Imbalance of fat molecules predicts risk in children with PWS: Study
Simple ratio found to accurately detect metabolic syndrome
An imbalance of fatty molecules in the blood, as assessed by the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), can accurately detect metabolic syndrome in children and adolescents with Prader-Willi syndrome (PWS), a study has shown.
Metabolic syndrome is a cluster of health conditions, including abdominal obesity, high blood pressure, and high blood sugar, that together increase the risk for diabetes and cardiovascular diseases like heart disease and stroke.
“The TG/HDL-C ratio, which requires only two standard biochemical markers, provides the same accuracy as more complex indexes in detecting [metabolic syndrome] in children and adolescents with PWS, making it the optimal predictor … in this population,” researchers wrote.
The study, “Assessing Metabolic Syndrome Risk in Children and Adolescents with Prader–Willi Syndrome: A Comparison of Index Performance,” was published in the Journal of Clinical Medicine by a team of researchers in Italy.
Early recognition of metabolic syndrome ‘could improve … life expectancy’
PWS is caused by the loss of paternally inherited genes at a particular region of the DNA. This results in the disease’s symptoms, such as muscle weakness, behavioral and cognitive problems, and excessive appetite, which increases the risk of obesity.
Life expectancy for people with PWS is reduced relative to the general population, mainly due to the impact of obesity and associated complications. Obesity is typically associated with metabolic syndrome, a condition marked by at least three of the following: abdominal obesity, elevated blood sugar, high blood pressure, high blood levels of the fatty molecule triglycerides, and low blood levels of high-density lipoprotein cholesterol (HDL-C), also known as good cholesterol.
“While the metabolic profile of PWS patients is usually more favorable than that of individuals with simple obesity, due to lower [organ fat], previous research has shown that obese individuals with PWS had a similar prevalence of [metabolic syndrome] to that of obese controls, both in pediatric and adult populations,” the researchers wrote.
Given that metabolic syndrome may contribute to the early mortality in PWS, “early recognition and treatment of [metabolic syndrome] could improve both health and life expectancy in these patients,” they added.
Ratio ‘could contribute to optimizing the clinical management of PWS’
To assess the accuracy of various body composition indices in predicting metabolic syndrome in children and adolescents with PWS, the team retrospectively examined data from 124 pediatric PWS patients (63 boys and 61 girls). They were enrolled at nine specialized PWS reference centers across Italy between June 2021 and January 2024.
Participants had a mean age of 13.6 years, and more than half (56.4%) were obese, according to the body mass index (BMI), a ratio of weight to height.
Overall, 24 participants (19.4%) had metabolic syndrome. Compared to those who did not have metabolic syndrome, those with the condition had a significantly worse metabolic profile. This included a higher body fat mass index, which quantifies the fat mass relative to height (18.8 vs. 9.5), and a higher visceral adiposity index, which estimates fat accumulation around organs (2.1 vs. 0.9).
Children and adolescents with metabolic syndrome also had significantly higher waist-to-height ratios (WtHR; 0.7 vs. 0.6), which is used to assess abdominal obesity, as well as higher total cholesterol/HDL-C (4 vs. 3) and triglyceride/HDL-C (3.4 vs. 1.4) ratios, both of which are commonly used to estimate the risk for cardiovascular diseases.
Their cardiometabolic index (CMI), which consists of WtHR multiplied by the TG/HDL-C ratio and assesses the risk for cardiovascular and metabolic conditions, was also higher than that of children and adolescents without metabolic syndrome (2.5 vs. 0.8).
No differences were found between boys and girls affected by metabolic syndrome.
Altogether, these findings suggest that the TG/HDL-C ratio is a reliable tool for detecting [metabolic syndrome] in children and adolescents with PWS, consistent with observations in the general population.
Further analysis revealed that, when considering all participants, the TG/HDL-C ratio and the CMI were the best performers at discriminating PWS patients with metabolic syndrome from those without, with an accuracy of 90%.
In boys, CMI showed a significantly higher accuracy at predicting metabolic syndrome than TG/HDL-C (91% vs. 89.4%), while there were no significant differences between the two indices in girls.
“Consequently, the TG/HDL-C ratio was chosen as the preferred index due to its simplicity, because it did not require any additional [body] measures compared to CMI,” the researchers wrote.
Considering all participants, there was a significant association between the TG/HDL-C ratio and all parameters of metabolic syndrome, including BMI, blood sugar levels, blood pressure, and blood HDL-C and triglyceride levels.
“Altogether, these findings suggest that the TG/HDL-C ratio is a reliable tool for detecting [metabolic syndrome] in children and adolescents with PWS, consistent with observations in the general population,” the team wrote. “The use of the TG/HDL-C ratio, both in obese and non-obese subjects, is recommended as a practical tool to be considered in current screening guidelines.”
They added that it “could contribute to optimizing the clinical management of PWS,” the researchers wrote.
They emphasized, however, that larger studies, following patients over time, are needed to confirm the predictive potential of the TG/HDL-C ratio in children and adolescents with PWS.
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