Clinico-Biochemical Profile of Overweight and Obese South Indian Children with Acanthosis Nigricans.

Sir,

Acanthosis Nigricans (AN) is invariably found clinically in most adult subjects with metabolic syndrome and insulin resistance, whereas in children, there is inadequate data to extrapolate this view especially among Indian children.[12] This cross-sectional study was done to find out the clinical and biochemical profile of children with overweight and obesity who have AN. Informed consent from the parents and assent from the older children were obtained before inclusion. Children attending outpatient department aged between 7 and 13 years with body mass index (BMI) equivalent to adults more than 23 kg/m2 were included in the study.[3] Waist circumference (WC) was measured in upright posture at the midpoint between lower margin of the last rib and upper border of iliac crest with non-stretchable tape. Neck was examined for the presence or absence of AN. Severity of AN was graded based on burke et al. classification.[4] A 3 ml of fasting blood sample was aspirated through venepuncture for lipid profile (Total cholesterol, triglycerides, HDL cholesterol, VLDL, and LDL), insulin level, and fasting blood glucose [FBS]). Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated by applying the formula HOMA-IR = fasting glucose (mg/dl) × fasting insulin (uIU/ml)/405. Metabolic syndrome was defined as according to International Diabetes Federation (IDF) criteria.[5] Based on the severity of AN, the study population was divided into two groups as Severe AN (SAN- Grades 3 and 4) (n = 24) and non-severe AN (NAN – Grades 0, 1, and 2) (n = 104).

Although the BMI was found to be higher in SAN group (mean ± SD = 24.78 ± 2.49) when compared to NAN group (mean ± SD = 23.77 ± 3.03), this difference was not statistically significant (P = 01.34). Similarly, there was no statistically significant difference noted in systolic blood pressure (P = 0.820), diastolic blood pressure (0.443), and WC (P = 0.842) between the two groups.

Children with SAN had higher LDL levels (P = 0.024) compared to NAN group. Children in NAN group had higher insulin levels (P = 0.001). There was no significant difference in FBS (P = 0.584), total cholesterol (P = 0.142), triglycerides (P = 0.085), HDL cholesterol (P = 0.896), VLDL cholesterol (P = 0.275), alanine aminotransferase (ALT) (P = 0.287), and aspartate aminotransferase (AST) (P = 0.207), among these groups. Metabolic syndrome was diagnosed in 23 out of 128 children. According to IDF criteria, 15 children had metabolic syndrome out of 89 in NAN group, whereas 8 children had metabolic syndrome out of 16 in SAN group (P = 0.030). Statistically significant association was found between SAN group and metabolic syndrome (P = 0.030). Six out of 18 children had HOMA-IR >2.5 in SAN group and 21 children had HOMA-IR >2.5 among 104 in NAN group (P = 0.603). Insulin levels were higher (P = 0.000) among children in NAN group (mean ± SD = 12.44 ± 4.86) compared to SAN group (mean ± SD = 8.75 ± 4.74). Obesity with higher grades of AN were significantly associated with lower insulin levels, higher LDL levels, and presence of metabolic syndrome. Follow up studies comparing these clinic-biochemical characteristics in obese children with AN are needed to study their predictive role of long-term outcomes.

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Conflicts of interest

There are no conflicts of interest.