ABC | Volume 115, Nº2, August 2020

Original Article Body Adiposity and Apolipoproteins in Children and Adolescents: A Meta-Analysis of Prospective Studies Gabriela dos Santos de Jesus, 1 Priscila Ribas de Farias Costa, 1 Lucivalda Pereira Magalhães de Oliveira, 1 Valterlinda Alves de Oliveira Queiroz, 1 Carla de Magalhães Cunha, 1 Emile Miranda Pereira, 1 Ana Marlúcia de Oliveira 1 Universidade Federal da Bahia, 1 Salvador, BA - Brazil Mailing Address: Gabriela dos Santos de Jesus • Universidade Federal da Bahia - Rua Araújo Pinho, Canela, nº 32. Postal Code 40110-150, Salvador, BA – Brazil E-mail: gabriela.nutsantos@gmail.com Manuscript received October 17, 2018, revised mnasucript May 21, 2019, accepted August 14, 2019 DOI: https://doi.org/10.36660/abc.20190331 Abstract Background: Excess Weight and Cardiovascular Diseases are health problems with increasing prevalence among children and adolescents, hence the need to investigate the issues related to them to better deal with the problem. Objective: To investigate the influence of excess adiposity on the levels of apolipoprotein B and A1 in children and adolescents. Methods: A systematic search was conducted in the PubMed, Embase, Lilacs, Web of Science, Ovid and Science direct databases, searching for cohort eligible studies and evaluating their results, methodological quality and risk of bias; combinable studies with good quality and low risk of bias were evaluated by meta-analysis. The summary measure used was the weighted mean difference (WMD) with its respective 95% confidence interval. Results: 8 articles attended the eligibility criteria including individuals with age mean varying from 9 to 15.7 years of age. The meta-analysis included 4 articles with a total of 7,974 children and adolescents. It was observed a mean increase of 4,94mg/dL (95%CI: 4,22 to 5,67) in the ApoB levels in individuals with excess of body adiposity. For the ApoA1, we identified a mean reduction of -8,13mg/dL (95%CI: -9,09 to -7,17 mg/dL) in its levels in children and adolescents with higher body adiposity. Beside this, the influence of excess adiposity on the ApoB and ApoA1 levels was higher between adolescents than children. Conclusions: The excess of body adiposity influenced both the reduction of ApoA1 values and the increase of ApoB levels, being these changes more relevant among adolescents. (Arq Bras Cardiol. 2020; 115(2):163-171) Keywords: Child; Adolescent; Obesity; Overweight; Waist Circumference; Apolipoproteins; Meta-Analysis Introduction The growing prevalence of excess body adiposity in children and adolescents is a worldwide health problem. 1,2 According to an editorial published by The Lancet, 3 obese children and adolescents are at increased risk of developing chronic non- communicable diseases (NCDs) in adulthood, such as obesity, heart diseases, type 2 diabetes, stroke; in addition to social and psychological problems, such as lack of self-esteem and stigmatization. Thus, efforts to face the high occurrence of excess body adiposity are justified by the link with the development of cardiovascular disease (CVD), one of the NCDs responsible for the high burden of morbidity around the globe. The factors that contribute to the development of CVDare called cardiometabolic risk factors, 4 and include excess adiposity, high blood glucose, lipid changes (LDL cholesterol and high triglycerides, low HDL cholesterol), high blood pressure, smoking and physical inactivity. Excess of adipocytes stimulates cells, cytokines and pro- inflammatory proteins to produce other inflammatory cells, interleukin 6 and tumor necrosis factor alpha (TNF α ), which cause inflammation and promote endothelial dysfunction. There is also the action of Apolipoproteins B (ApoB), which adhere to endothelial cells and favor a greater expression of endothelium adhesion molecules, and such effects have a response on the formation of atherosclerotic plaques and other cardiovascular events. 5-9 Evidence indicates that excess adiposity is strongly correlated with lipid disorders, such as elevated plasma ApoB levels and reduced apolipoprotein A1 (ApoA1). 10,11 Despite this well-established evidence in adults, such knowledge in regard to children and adolescents is still incipient. Therefore, this study aimed to investigate other longitudinal studies that assessed the influence of excess body adiposity on serum levels of ApoB and ApoA1 in children and adolescents. Method Identification and Selection of Articles This is a systematic review with meta-analysis, carried out according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). 12 163