Endocrine Abstracts

Background: The increase of global childhood obesity has led to an increase of associated co-morbidities also at a young age. The pro-inflammatory state and insulin resistance are two master regulators of several complications, including hypertension and pre-diabetes frequently connected in a complex cross-talk.

Aim: To evaluate the relationship between glucose alterations and blood pressure and the pathogenetic involvement of the renin-aldosterone system (RAAS) in pediatric obesity.

Methods: We retrospectively evaluated 800 paediatric subjects (11.4 ± 3.1 years) with overweight or obesity at the first visit with a complete clinical and metabolic screening (BMI, BMI-SDS, blood pressure, glucose, and insulin levels during an OGTT). Aldosterone and renin were measured with chemiluminescence, and their ratio (ARR) was calculated.

Results: 774 patients had all the parameters. 11.5% of patients were with overweight and 88.5% with obesity. Blood pressure has been characterized following the last American Academy of Pediatrics guidelines: 679 patients (87,6% 88.0%) had hypertension (HTN). Of them, 38 (5%) had elevated blood pressure, 226 (29.2%) were classified as HTN stage 1, and 414 (53.4%) stage 2. Regarding glucose levels, 41 subjects had impaired glucose levels, (IFG), 52 impaired glucose tolerance (IGT), 3 type 2 diabetes (T2DM), and a totally 80 subjects had one or more glucose alterations (IFG/IGT/T2DM). Patients with IFG (P<0.01), IGT (P<0.02), or T2DM/glucose alterations (P<0.02) were more frequently with HTN. Blood pressure levels were higher in subjects with glucose alterations (P<0.04) than those with normal glucose levels (NGT). OGTT glucose levels and HOMA-IR (P<0.002) were higher in subjects with the three HTN stages than those with normal levels. Subjects with glucose levels > 155 mg/dl after 60’ at OGTT had more frequent HTN (P<0.001) and higher diastolic blood pressure levels (P<0.002) than NGT. We also found increased activation of the renin-angiotensin-aldosterone system (RAAS), positively correlated with BMI and female gender, that mainly characterized subjects in HTN stage 2. Aldosterone levels were higher in subjects with glucose levels > 155 mg/dl after 60’ at OGTT than those without it (P<0.003).

Conclusions: Already in childhood obesity, there is a close relationship between insulin resistance, glucose alterations, hypertension, and RAAS. The identification of specific risk categories, such as the presence of altered blood glucose or hypertension, could provide risk indicators to close clinical surveillance for the prevention and identification of complications and follow-up of organ damage.