The evaluation of the relationship between serum levels of A-FABP, sVCAM-1, sE--selectin, adiponectin and carotid intima media thickness in pediatric obese patients

There are some parameters required informing us about the early atherosclerotic changes in the follow-up of obesity for demonstrating the damage that obesity and non-alcoholic fatty liver disease (NAFLD) gave to the cardiovascular system in preclinical stages. The aim of this study is to determine the serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and sE-selectin which are adhesion molecules participating the atherosclerosis in endothelial activation stage and also the serum levels of adiponectin and adipocyte fatty acide binding protein (A-FABP) which is expressed by adipocytes and thought to be involved in atherosclerosis in paediatric obese patients. We also investigated the relationship between these parameters and carotid intima media thickness (IMT) which is a surrogate marker of early atherosclerosis. These parameters were also evaluated regarding the presence of nonalcoholic fatty liver disease among obese patients.A total of 56 children, composed of 31 obese children diagnosed as exogen obesity and 26 healthy children with age interval 10-18 years were enrolled in the study. Serum levels of sVCAM-1, sE-selektin, adiponektin, AFABP and routine biochemical parameters (glucose, liver enzymes, lipid profile, insülin) were determined in all children. Insulin resistance were evaluated by homeostasis model assessment insulin-resistance (HOMA-IR) index that was calculated from fasting insulin and glucose values. Serum levels of sVCAM-1, sE-selectin, adiponectin and AFABP levels were determined by ELISA. All patients underwent carotide Doppler ultrasonography for the evaluation of IMT, and obese patients underwent abdominal ultrasonography for the evaluation of NAFLD. The children were divided into three groups as NAFLD (-) obese, NAFLD (+) obese and healthy children. Statistical analysis was performed by SPSS 15.0 .There were significant differences for liver enzymes, lipid levels and insulin levels between obese and healthy children. Serum adiponectin levels were lower (p= 0,035 ); serum A-FABP (p= 0,000), sE-selektin (p= 0,012) and IMT (p= 0,037) were higher in obese patients compared to control group; however there was no significant difference for sVCAM-1 levels between groups. When obese group is evaluated for NAFLD, HOMA-IR levels were higher in NAFLD (+) obese group compared to NAFLD (-) obese and control groups. Serum levels of sE-selectin and A-FABP were higher in both NAFLD (+) and NAFLD (-) obese groups when compared with control group. No significant differences were found between groups for adiponectin levels. İMK levels of NAFLD (+) obese group were significantly higher compared to control (p= 0,032 ); however there was no significant difference between NAFLD (-) obese and control groups. Significant associations between sE-selectin and AST, ALT, GGT, triglycerid, A-FABP levels proceeded after adjustment for age and sex. Correlation between adiponectin and weight for height, ALT, GGT, triglycerid, HOMA-IR were not changed after adjustment for age and sex. Significant associations between A-FABP and weight for height, ALT, GGT, trigliserid, HDL-K, HOMA-IR were not changed after adjustment for age and sex.In conclusion, serum levels of adiponectin and A-FABP changed with increased adipose tissue and it was shown that these parameters were associated with insulin resistance that was enrolled in pathogenesis of NAFLD. There was no significant association between IMT that was the predictor of subclinic atherosclerosis and serum levels of adhesion molecules and adipokines; however age- and sex adjusted serum levels of A-FABP were associated with sE-selectin which reminds us that A-FABP may have an important role in the pathogenesis of endothelial injury. It was shown that sE-selectin levels increase as a predictor of endothelial damage in paediatric obesity and IMT increase predicting the structural vascular wall changes just develop if fatty liver disease accompany obesity. According to our results, in the follow-up of early atherosclerotic changes in paediatric obese patients, determining serum levels of sE-selectin and A-FABP may be elucidatory, however carotis intima media thickness measurement with abdominal ultrasonography may be more helpful in fatty liver disease accompanying obesity.