Selenoprotein-p and insulin resistance in children and adolescents with obesity

doi:10.5409/wjcp.v13.i3.94721

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World Journal of Clinical Pediatrics

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Observational Study

World J Clin Pediatr. Sep 9, 2024; 13(3): 94721
Published online Sep 9, 2024. doi: 10.5409/wjcp.v13.i3.94721

Table 1 Characteristics of studied groups, n (%)

		Control, n = 85	With obesity, n = 85	P value
Age of enrolment (years)	mean ± SD	10.35 ± 2.33	10.48 ± 2.34	0.743¹
Age of enrolment (years)	Median [IQR]	10.00 [9.00-12.00]	10.00 [8.50-12.00]	0.743¹
Sex	Male	46 (54.1)	35 (41.2)	0.091²
Sex	Female	39 (45.9)	50 (58.8)	0.091²
Family history	DM	19 (22.4)	33 (39.3)	0.023^a^,³; 0.002^a^,³; < 0.001^a^,³
	HTN	15 (17.9)	34 (40.0)
	Obesity	3 (3.6)	42 (49.4)
weight Z-score (SD)	mean ± SD	0.12 ± 0.72	2.32 ± 0.28	< 0.001^a^,³
weight Z-score (SD)	Median [IQR]	0.29 [-0.33 to 0.70]	2.30 [2.10 to 2.42]	< 0.001^a^,³
Height Z-score (SD)	mean ± SD	-0.05 ± 0.76	0.78 ± 0.66	< 0.001^a^,³
Height Z-score (SD)	Median [IQR]	-0.14 [-0.65 to 0.36]	0.62 [0.24 to 1.40]	< 0.001^a^,³
BMI (kg/m²)	mean ± SD	18.00 ± 2.60	28.32 ± 3.51	< 0.001^a^,³
BMI (kg/m²)	Median [IQR]	17.80 [16.00-19.50]	28.40 [25.80-30.50]	< 0.001^a^,³
BMI Z-score (SD)	mean ± SD	0.22 ± 0.78	2.24 ± 0.19	< 0.001^a^,³
BMI Z-score (SD)	Median [IQR]	0.36 [0.00-0.82]	2.20 [2.10-2.36]	< 0.001^a^,³
Waist circumference (cm)	mean ± SD	60.44 ± 3.86	88.08 ± 8.71	< 0.001^a^,³
Waist circumference (cm)	Median [IQR]	60.00 [57.50-62.00]	86.00 [81.00-94.00]	< 0.001^a^,³
Waist circumference (centile)	mean ± SD	38.36 ± 13.27	96.45 ± 2.31	< 0.001^a^,³
Waist circumference (centile)	Median [IQR]	43.00 [26.30-49.10]	97.00 [95.80-98.00]	< 0.001^a^,³
W/H ratio	mean ± SD	0.43 ± 0.02	0.60 ± 0.04	< 0.001^a^,³
W/H ratio	Median [IQR]	0.43 [0.41-0.44]	0.60 [0.57-0.63]	< 0.001^a^,³
W/H ratio (centile)	mean ± SD	33.27 ± 15.93	95.39 ± 3.38	< 0.001^a^,³
W/H ratio (centile)	Median [IQR]	30.80 [18.70-50.00]	96.00 [93.60-97.80]	< 0.001^a^,³
SBP (centile)	mean ± SD	51.76 ± 13.95	54.89 ± 18.98	0.200³
SBP (centile)	Median [IQR]	51.00 [46.00-58.00]	55.00 [49.00-61.00]	0.200³
DBP (centile)	mean ± SD	53.72 ± 13.45	54.36 ± 14.80	1.000³
DBP (centile)	Median [IQR]	47.00 [43.00-59.00]	51.00 [48.00-66.00]	1.000³
ALT (U/L)	mean ± SD	24.44 ± 3.54	24.75 ± 7.68	1.000³
ALT (U/L)	Median [IQR]	26.00 [22.00-27.00]	24.00 [22.00-26.00]	1.000³
AST (U/L)	mean ± SD	22.42 ± 4.20	23.20 ± 5.65	0.300³
AST (U/L)	Median [IQR]	22.00 [18.00-26.00]	22.00 [19.00-26.00]	0.300³
Total cholesterol (mg/dL)	mean ± SD	145.91 ± 14.21	156.86 ± 23.93	< 0.001^a^,³
Total cholesterol (mg/dL)	Median [IQR]	146.00 [138.00-159.00]	151.00 [143.00-165.00]	< 0.001^a^,³
HDL-C (mg/dL)	mean ± SD	48.25 ± 3.88	40.66 ± 3.03	< 0.001^a^,³
HDL-C (mg/dL)	Median [IQR]	47.00 [45.00-50.00]	42.00 [40.00-42.00]	< 0.001^a^,³
LDL-C (mg/dL)	mean ± SD	92.71 ± 11.60	101.12 ± 19.68	0.001^a^,³
LDL-C (mg/dL)	Median [IQR]	94.00 [82.00-104.00]	91.00 [85.00-110.00]	0.001^a^,³
Triglycerides (mg/dL)	mean ± SD	75.65 ± 16.95	109.12 ± 28.24	< 0.001^a^,³
Triglycerides (mg/dL)	Median [IQR]	73.00 [60.00-89.00]	103.00 [89.00-115.00]	< 0.001^a^,³
VAI	mean ± SD	0.94 ± 0.22	1.70 ± 0.57	< 0.001^a^,³
VAI	Median [IQR]	1.01 [0.76-1.05]	1.63 [1.11-2.20]	< 0.001^a^,³
Serum insulin (uIU/mL)	mean ± SD	8.05 ± 2.09	17.23 ± 7.50	< 0.001^a^,³
Serum insulin (uIU/mL)	Median [IQR]	8.00 [6.20-8.90]	17.20 [11.60-19.70]	< 0.001^a^,³
FBS (mg/dL)	mean ± SD	72.04 ± 6.97	81.37 ± 15.21	< 0.001^a^,³
FBS (mg/dL)	Median [IQR]	71.00 [68.00-74.00]	80.00 [70.00- 5.00]	< 0.001^a^,³
HOMA-IR	mean ± SD	1.42 ± 0.42	3.51 ± 1.85	< 0.001^a^,³
HOMA-IR	Median [IQR]	1.40 [1.20-1.60]	3.50 [2.10-4.00]	< 0.001^a^,³
SEPP1 (ng/mL)	mean ± SD	70.97 ± 6.49	12.12 ± 10.92	< 0.001^a^,³
SEPP1 (ng/mL)	Median [IQR]	69.47 [65.89-77.42]	7.69 [5.82-13.99]	< 0.001^a^,³
Insulin resistance	Present	5 (5.9)	39 (45.9)	< 0.001^a^,³
Insulin resistance	Absent	80 (94.1)	46 (54.1)	< 0.001^a^,³

¹Mann-Whitney test.

²Pearson’s χ² test for independence of observations.

³Adjusted by regression for age at enrollment and sex.

^aP < 0.05.

ALT: Alanine transaminase; AST: Aspartate aminotransferase; BMI: Body mass index; DBP: Diastolic blood pressure; DM: Diabetes mellitus; FBS: Fasting blood sugar; HDL-C: High-density lipoprotein-cholesterol; HOMA-IR: Homeostasis Model Assessment insulin resistance; HTN: Hypertension; IQR: Interquartile range (25^th–75^th percentiles; LDL-C: Low-density lipoprotein-cholesterol; SBP: Systolic blood pressure; SD: Standard deviation; SEPP1: Selenoprotien P1; VAI: Visceral adiposity index; W/H ratio: Waist/height ratio.

Table 2 Correlations of serum selenoprotein P1 in children with obesity

	SEPP1 (ng/mL), children with obesity
	r_s	P value
Age of enrolment (years)	-0.098	0.371
weight Z score (SD)	-0.001	0.995
Height Z score (SD)	0.042	0.701
BMI (kg/m²)	-0.338	0.002^a
BMI Z score (SD)	-0.044	0.686
Waist circumference (cm)	-0.527	< 0.001^a
Waist circumference (centile)	-0.183	0.094
W/H ratio	-0.394	< 0.001^a
W/H ratio (centile)	-0.279	0.010^a
ALT (U/L)	-0.240	0.027^a
AST (U/L)	-0.219	0.044^a
Total cholesterol (mg/dL)	-0.185	0.089
HDL (mg/dL)	0.084	0.443
LDL (mg/dL)	0.076	0.491
Triglycerides (mg/dL)	-0.012	0.916
VAI	-0.252	0.020^a
Serum insulin (uIU/mL)	-0.223	0.040^a
FBS mg/dL	-0.258	0.017^a
HOMA-IR	-0.279	0.010^a

^aP < 0.05.

ALT: Alanine transaminase; AST: Aspartate aminotransferase; BMI: Body mass index; FBS: Fasting blood sugar; FE: Fisher’s exact test; HDL: High-density lipoprotein; HOMA-IR: Homeostasis Model Assessment insulin resistance; IQR: Interquartile range (25^th – 75^th percentiles); LDL: Low-density lipoprotein; Max: Maximum; Min: Minimum; NA: Non-applicable; SD: Standard deviation; SEPP1: Selenoprotien P1; VAI: Visceral adiposity index; W/H Ratio: Waist/height ratio; χ²: Pearson’s Chi-square test for independence of observations; Z: Mann-Whitney test; r_s < 0.3: Weak correlation; 0.3-0.7: Moderate; > 0.7: Strong correlation (regardless of the + /- signs); -ve sign: Inverse correlation (one variable increases while the other variable decreases); + ve sign: Direct correlation (both variables decrease or increase together).

Table 3 Selenoprotein P1 level in Insulin and non-insulin resistant children with obesity based on Homeostatic Model Assessment of Insulin Resistance[15]

			Non-insulin resistant, n = 46		Insulin resistant, n = 39	P value
SEPP1 ng/mL	mean ± SD	15.84 ± 12.91		7.73 ± 5.46		< 0.001¹^,^a
SEPP1 ng/mL	Median [IQR]	12.41 [8.00-18.42]		6.26 [5.56-6.73]		< 0.001¹^,^a

¹Mann-Whitney test.

^aP < 0.05.

IQR: Interquartile range (25^th–75^th percentiles); SEPP1: Selenoprotien P1.

Table 4 Predictive/diagnostic performance of selenoprotien P1 from receiver operating characteristic curve analysis

	Obesity children
AUC	0.828
SE	0.053
95%CI	0.724-0.931
P value	< 0.0001^a
Cut-off value	≤ 7.5
Sensitivity (%)	92.31
Specificity (%)	86.96
PPV (%)	85.7
NPV (%)	93.0

^aP < 0.05 (testing the null hypothesis AUC = 0.5 against observed AUC).

AUC: Area under the receiver operating characteristics curve; CI: Confidence interval of AUC; NPV: Negative predictive value; PPV: Positive predictive value; SE: Standard error of AUC.

Table 5 Univariate and multivariate logistic regression analysis for variables affecting insulin resistance in the obese group

Independent variables	Univariate regression			Multivariate regression
Independent variables	P value	OR	95%CI for OR	P value	OR	95%CI for OR
Sex (Male)	0.018^a	0.399	0.186-0.855	0.106	0.384	0.120-1.224
Age of enrolment (years)	0.046^a	1.170	1.003-1.366	0.025^a	1.355	1.038-1.767
Waist circumference (centile)	0.034^a	1.150	1.010-1.309	_	_	_
W/H ratio (centile)	0.013^a	1.154	1.031-1.292	_	_	_
BMI Z score (SD)	0.001^a	18.684	4.415-79.071	0.101	13.458	0.600-301.944
SEEP1 (ng/mL)	0.002^a	0.837	0.746-0.938	0.007^a	0.880	0.803-0.966

^aP < 0.05.

BMI: Body mass index; SEPP1: Selenoprotien P1; W/H Ratio: Waist/height ratio; OR: Odds ratio.

Table 6 Multiple linear regression analysis for factors affecting selenoprotien P1 level in children with obesity (n = 85)

Variables¹	B	95%CI	P value
DBP	-0.571	-1.313 to 0.171	0.129
Height (cm)	0.077	-2.640 to 2.794	0.955
Waist circumference (cm)	0.414	-4.348 to 5.176	0.863
BMI (kg/m²)	-0.542	-1.726 to 0.643	0.365
W/H ratio	33.413	-631.753 to 698.579	0.920
ALT (U/L)	-0.100	-0.467 to 0.267	0.589
AST (U/L)	-0.470	-1.005 to 0.066	0.085
Total Cholesterol (mg/dL)	-0.321	-0.526 to -0.117	0.003^a
HDL (mg/dL)	-0.893	-1.835 to 0.049	0.063
LDL (mg/dL)	0.335	0.089 to 0.581	0.008^a
Triglycerides (mg/dL)	0.163	0.016 to 0.309	0.030^a
VAI	-8.340	-15.321 to -1.359	0.020^a
Serum insulin (uIU/mL)	1.295	0.443 to 2.146	0.003^a
HOMA-IR	-6.224	-9.685 to -2.764	0.001^a

¹Every variable was adjusted for other variables in the table.

^aP < 0.05.

B: Regression coefficient. ALT: Alanine transaminase; AST: Aspartate aminotransferase; BMI: Body mass index; DBP: Diastolic blood pressure; DM: Diabetes mellitus; FBS: Fasting blood sugar; HDL: High-density lipoprotein; HOMA-IR: Homeostasis Model Assessment insulin resistance; HTN: Hypertension; IQR: Interquartile range (25^th–75^th percentiles); LDL: Low-density lipoprotein; SEPP1: Selenoprotien P1; VAI: Visceral adiposity index, W/H ratio: Waist/height ratio.

Citation: Elbarky A, Ismail KG, Yousef YF, Elshafiey RMG, Elsharaby RM, El-Kaffas A, Al-Beltagi M. Selenoprotein-p and insulin resistance in children and adolescents with obesity. World J Clin Pediatr 2024; 13(3): 94721
URL: https://www.wjgnet.com/2219-2808/full/v13/i3/94721.htm
DOI: https://dx.doi.org/10.5409/wjcp.v13.i3.94721