Association between Leptin, Adiponectin Levels, and Nutritional Status in Children with Down Syndrome

Agustini  Utari; Damianus Galih  Panunggal; Tithasiri Audi  Rahardjo; Wiwik  Lestari; Ferdy K  Cayami; Tri Indah  Winarni

doi:10.6000/2292-2598.2022.10.06.5

Authors

Agustini Utari Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia and Department of Pediatrics, Faculty of Medicine, Universitas Diponegoro / RS Dr Kariadi Hospital Semarang, Central Java, Indonesia
Damianus Galih Panunggal Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia
Tithasiri Audi Rahardjo Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia
Wiwik Lestari Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia
Ferdy K Cayami Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia and Department of Anatomy, Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia
Tri Indah Winarni Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia and Department of Anatomy, Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia

DOI:

https://doi.org/10.6000/2292-2598.2022.10.06.5

Keywords:

Adiponectin, Down syndrome, leptin, nutritional status, wasted, young children

Abstract

Background: Children with Down Syndrome (DS) have been associated with obesity. Leptin and adiponectin were also significant predictors of obesity and its comorbidity in DS. However, there was limited data regarding leptin and adiponectin in children with DS, particularly who were undernutrition. This study aimed to seek the role of leptin levels, adiponectin levels, and nutritional status in children with DS.

Methods: This cross-sectional study was conducted on 40 children with DS aged 1 - 5 years. Height and weight were measured, and then the growth was interpreted using a DS growth chart. The Weight for Height Z-Score (WHZ) and Height for Age Z-Score (HAZ) were determined, and Mid-Upper Arm Circumference (MUAC) was measured. Leptin and adiponectin serum were analyzed using the enzyme-linked immunosorbent assay (ELISA) method. Mann-Whitney test was done to compare leptin and adiponectin levels in normal and wasted groups, while Spearman’s analysis was carried out to correlate laboratory results and anthropometric parameters.

Results: Forty children participated (23 males, 17 females) with a median age was 25.5 months. Ten out of 40 children with DS (25%) were wasted and leptin was significantly lower in wasted compared to normal children. In addition, leptin was significantly correlated with WHZ (r = 0.415; p = 0.008), and MUAC (r = 0.427; p = 0.006), while adiponectin did not significantly correlate with those anthropometric variables in both wasted or non-wasted groups.

Conclusion: Leptin is associated with WHZ and MUAC, and it decreases in wasted children with DS.

References

Ivan DL, Cromwell P. Clinical Practice Guidelines for Management of Children With Down Syndrome: Part I. J Pediatr Heal Care 2014; 28: 105-10. https://doi.org/10.1016/j.pedhc.2013.05.002

Stanley MA, Shepherd N, Duvall N, Jenkinson SB, Jalou HE, Givan DC, et al. Clinical identification of feeding and swallowing disorders in 0-6-month-old infants with Down syndrome. Am J Med Genet Part A 2019; 179: 177-82. https://doi.org/10.1002/ajmg.a.11

Zemel BS, Pipan M, Stallings VA, Hall W, Schadt K, Freedman DS, et al. Growth Charts for Children With Down Syndrome in the United States. Pediatrics 2015; 136: 1204-11. https://doi.org/10.1542/peds.2015-1652

Bertapelli F, Pitetti K, Agiovlasitis S, Guerra-Junior G. Overweight and obesity in children and adolescents with Down syndrome—prevalence, determinants, consequences, and interventions: A literature review. Res Dev Disabil 2016; 57: 181-92. https://doi.org/10.1016/j.ridd.2016.06.018

Anil MA, Shabnam S, Narayanan S. Feeding and swallowing difficulties in children with Down syndrome. J Intellect Disabil Res 2019; 63: jir.12617. https://doi.org/10.1111/jir.12617

Nordstrøm M, Retterstøl K, Hope S, Kolset SO. Nutritional challenges in children and adolescents with Down syndrome. Lancet Child Adolesc Heal 2020; 4: 455-64. https://doi.org/10.1016/S2352-4642(19)30400-6

Basil JS, Santoro SL, Martin LJ, Healy KW, Chini BA, Saal HM. Retrospective Study of Obesity in Children with Down Syndrome. J Pediatr 2016; 173: 143-8. https://doi.org/10.1016/j.jpeds.2016.02.046

Tenneti N, Dayal D, Sharda S, Panigrahi I, Didi M, Attri SV, et al. Concentrations of leptin, adiponectin and other metabolic parameters in non-obese children with Down syndrome. J Pediatr Endocrinol Metab 2017; 30. https://doi.org/10.1515/jpem-2016-0422

Magge SN, O’Neill KL, Shults J, Stallings VA, Stettler N. Leptin Levels among Prepubertal Children with Down Syndrome Compared with Their Siblings. J Pediatr 2008; 152: 321-6. https://doi.org/10.1016/j.jpeds.2007.08.008

Mazurek D, Wyka J. Down syndrome--genetic and nutritional aspects of accompanying disorders. Rocz Panstw Zakl Hig 2015; 66: 189-94.

Sáinz N, Barrenetxe J, Moreno-Aliaga MJ, Martínez JA. Leptin resistance and diet-induced obesity: Central and peripheral actions of leptin. Metabolism 2015; 64: 35-46. https://doi.org/10.1016/j.metabol.2014.10.015

Farr OM, Gavrieli A, Mantzoros CS. Leptin applications in 2015. Curr Opin Endocrinol Diabetes Obes 2015; 22: 353-9. https://doi.org/10.1097/MED.0000000000000184

Obradovic M, Sudar-Milovanovic E, Soskic S, Essack M, Arya S, Stewart AJ, et al. Leptin and Obesity: Role and Clinical Implication. Front Endocrinol (Lausanne) 2021; 12. https://doi.org/10.3389/fendo.2021.585887

Yadav A, Kataria MA, Saini V, Yadav A. Role of leptin and adiponectin in insulin resistance. Clin Chim Acta 2013; 417: 80-4. https://doi.org/10.1016/j.cca.2012.12.007

Fang H, Judd RL. Adiponectin Regulation and Function. Compr. Physiol., Wiley 2018; pp. 1031-63. https://doi.org/10.1002/cphy.c170046

Akib RD, Aminuddin A, Hamid F, Prihantono P, Bahar B, Hadju V. Leptin levels in children with malnutrition. Gac Sanit 2021; 35(Suppl 2): S278-80. https://doi.org/10.1016/j.gaceta.2021.10.033

Blüher S, Shah S, Mantzoros CS. Leptin Deficiency. J Investig Med 2009; 57: 784-8. https://doi.org/10.2310/JIM.0b013e3181b9163d

Kelesidis T, Kelesidis I, Chou S, Mantzoros CS. Narrative review: the role of leptin in human physiology: emerging clinical applications. Ann Intern Med 2010; 152: 93-100. https://doi.org/10.7326/0003-4819-152-2-201001190-00008

Samaranayake D, Lanerolle P, Waidyatilaka I, de Lanerolle-Dias M, Hills AP, Wickremasinghe AR, et al. Association between early weight gain and later adiposity in Sri Lankan adolescents. J Dev Orig Health Dis 2021; 12: 250-9. https://doi.org/10.1017/S2040174420000331

Hulley S, Cummings S, Browner W, Grady D, Newman T. Designing Clinical Research: An Epidemiologic Approach. 4th edn. Philadelphia: Lippincott Williams & Wilkins 2013.

World Health Organization. Training Course on Child Growth Assessment 2008.

Faulks D, Collado V, Mazille M-N, Veyrune J-L, Hennequin M. Masticatory dysfunction in persons with Down's syndrome. Part 1: aetiology and incidence. J Oral Rehabil 2008; 35: 854-62. https://doi.org/10.1111/j.1365-2842.2008.01877.x

Pierce M, Ramsey K, Pinter J. Trends in Obesity and Overweight in Oregon Children With Down Syndrome. Glob Pediatr Heal 2019; 6: 2333794X19835640. https://doi.org/10.1177/2333794X19835640

Soliman AT, ElZalabany MM, Salama M, Ansari BM. Serum leptin concentrations during severe protein-energy malnutrition: correlation with growth parameters and endocrine function. Metabolism 2000; 49: 819-25. https://doi.org/10.1053/meta.2000.6745

Beghini M, Brandt S, Körber I, Kohlsdorf K, Vollbach H, Lennerz B, et al. Serum IGF1 and linear growth in children with congenital leptin deficiency before and after leptin substitution. Int J Obes (Lond) 2021; 45: 1448-56. https://doi.org/10.1038/s41366-021-00809-2

Yu B, Jiang K, Chen B, Wang H, Li X, Liu Z. Leptin differentially regulates chondrogenesis in mouse vertebral and tibial growth plates. BMC Musculoskelet Disord 2017; 18: 235. https://doi.org/10.1186/s12891-017-1601-6

Chen XX, Yang T. Roles of leptin in bone metabolism and bone diseases. J Bone Miner Metab 2015; 33: 474-85. https://doi.org/10.1007/s00774-014-0569-7

Kilic M, Taskin E, Ustundag B, Aygun AD. The evaluation of serum leptin level and other hormonal parameters in children with severe malnutrition. Clin Biochem 2004; 37: 382-7. https://doi.org/10.1016/j.clinbiochem.2003.12.010

Mogendi JB, De Steur H, Gellynck X, Saeed HA, Makokha A. Efficacy of mid-upper arm circumference in identification, follow-up, and discharge of malnourished children during nutrition rehabilitation. Nutr Res Pr 2015; 9: 268-77. https://doi.org/10.4162/nrp.2015.9.3.268

Muñoz Esparza NC, Vasquez-Garibay EM, Larrosa Haro A, Romero Velarde E. Relationship of anthropometric indexes and indicators of body composition by arm anthropometry on hospitalized pediatric patients. Nutr Hosp 2019; 36: 611-7. https://doi.org/10.20960/nh.2309

Nixon DW. Down Syndrome, Obesity, Alzheimer’s Disease, and Cancer: A Brief Review and Hypothesis. Brain Sci 2018; 8. https://doi.org/10.3390/brainsci8040053

Kamariski M, Biscardi M, Cestino L, Miatello R, Guntsche E, Valles PG. Adiponectin in children on peritoneal dialysis: relationship to insulin resistance and nutritional status. Nephron Clin Pract 2009; 113: c24-32. https://doi.org/10.1159/000228072

Weber DR, Leonard MB, Zemel BS. Body composition analysis in the pediatric population. Pediatr Endocrinol Rev 2012; 10: 130-9.