ABC | Volume 115, Nº2, August 2020

Original Article Jesus et al. Meta-analysis: body adiposity and apolipoproteins Arq Bras Cardiol. 2020; 115(2):163-171 Heterogeneity and Meta-regression The studies had high heterogeneity, with an I 2 greater than 50%. Possible sources of heterogeneity were investigated through meta-regression, including the variables: gender (95%CI -0.76 to 0.71), mean age (95%CI -2.06 to 1.71), mean BMI (95%CI -0.17 to 0.33) and sample size (95%CI: 0.12 to 0.36). None of these covariables could explain the wide heterogeneity between studies (data not shown in table). Discussion The results indicated that children and adolescents with excess body adiposity have an inadequate profile of ApoB and ApoA1 markers. These changes were also found to be more pronounced in adolescents than in children. These variations in serum values of apolipoproteins are clinically important and indicate that children and adolescents with excess body adiposity tend to present an inadequate profile of such markers, which can predict higher cardiovascular risk and comorbidities in future life cycles. Thus, based on the available evidence on the subject and the results of this meta-analysis, the likelihood of a higher cardiometabolic risk in later life cycles should be considered for this population group. Results of some studies have indicated an association between excess body adiposity and increase in atherogenic particles or decrease in non- atherogenic particles in children and adolescents. 29,30 There has also been a higher mean of ApoB in overweight and obese children compared to eutrophic children. 29 This same study 29 found a positive correlation between ApoB, thickness of epicardial adipose tissue and serum triglycerides, placing ApoB as a cardiometabolic marker with a strong correlation with body fat profile. The persistence and worsening of the risk of ApoB over time has been observed in young adults identified with a more pronounced BMI/Age ratio and greater volume of epicardial fat. The authors observed that this association became more pronounced 12 years after exposure, suggesting that the risk of excess adiposity tends to remain throughout life. 31 ApoA1 and ApoB are important structural and functional proteins of the HDL and VLDL/LDL lipoprotein particles, respectively. These proteins are essential for the integrity of particles during processing and to lead them to their metabolic destination. When there is a change in the physiological route, the atherogenic particles are directed to organs and systems, compromising their physiological functions, such as the forwarding of VLDL/LDL cholesterol to the artery wall, leading to pathological impairment, as occurs with the etiology of atherosclerosis. Excessive body adiposity is related to a high serum concentration of ApoB. This particle is oxidized on the vessel wall, giving raise to an inflammatory process with local accumulation of macrophages, involving LDL and ApoB residues in the subendothelial space of the vessel, and culminating in endothelial dysfunction, atheroma formation and thickening of the vascular wall. 32,33 Figure 4 – Forest plot of the influence of excess body adiposity on the difference from the weighted mean of ApoB, according to the age of children and adolescents. Falaschetti et al. 1 and 3: correspond to overweight and obese boys, respectively. Falaschetti et al. 2 and 4: correspond to overweight and obese girls, respectively. 168