Micronutrients and Metabolic Syndrome in Children and Adults

Abstract

Background: Metabolic syndrome (MetS) is a cluster of independent risk factors for cardiovascular disease and its prevalence is increasing worldwide, including in the region of Latin America. Independent predictors of MetS include age, sex, socioeconomic characteristics, and diet. Micronutrients play vital roles in several biological pathways that could be associated with MetS. However, the associations between micronutrient status and MetS remains controversial, especially in children. Objectives: To evaluate the association between the B-vitamins and homocysteine (Hcys) (aim 1), sodium and iodine (aim 2), and the trace minerals zinc, manganese, and copper (aim 3), with MetS in children and adults (aim 4) from Mesoamerica. Methods: We conducted a cross-sectional study among 237 children and 524 parents from the capitals of Belize, Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, and Chiapas State in Mexico. Sociodemographic and health status information was collected through questionnaires. Anthropometric measures were done according to standardized protocols. Exposures for aim 1 were plasma concentrations of vitamin B6, B12, Hcys, and erythrocyte folate categorized as quartiles of the population distribution. For aim 2, urinary sodium and iodine were obtained from 24h urine samples and categorized as recommended sodium intake and excessive iodine intake according to the World Health Organization (WHO) definitions. For aim 3, the exposures were plasma concentrations of zinc, manganese, and cooper categorized as quartiles. For adults, the exposures were categorized as in children. The outcome in children was a continuous metabolic risk score calculated through sex- and age-standardization of waist circumference, the homeostatic model assessment for insulin resistance (HOMA-IR), mean arterial pressure (MAP), serum high-density lipoprotein cholesterol (HDL-C), and serum triglycerides. In parents, the outcome was the prevalence of MetS according to the Adult Treatment Panel (ATP) III criteria1. We estimated mean differences in the metabolic risk score and prevalence ratios of MetS between the exposure categories using multivariable-adjusted linear and Poisson regression models, respectively. Results: We found an inverse association between vitamin B6 and MetS, only in adults. Vitamin B12 and MetS were inversely associated in children, whereas they were positively associated in adults. Folate had a positive relation with MetS in both children and adults. Hcys was not associated with MetS in either children or adults. Exceeding the recommended sodium intake was positively associated with MetS and hypertension only in adults. Similarly, excessive iodine intake was positively associated with MetS in both children and adults. Plasma zinc was not associated with MetS in either children or adults. In contrast, we found an inverse association between plasma manganese with MetS only in children. Plasma copper had a positive association between the waist circumference score and abdominal obesity in children and adults, respectively. Conclusions and significance: Micronutrient status biomarkers are associated with MetS and the associations differs between children and adults from the Mesoamerican region. Further evaluation of these associations is warranted along with closer monitoring of food fortification policies. Efforts to adhere to the recommended nutritional guidelines can help decrease the burden of cardiometabolic diseases that is affecting the region.