIMT. While there was a negative correlation between ADMA and DAP, a positive correlation was found between HbA1c, AST and ALT. While there was a negative correlation between L-NMMA and DAP and ECD, a positive correlation was found between HbA1c, glucose and hs-CRP. In the multiple linear regression analysis, it was determined that the independent variables effective on adropin levels were SAP, DAP, and CIMT; on ADMA levels were SDMA, WC/HC, DAP, HbA1c; on SDMA levels were TG, LDL cholesterol, and ADMA; on L-NMMA levels were WC/HC, SAP, hs-CRP, and ECD. Sensitivity and selectivity of adropin, ADMA, SDMA and L-NMMA were found to be low in the diagnosis of obesity. Conclusion: Adropin levels are low in obese children, and there are significant relationships between adropin and anthropometric, hemodynamic, metabolic, inflammatory and echocardiographic parameters. Its reliability can be increased when used together with other parameters in determining the CVD risk in obese children. The use of methyl arginines as a CVD risk marker in obese children may not be reliable enough. Keywords: obesity, cardiovascular disease, adropin, asymmetric dimethylarginine, symmetric dimethyl arginine, N-monomethyl-L-arginine