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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-17082021-112726
Document
Author
Full name
Louise Cominato
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Damiani, Durval (President)
Kochi, Cristiane
Mancini, Márcio Corrêa
Odone Filho, Vicente
Title in Portuguese
Obesidade infantil como fator trombogênico e de risco cardiovascular
Keywords in Portuguese
Adiponectina
Coagulação
Dímero D
Fibrinólise
Índice de massa corporal
Obesidade pediátrica
Abstract in Portuguese
A obesidade leva a um risco maior de fenômenos tromboembólicos em adultos. Poucos estudos avaliaram a relação de obesidade com risco trombogênico na infância. O objetivo desse trabalho foi avaliar o estado pró trombótico de crianças obesas e comparar com crianças saudáveis, além de comparar a evolução das variáveis metabólicas e de hemostasia após perda de peso e correlacionar com as seguintes adipocinas: leptina e adiponectina. Foram realizados Teste de Geração de Trombina, Fibrinogênio, Dímero D, além de parâmetros metabólicos, em 72 crianças pré púberes, 47 obesas e 25 eutróficas. Foi encontrado um aumento significante da geração de trombina, fibrinogênio, dímero D e dislipidemia entre os pacientes obesos, confirmando a hipótese de que um estado pró trombótico em crianças obesas já se inicia na fase pré púbere. Ao comparar as variáveis pré e após perda de peso observamos diminuição na geração de trombina, diminuição do dímero D, assim como melhora nos marcadores metabólicos. Houve correlação positiva entre o Índice de massa corpórea e as variáveis hemostáticas, porém não encontrado correlação com insulina. A adiponectina foi a adipocina com melhor correlação com os marcadores pró trombóticos, confirmando sua importância antitrombótica já na infância. O IMC mostrou-se mais relevante do que a resistência insulínica como fator trombogênico. Medidas preventivas contra a obesidade, além de tratamento precoce devem ser iniciados já na infância para proteção de eventos trombóticos e cardiovasculares
Title in English
Obesity as a thrombogenic and cardiovascular risk factor in children
Keywords in English
Adiponectin
Body mass index
Coagulation
Fibrinolysis, Dimer- D
Pediatric obesity
Abstract in English
Obesity leads to increased risk of thromboembolic events in adults but few studies have addressed the relationship between obesity and thrombogenic risk during childhood. The aim of this study was to evaluate the prothrombotic state of obese children in comparison to healthy children. We also studied the effect of weight loss on metabolic and hemostatic variables, and how it correlates with the levels of two major adipokines, leptin and adiponectin. Thrombin generation, fibrinogen, and D-dimer levels, along with metabolic parameters, were measured in 72 prepubertal children, of which 47 were obese, and 25 eutrophic. A significant increase in thrombin generation, fibrinogen, D-dimer, and dyslipidemia was found among obese patients, confirming the hypothesis that a prothrombotic state develops early in life, during prepubertal phase. Comparison of variables before and after weight loss showed a reduction in thrombin generation and D-dimer values, and an improvement in metabolic markers, associated with weight loss. There was a positive correlation between body mass index (BMI) and hemostatic variables, although no correlation was found between BMI and insulin. Adiponectin was more strongly associated with prothrombotic markers than leptin, supporting its key anti-thrombotic role already in childhood. In addition, BMI was shown to be a more important prothrombotic risk factor than insulin resistance. Our findings highlight the importance of implementing childhood obesity preventive measures, in addition to early treatment strategies, in order to protect children from thromboembolic events
 
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LouiseCominato.pdf (644.63 Kbytes)
Publishing Date
2021-08-18
 
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