The effect of obesity and insulin resistance on macular choroidal thickness in a pediatric population as assessed by enhanced depth imaging optical coherence tomography
-
Pinar Topcu-Yilmaz
,
Nesibe Akyurek
Abstract
Background:
The purpose of this study was to evaluate the macular choroidal thickness in obese children with and without insulin resistance (IR).
Methods:
Thirty-six patients with obesity and 26 healthy volunteers were included in this cross-sectional study. The choroidal thickness was measured with enhanced depth imaging optical coherence tomography (EDI-OCT) at the fovea and at positions 500 μm, 1000 μm, 1500 μm nasal and temporal to the fovea. The choroidal thickness measurements of the groups were compared and the correlation between the homeostasis model assessment of insulin resistance (HOMA-IR) and choroidal thickness values was evaluated.
Results:
The average choroidal thickness in the obese group was significantly lower than that of controls at locations 1000 μm (303.31±58.52 vs. 340.58±69.47, p=0.026) and 1500 μm (284.14±65.06 vs. 336.85±71.37, p=0.004) temporal to the fovea. A subgroup analysis depending on the presence of IR revealed that the choroidal thickness measurements at all positions were thinner in obese children without IR compared to children with IR and healthy controls. This thinning reached a statistical significance at locations 500 μm temporal, 1000 μm temporal and 1500 μm temporal to the fovea (p=0.03, p=0.009 and p=0.006; respectively). There was a moderate correlation between the choroidal thickness measurements and HOMA-IR values (r-values between 0.37 and 0.48; p<0.05).
Conclusions:
Our results suggest that obesity and IR may have an influence on the choroidal thickness in children. Longitudinal studies will clarify whether these choroidal changes are progressive and are a sign of microvascular dysfunction in childhood obesity.
Author contributions: Concept: Pinar Topcu Yilmaz and Nesibe Akyurek. Design: Pinar Topcu Yilmaz and Nesibe Akyurek. Data collection and processing: Pinar Topcu Yilmaz, Nesibe Akyurek and Erkan Erdogan. Analysis and interpretation: Pinar Topcu Yilmaz, Nesibe Akyurek. Literature search: Pinar Topcu Yilmaz and Nesibe Akyurek. Writing: Pinar Topcu Yilmaz and Nesibe Akyurek. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. de Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010;92:1257–64.10.3945/ajcn.2010.29786Suche in Google Scholar PubMed
2. Orsi CM, Hale DE, Lynch JL. Pediatric obesity epidemiology. Curr Opin Endocrinol Diabetes Obes 2011;18:14–22.10.1097/MED.0b013e3283423de1Suche in Google Scholar PubMed
3. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev 2016;17:95–107.10.1111/obr.12334Suche in Google Scholar PubMed
4. Llewellyn A, Simmonds M, Owen CG, Woolacott N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev 2016;17:56–67.10.1111/obr.12316Suche in Google Scholar PubMed
5. Micić D. Obesity in children and adolescents – a new epidemic? Consequences in adult life. J Pediatr Endocrinol Metab 2001;14:1345–52.Suche in Google Scholar
6. Mijailović V, Micić D, Mijailovi M. Effects of childhood and adolescent obesity on morbidity in adult life. J Pediatr Endocrinol Metab 2001;14:1339–44.Suche in Google Scholar
7. Kollias A, Skliros E, Stergiou GS, Leotsakos N, Saridi M, et al. Obesity and associated cardiovascular risk factors among schoolchildren in Greece: a cross-sectional study and review of the literature. J Pediatr Endocrinol Metab 2011;24:929–38.10.1515/JPEM.2011.309Suche in Google Scholar PubMed
8. Gong W, Hu Y, Niu Y, Wang D, Wang Y, et al. Effects of longitudinal body mass index variability on microvasculature over 5 years in adult Chinese. Obesity 2016;24:743–9.10.1002/oby.21398Suche in Google Scholar PubMed
9. de Jongh RT, Serné EH, IJzerman RG, de Vries G, Stehouwer CD. Impaired microvascular function in obesity: implications for obesity-associated microangiopathy, hypertension, and insulin resistance. Circulation 2004;109:2529–35.10.1161/01.CIR.0000129772.26647.6FSuche in Google Scholar PubMed
10. Yuan Y, Ikram MK, Vingerling JR, Jiang S, Lin H, et al. Retinal vascular caliber and metabolic syndrome in a Chinese population. Intern Med J 2012;42:1014–22.10.1111/j.1445-5994.2011.02470.xSuche in Google Scholar PubMed
11. Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, et al. Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. J Am Med Assoc 2002;287:1153–9.10.1001/jama.287.9.1153Suche in Google Scholar PubMed
12. Boillot A, Zoungas S, Mitchell P, Klein R, Klein B, et al. Obesity and the microvasculature: a systematic review and meta-analysis. PLoS One 2013;8:e52708.10.1371/journal.pone.0052708Suche in Google Scholar PubMed PubMed Central
13. Tirsi A, Duong M, Tsui W, Lee C, Convit A. Retinal vessel abnormalities as a possible biomarker of brain volume loss in obese adolescents. Obesity 2013;21:E577–85.10.1002/oby.20450Suche in Google Scholar PubMed PubMed Central
14. Spaide RF, Koizumi H, Pozzoni MC. Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 2008;146:496–500.10.1016/j.ajo.2008.05.032Suche in Google Scholar PubMed
15. Erşan I, Battal F, Aylanç H, Kara S, Arikan S, et al. Noninvasive assessment of the retina and the choroid using enhanced-depth imaging optical coherence tomography shows microvascular impairments in childhood obesity. J AAPOS 2016;20:58–62.10.1016/j.jaapos.2015.10.006Suche in Google Scholar PubMed
16. Bulus AD, Can ME, Baytaroglu A, Can GD, Cakmak HB, et al. Choroidal thickness in childhood obesity. Ophthalmic Surg Lasers Imaging Retina 2017;48:10–7.10.3928/23258160-20161219-02Suche in Google Scholar PubMed
17. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, et al. Body mass index references for Turkish children. Acta Paediatr 2006;95:194–8.10.1080/08035250500334738Suche in Google Scholar PubMed
18. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivitycheck index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:500–3.10.1542/peds.2004-1921Suche in Google Scholar PubMed
19. Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, et al. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010;362:485–93.10.1056/NEJMoa0904130Suche in Google Scholar PubMed PubMed Central
20. Taylor B, Rochtchina E, Wang JJ, Wong TY, Heikal S, et al. Body mass index and its effects on retinal vessel diameter in 6-year-old children. Int J Obes (Lond) 2007;31:1527–33.10.1038/sj.ijo.0803674Suche in Google Scholar PubMed
21. Gopinath B, Baur LA, Teber E, Liew G, Wong TY, et al. Effect of obesity on retinal vascular structure in pre-adolescent children. Int J Pediatr Obes 2011;6:e353–9.10.3109/17477166.2010.500390Suche in Google Scholar PubMed
22. Cheung N, Saw SM, Islam FM, Rogers SL, Shankar A, et al. BMI and retinal vascular caliber in children. Obesity (Silver Spring) 2007;15:209–15.10.1038/oby.2007.576Suche in Google Scholar PubMed
23. Li LJ, Cheung CY, Chia A, Selvaraj P, Lin XY, et al. The relationship of body fatness indices and retinal vascular caliber in children. Int J Pediatr Obes 2011;6:267–74.10.3109/17477166.2011.583657Suche in Google Scholar PubMed
24. Kurniawan ED, Cheung CY, Tay WT, Mitchell P, Saw SM, et al. The relationship between changes in body mass index and retinal vascular caliber in children. J Pediatr 2014;165:1166–71.10.1016/j.jpeds.2014.08.033Suche in Google Scholar PubMed
25. Wang JJ, Taylor B, Wong TY, Chua B, Rochtchina E, et al. Retinal vessel diameters and obesity: a population-based study in older persons. Obesity (Silver Spring) 2006;14:206–14.10.1038/oby.2006.27Suche in Google Scholar PubMed
26. Cheung N, Wong TY. Obesity and eye diseases. Surv Ophthalmol 2007;52:180–95.10.1016/j.survophthal.2006.12.003Suche in Google Scholar PubMed PubMed Central
27. Yilmaz I, Ozkaya A, Kocamaz M, Ahmet S, Ozkaya HM, et al. Correlation of choroidal thickness and body mass index. Retina 2015;35:2085–90.10.1097/IAE.0000000000000582Suche in Google Scholar PubMed
28. Wong IY, Wong RL, Zhao P, Lai WW. Choroidal thickness in relation to hypercholesterolemia on enhanced depth imaging optical coherence tomography. Retina 2013;33:423–8.10.1097/IAE.0b013e3182753b5aSuche in Google Scholar PubMed
29. Ahn SJ, Woo SJ, Park KH. Retinal and choroidal changes with severe hypertension and their association with visual outcome. Invest Ophthalmol Vis Sci 2014;55:7775–85.10.1167/iovs.14-14915Suche in Google Scholar PubMed
30. Siegrist M, Hanssen H, Neidig M, Fuchs M, Lechner F, et al. Association of leptin and insulin with childhood obesity and retinal vessel diameters. Int J Obes (Lond) 2014;38:1241–7.10.1038/ijo.2013.226Suche in Google Scholar PubMed
31. Polak K, Dallinger S, Polska E, Findl O, Eichler HG, et al. Effects of insulin on retinal and pulsatile choroidal blood flow in humans. Arch Ophthalmol 2000;118:55–9.10.1001/archopht.118.1.55Suche in Google Scholar PubMed
32. Schmetterer L, Müller M, Fasching P, Diepolder C, Gallenkamp A, et al. Renal and ocular hemodynamic effects of insulin. Diabetes 1997;46:1868–74.10.2337/diab.46.11.1868Suche in Google Scholar PubMed
33. Kur J, Newman EA, Chan-Ling T. Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. Prog Retin Eye Res 2012;31:377–406.10.1016/j.preteyeres.2012.04.004Suche in Google Scholar PubMed PubMed Central
34. Nilsson SF. Nitric oxide as a mediator of parasympathetic vasodilation in ocular and extraocular tissues in the rabbit. Invest Ophthalmol Vis Sci 1996;37:2110–9.Suche in Google Scholar
35. Rahman W, Chen FK, Yeoh J, Patel P, Tufail A, et al. Repeatability of manual subfoveal choroidal thickness measurements in healthy subjects using the technique of enhanced depth imaging optical coherence tomography. Invest Ophthalmol Vis Sci 2011;52:2267–71.10.1167/iovs.10-6024Suche in Google Scholar PubMed
36. Sanchez-Cano A, Orduna E, Segura F, Lopez C, Cuenca N, et al. Choroidal thickness and volume in healthy young white adults and the relationships between them and axial length, ammetropy and sex. Am J Ophthalmol 2014;158:574–83.e1.10.1016/j.ajo.2014.05.035Suche in Google Scholar PubMed
©2018 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Urinary bisphenol-A levels in children with type 1 diabetes mellitus
- The relationship between metabolic syndrome, cytokines and physical activity in obese youth with and without Prader-Willi syndrome
- Association of anthropometric measures and cardio-metabolic risk factors in normal-weight children and adolescents: the CASPIAN-V study
- The effect of obesity and insulin resistance on macular choroidal thickness in a pediatric population as assessed by enhanced depth imaging optical coherence tomography
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets (HVDRR): clinical heterogeneity and long-term efficacious management of eight patients from four unrelated Arab families with a loss of function VDR mutation
- Long-term thyroid disorders in pediatric survivors of hematopoietic stem cell transplantation after chemotherapy-only conditioning
- Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes
- Resistance exercise alone improves muscle strength in growth hormone deficient males in the transition phase
- Sequential measurements of IGF-I serum concentrations in adolescents with Laron syndrome treated with recombinant human IGF-I (rhIGF-I)
- Symptomatic Rathke cleft cyst in paediatric patients – clinical presentations, surgical treatment and postoperative outcomes – an analysis of 38 cases
- Molecular genetics of tetrahydrobiopterin deficiency in Chinese patients
- Single center experience of biotinidase deficiency: 259 patients and six novel mutations
- Next-generation sequencing as a second-tier diagnostic test for newborn screening
- Case Reports
- Thyroid storm after choking
- Three new Brazilian cases of 17α-hydroxylase deficiency: clinical, molecular, hormonal, and treatment features
- Diazoxide toxicity in a child with persistent hyperinsulinemic hypoglycemia of infancy: mixed hyperglycemic hyperosmolar coma and ketoacidosis
- Refractory hypoglycemia in a pediatric patient with desmoplastic small round cell tumor
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Urinary bisphenol-A levels in children with type 1 diabetes mellitus
- The relationship between metabolic syndrome, cytokines and physical activity in obese youth with and without Prader-Willi syndrome
- Association of anthropometric measures and cardio-metabolic risk factors in normal-weight children and adolescents: the CASPIAN-V study
- The effect of obesity and insulin resistance on macular choroidal thickness in a pediatric population as assessed by enhanced depth imaging optical coherence tomography
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets (HVDRR): clinical heterogeneity and long-term efficacious management of eight patients from four unrelated Arab families with a loss of function VDR mutation
- Long-term thyroid disorders in pediatric survivors of hematopoietic stem cell transplantation after chemotherapy-only conditioning
- Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes
- Resistance exercise alone improves muscle strength in growth hormone deficient males in the transition phase
- Sequential measurements of IGF-I serum concentrations in adolescents with Laron syndrome treated with recombinant human IGF-I (rhIGF-I)
- Symptomatic Rathke cleft cyst in paediatric patients – clinical presentations, surgical treatment and postoperative outcomes – an analysis of 38 cases
- Molecular genetics of tetrahydrobiopterin deficiency in Chinese patients
- Single center experience of biotinidase deficiency: 259 patients and six novel mutations
- Next-generation sequencing as a second-tier diagnostic test for newborn screening
- Case Reports
- Thyroid storm after choking
- Three new Brazilian cases of 17α-hydroxylase deficiency: clinical, molecular, hormonal, and treatment features
- Diazoxide toxicity in a child with persistent hyperinsulinemic hypoglycemia of infancy: mixed hyperglycemic hyperosmolar coma and ketoacidosis
- Refractory hypoglycemia in a pediatric patient with desmoplastic small round cell tumor
