Macular Variability in Children and Adolescents with Metabolic Syndrome: A Cross-sectional Study Examining the Associations with Anthropometric Measurements, Metabolic Parameters and Inflammatory Markers

Abstract

Macular damage may be observed in obesity and metabolic syndrome (MetS), a condition which leads to chronic subclinical inflammation and affects most organ systems. To investigate the association between macular variability and anthropometric measurements, metabolic parameters, and inflammatory markers in children and adolescents with MetS. Methods: Two hundred and twenty eyes of 62 obese and 48 healthy children and adolescents were examined. Bilateral macular retinal thickness (MRT) and macular retinal volume (MRV) were measured in all subjects using optical coherence tomography. Associations between mean MRT and mean MRV and age, auxological measurements including body mass index standard deviation scores (BMI-SDS) and waist circumference-SDS (WC-SDS), metabolic parameters and inflammatory parameters including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio and systemic immune-inflammatory index (SIII) were investigated. Results: No statistically significant difference was observed between the groups in terms of age or sex distribution (p>0.05). Mean MRT (r=-0.326, p=0.007) and MRV (r=-0.303, p=0.007) values in the obese group with MetS decreased as homeostasis model assessmentinsulin resistance (HOMA-IR) values increased. SIII values were higher in obese groups, but particularly in obese subject with MetS, compared to the control group (p=0.021). The decrease in mean MRT (r=-0.544, p=0.046) and MRV (r=-0.651, p=0.031) in the obese subjects with MetS was negatively correlated with NLR. Mean MRT and MRV decreased in all obese subjects as SIII increased (p<0.05). Conclusion: This is the first study to show that mean MRT and MRV values decrease as BMI-SDS, WC-SDS and HOMA-IR increase in obese children and adolescents with MetS. NLR and SIII may serve as markers of chronic inflammation in obese children with MetS associated with macular damage.

Quantitatively Evaluating the Relationships between Insulin Resistance and Retinal Neurodegeneration with Optical Coherence Tomography in Early Type 2 Diabetes Mellitus

“…This finding means that IR could accelerate retinal neurodegeneration in the early stages of T2DM. Similar tendency was obtained in previous studies with obese or metabolic positive subjects [15,28]. In contrary, another study in patients with a long history of T2DM but no DR found that serum insulin levels and HOMA-IR values correlated inversely with macular microvascular impairment [31].…”

“…All these comorbidities complicate the challenges they face, subsequently causing chronic inflammation, microvascular damage, and oxidative stress. These factors would impair blood supply of microvessels, which in turn leads to oxidative stress and hypoxia in tissues [[15]]. Apoptosis of neural cells and tissue necrosis may then be triggered in the early course of diabetes development [[24]].…”

“…Insulin resistance (IR) could explain the coexistent risk factors in early T2DM [[13]], which is a clinical condition characterized by a decreased sensitivity to insulin in peripheral tissues and is strongly associated with metabolic diseases. Beyond diabetes, metabolic syndrome has also been proven to increase the risk of retinal neurodegeneration [[14], [15]]. IR is the most widely accepted pathophysiological mechanism in the occurrence of metabolic syndrome with the production of chronic inflammation and oxidative stress [[16]].…”

Obesity-induced ocular changes in children and adolescents: A review

“…Some studies have reported that these ocular parameters are significantly decreased in obese children (52,54). In one study, MRT and MRV values tended to be thinner with an increase in BMI-SDS and waist circumference standard deviation score (WC-SDS) (54). However, a clear link between obesity and decreased CT and MRT has not yet been established.…”

“…Obesity not only affects CT but also macular retinal thickness (MRT) and macular retinal volume (MRV). Some studies have reported that these ocular parameters are significantly decreased in obese children ( 52 , 54 ). In one study, MRT and MRV values tended to be thinner with an increase in BMI-SDS and waist circumference standard deviation score (WC-SDS) ( 54 ).…”