Association of TSH With Cardiovascular Disease Risk in Overweight and Obese Children During Lifestyle Intervention

Abstract

Context: Overweight and obese children have an increased risk to develop cardiovascular diseases (CVDs) in which thyroid-stimulating hormone (TSH) has been suggested as an intermediary factor. However, results of cross-sectional studies are inconclusive, and intervention studies investigating changes in TSH concentrations in association with changes in cardiovascular risk parameters in overweight and obese children are scarce.

Objective: To gain insight in associations of circulating TSH concentrations and cardiovascular risk parameters in overweight and obese children.

Design: Nonrandomized lifestyle intervention.

Setting: Centre for Overweight Adolescent and Children's Healthcare.

Patients: Three hundred thirty euthyroid overweight and obese children.

Intervention: Long-term lifestyle intervention.

Main outcome measures: TSH concentrations, pituitary TSH release in response to thyrotropin-releasing hormone (TRH), and cardiovascular risk parameters.

Results: At baseline, serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triacylglycerol (TAG), and monocyte chemotactic protein 1 concentrations were significantly associated with serum TSH concentrations. TSH release by the pituitary in response to exogenous TRH was not associated with cardiovascular risk parameters. During lifestyle intervention, several cardiovascular risk parameters significantly improved. In children whose body mass index z score improved, changes in TSH concentrations were significantly associated with changes in TC, LDL-C, and TAG concentrations.

Conclusions: In euthyroid overweight and obese children, circulating TSH concentrations are positively associated with markers representing increased CVD risk. Changes in TSH concentrations are also associated with changes in lipid concentrations in children with successful weight loss, which is consistent with TSH being an intermediary factor in modulating lipid and lipoprotein metabolism.

Trial registration: ClinicalTrials.gov NCT02091544.