Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCc9dPsVLVbdGbNX9QmtSvnbJS0066-782X201700130038010.5935/abc.20170127Letter to the EditorChildhood Obesity, MMP-9 Levels, and Vitamin DCeritZeynepNear East University HospitalNicosiaChipreNear East University Hospital, Nicosia - ChipreMailing Address: Zeynep Cerit, Near East University, Department of Pediatric Cardiology, 07100, Nicosia. E-mail: drceritzeyno@gmail.com, drcerit@yahoo.com1020171094380381200420170906201709062017This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.KeywordsPediatric ObesityChildAdolescentsCardiovascular DiseasesOverweightMatrix Metaloproteinase 9
Dear Editor,
I have read the article entitled “MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese” by Andrade et al.1, recently published in journal, with great interest. The investigators reported that obese children and adolescents present higher mean intima-media thickness (IMT), plasma matrix metalloproteinase (MMP)-9 and MMP-9/tissue inhibitor of metalloproteinase-1 ratio compared to the non-obese. Thus, these findings indicate that this group presents a risk profile for early atherosclerosis.1
Childhood obesity is an international public health problem leading to an increased risk of adult obesity and associated with cardiovascular diseases such as hypertension, peripheral and coronary artery disease.2 Vitamin D (vit D) may regulate adipose tissue mass, differentiation, and metabolism. Vit D deficiency might contribute with overweight and/or obesity, possibly by effects on lipogenesis and/or adipogenesis.3 Coussens et al.4 reported an inverse correlation between circulating vit D concentration and serum inflammatory biomarkers. Increased tumor necrosis factor-alpha (TNF-α) is associated with low vit D concentrations. Vit D down-regulates MMP-9 production by TNF-α and decreases production of MMP-9. Wang et al.5 reported that vit D derivatives could significantly inhibit TNF-α induced MMP-2 and MMP-9 secretion in nasal polyp-derived fibroblasts.
In this context, considering a close association among childhood obesity, serum MMP-9 and vit D levels, the correlation of this study’s result1 with serum vit D levels might be beneficial.
References1 Andrade C, Bosco A, Sandrim V, Silva F. MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese. Arq Bras Cardiol. 2017;108(3):198-203. doi: 10.5935/abc.20170025.AndradeCBoscoASandrimVSilvaFMMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-ObeseArq Bras Cardiol2017108319820310.5935/abc.201700252 Saggese G, Vierucci F, Boot AM, Czech-Kowalska J, Weber G, Camargo CA Jr, et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr. 2015;174:565-76. doi: 10.1007/s00431-015-2524-6.SaggeseGVierucciFBootAMCzech-KowalskaJWeberGCamargoCAJrVitamin D in childhood and adolescence: an expert position statementEur J Pediatr201517456557610.1007/s00431-015-2524-63 Cerit Z. Prediction of childhood obesity with or without vitamin D deficiency. Eur J Pediatr. 2017;176(4):557. doi: 10.1007/s00431-017-2860-9.CeritZPrediction of childhood obesity with or without vitamin D deficiencyEur J Pediatr2017176455755710.1007/s00431-017-2860-94 Coussens A, Timms PM, Boucher BJ, Venton TR, Ashcroft AT, Skolimowska KH, et al. A1alpha, 25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009;127:539-48. doi: 10.1111/j.1365-2567.2008.03024..CoussensATimmsPMBoucherBJVentonTRAshcroftATSkolimowskaKHA1alpha, 25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infectionImmunology200912753954810.1111/j.1365-2567.2008.03024.5 Wang LF, Tai CF, Chien CY, Chiang FY, Chen JY. Vitamin D decreases the secretion of matrix metalloproteinase-2 and matrix metalloproteinase-9 in fibroblasts derived from Taiwanese patients with chronic rhinosinusitis with nasal polyposis. Kaohsiung J Med Sci. 2015;31(5):235-40. doi: 10.1016/j.kjms.2015.02.001.WangLFTaiCFChienCYChiangFYChenJYVitamin D decreases the secretion of matrix metalloproteinase-2 and matrix metalloproteinase-9 in fibroblasts derived from Taiwanese patients with chronic rhinosinusitis with nasal polyposisKaohsiung J Med Sci201531523524010.1016/j.kjms.2015.02.001ReplyAndradeClaudioBoscoAdrianaSandrimValeriaSilvaFrancisco
We would like to thank you and agree with the considerations inserted in the letter about obesity and atherosclerosis. Indeed, we found a close association between obese children and adolescents with atherosclerosis, compared to non-obese ones.1
Besides, many authors have cited the important role of Vitamin D in these situations. Certainly, there is an inverse association between Vitamin and obesity. In this point, the Vitamin should regulate the adipose tissue metabolism, although its real role is still unknown, that is, whether it is cause or consequence.2
Indeed, obesity and Vitamin D deficiency represent an important health concern in the United States among children and adults.2
Because of the association between cardiovascular risk in obese children and adolescents, Atabeck et al.3 suggest the prescription of Vitamin D as a way to prevent the premature onset of atherosclerosis. Gul at al.4 reported that Vitamin D deficiency could contribute with morbidities associated to childhood obesity, such as increasing cardiovascular cardiometabolic risks, atherogenic dyslipidemia and hypertension.
In short, we think it would be important to promote more studies in order to prevent and treat atherosclerosis in obesity, as well to considerer the other diseases.
Sincerely,
Claudio AndradeAdriana BoscoValeria SandrimFrancisco SilvaReferences1 Andrade C, Bosco A, Sandrim V, Silva F. MMP-9 levels and IMT of Carotid Arteries are elevated in Obese Children and Adolescents Compared to Non-Obese. Arq Bras Cardiol. 2017;108(3):108-203. Doi:10.5935/abc.20170025AndradeCBoscoASandrimVSilvaFMMP-9 levels and IMT of Carotid Arteries are elevated in Obese Children and Adolescents Compared to Non-ObeseArq Bras Cardiol2017108310820310.5935/abc.201700252 Peterson CA, Belenchia AM. Vitamin D deficiency and childhood obesity: a tale of two epidemics. Mo Med. 2014;111(1):49-53. PMID:24645299PetersonCABelenchiaAMVitamin D deficiency and childhood obesity: a tale of two epidemicsMo Med2014111149533 Atabeck ME, Eklioglu BS, Akyürek N, Alp H. Association between vitamin D level and cardiovascular risk in obese children and adolescents. J Pediatr Endocr Met. 2014;27(7-8):661-6. doi: 10.1515/jpem-2013-0379.AtabeckMEEkliogluBSAkyürekNAlpHAssociation between vitamin D level and cardiovascular risk in obese children and adolescentsJ Pediatr Endocr Met2014277-866166610.1515/jpem-2013-03794 Gul A, Ozer S, Yılmaz R, Sonmezgoz E, Kasap T, Takçı S, et al. Association between vitamin D levels and cardiovascular risk factors in obese children and adolescents. Nutr Hosp. 2017;34(2):323-9. doi: 10.20960/nh.412GulAOzerSYılmazRSonmezgozEKasapTTakçıSAssociation between vitamin D levels and cardiovascular risk factors in obese children and adolescentsNutr Hosp201734232332910.20960/nh.412Carta ao EditorObesidade Infantil, Níveis de MMP-9 e Vitamina DCeritZeynep2Near East University Hospital, Nicosia - ChipreCorrespondência: Zeynep Cerit, Near East University, Department of Pediatric Cardiology, 07100, Nicosia. E-mail: drceritzeyno@gmail.com, drcerit@yahoo.comPalavras-chaveObesidade PediátricaCriançaAdolescentesDoenças CardiovascularesSobrepesoMetaloproteinase 9 da Matriz
Caro Editor,
Li o artigo entitulado “MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese CHildren and Adolescents Compared to Non-Obese, de Andrade et al.,1 publicado recentemente, com muito interesse. Os pesquisadores demonstraram que crianças e adolescentes obesos tinham média de espessamento médio-intimal (EMI) mais alta, assim como a metaloproteinase da matriz-9 no plasma (MMP-9) e inibidor tecidual de metaloproteinase de matriz 1 em comparação aos não-obesos. Assim, esses achados indicam que este grupo apresenta um perfil de risco para aterosclerose precoce.1
A obesidade infantil é um problema de saúde pública internacional, que leva ao maior risco de obesidade na vida adulta e está associada a doenças cardiovasculares, como hipertensão, doença arterial coronária e periférica.2 A vitamina D (vit D) pode regular a massa tecidual adiposa, a diferenciação e o metabolismo. A deficiência de vit D pode contribuir com o sobrepeso e/ou com a obesidade, possivelmente por seu efeito na lipogênese e/ou adipogênese.3 Coussens et al.,4 relataram uma correlação inversa entre a concentração de vit D e os biomarcadores inflamatórios. O aumento do fator de necrose tumoral alfa (TNF-α) está associado à baixa concentração de vit D. A redução da vit D regula a produção de MMP-9 pelo TNF-α e reduz a produção de MMP-9. Wang et al.,5 relataram que os derivados da vit D podem inibir significativamente a MMP-2 induzida pelo TNF-α e a secreção de MMP-9 em fibroblastos derivados de pólipos nasais.
Neste contexto, considerando a associação entre a obesidade infantil, a MMP-9 e os níveis de vit D, a correlação do resultado deste estudo1 com os níveis de vit D pode ser benéfica.
Agradecemos e concordamos com a consideração inserida na carta com relação à obesidade e à aterosclerose. De fato, encontramos uma associação entre crianças e adolescentes obesos com a aterosclerose, em comparação aos não-obesos.1
Além disso, muitos autores mencionaram o importante papel da Vitamina D nessas situações. Certamente há uma associação inversa entre a vitamina e a obesidade. Neste ponto, a vitamina deveria regular o metabolismo do tecido adiposo, embora seu papel real ainda seja desconhecido - sendo causa ou consequência.2
De fato, a obesidade e a deficiência da vitamina D representam uma preocupação de saúde importante nos Estados Unidos entre crianças e adultos.2
Por causa da associação entre o risco cardiovascular em crianças e adolescentes obesos, Atabeck et al.,3 sugerem a prescrição da vitamina D como forma de prevenir o surgimento prematuro da aterosclerose. Gul et al.,4 relataram que a deficiência de vitamina D poderia contribuir com as morbidades associadas à obesidade infantil, como aumento dos riscos cardiovasculares ligados ao metabolismo, dislipidemia aterogênica e hipertensão.
Resumindo, consideramos a importância de promover mais estudos para prevenir e tratar a aterosclerose na obesidade, assim como considerar outras doenças.