Abstract
Obesity and the metabolic syndrome are becoming increasingly prevalent not only in adults, but also in adolescents. The metabolic syndrome, a complex cluster of metabolic abnormalities, increases one's risk of developing type 2 diabetes and cardiovascular disease (CVD). Dyslipidemia, a key component of the metabolic syndrome, is highly associated with insulin resistance and contributes to increased CVD risk. Dyslipidemia has traditionally been assessed using a fasting lipid profile [i.e. fasting triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)]. However, the postprandial state predominates over the course of a day and non-fasting triglycerides independently predict CVD risk. In insulin resistant states, the intestine overproduces triglyceride-rich lipoprotein (TRL) particles, termed chylomicrons (CMs), following ingestion of a fat-containing meal, as well as in the fasting state. Along with elevated hepatic TRLs (i.e. very-low density lipoproteins), CMs contribute to remnant lipoprotein accumulation, small dense LDL particles, and reduced HDL-C, which collectively increase CVD risk. Given the early genesis of atherosclerosis and physiological metabolic changes during adolescence, studying postprandial dyslipidemia in the adolescent population is an important area of study. Postprandial dyslipidemia in the pediatric population poses a significant public health concern, warranting a better understanding of its pathogenesis and association with insulin resistance and CVD. This review discusses the metabolic syndrome, focusing on the link between insulin resistance, postprandial dyslipidemia, and CVD risk. Furthermore, the clinical significance and functional assessment of postprandial dyslipidemia, specifically in the adolescent population, is discussed in more detail.
Highlights
Obesity and insulin resistance are highly associated with additional metabolic abnormalities, collectively termed the metabolic syndrome (MetS)[1]
While specific cut-off values and emphasis of clinical features/ components vary between definitions of the MetS, they all require a partial combination of central obesity, elevated triglycerides (TG), reduced highdensity lipoprotein cholesterol (HDL-C), glucose intolerance, and increased blood pressure
Several studies in adolescents have shown an association of adiposity and insulin resistance with an atherogenic lipoprotein profile, as measured by Nuclear magnetic resonance (NMR) spectroscopy, including increased concentration of small LDL-P and large VLDL particle number (VLDL-P), decreased concentration of large LDL-P and large HDL particle number (HDL-P), as well as decreased LDL-P size and HDL-P size[111,113,114,115,116,117]
Summary
Obesity and insulin resistance are highly associated with additional metabolic abnormalities, collectively termed the metabolic syndrome (MetS)[1]. While specific cut-off values and emphasis of clinical features/ components vary between definitions of the MetS, they all require a partial combination of central obesity, elevated triglycerides (TG), reduced highdensity lipoprotein cholesterol (HDL-C), glucose intolerance, and increased blood pressure. The most widely accepted definition, proposed by the International Diabetes Federation (IDF), bases the MetS diagnosis on the presence of central obesity (ethnic-specific waist circumference cut-offs) in addition to two of the following: increased TG (≥1.7 mmol/L), reduced HDL-C (
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