Association of lipid metabolism with pneumonia risk in under-five children in China

Wang, Qianhan; Miao, Yonghong; Zhao, Qiongdan

doi:10.1016/j.jped.2023.03.006

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Sumário

ORIGINAL ARTICLE • J. Pediatr. (Rio J.) 99 (5) • 2023 • https://doi.org/10.1016/j.jped.2023.03.006 copy

Association of lipid metabolism with pneumonia risk in under-five children in China

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The relationship between lipid metabolism and pneumonia in under-five children remains unclear. The aim of the study was to explore the association of several lipids, lipoproteins and apolipoproteins with the risk of childhood pneumonia, and to initially reveal the mechanisms involved.

Methods:

There were 1000 children with confirmed severe pneumonia and 1000 healthy controls (18-59 months old) in the study. Serum levels of several lipids, lipoproteins and apolipoproteins were measured. The occurrence of hypoxaemia and serum level of C-reactive protein were recorded. Multivariate logistic regression and spearman correlation analysis were adopted to assess the correlation between these variables to achieve the research objective.

Results:

First, higher triglycerides, total cholesterol, LDL cholesterol, VLDL cholesterol and apolipoprotein B levels were associated with the elevated risk of severe pneumonia (OR: 1.407, 95%CI: 1.336~1.480; OR: 1.947, 95%CI: 1.741~2.175; OR: 1.153, 95%CI: 1.116~1.189; OR: 1.310, 95%CI: 1.222~1.404; OR: 1.075, 95%CI: 1.003~1.151). Higher HDL cholesterol and apolipoprotein A1 levels were associated with a decreased risk of the disease (OR: 0.903, 95%CI: 0.873~0.933; OR: 0.921, 95%CI: 0.891~0.952). Second, higher triglycerides level was associated with an increased risk of hypoxemia in these children (OR: 1.142, 95%CI: 1.072~1.215). Third, serum HDL cholesterol level was linearly associated with C-reactive protein level in these children (p = -0.343, P < 0.001).

Conclusion:

Abnormal levels of several lipids, lipoproteins and apolipoproteins were related to severe childhood pneumonia. The findings that triglycerides and HDL cholesterol were respectively implicated in hypoxaemia and inflammation might partly explain the mechanisms linking lipid metabolism to severe pneumonia.

KEYWORDS
Apolipoprotein; Hypoxemia; Lipid metabolism; Pneumonia; Inflammation

	Control	Common case	Severe case	F/H value	P value
Total(n)	1000	1000	1000	-	-
Demography data
Age (months)	48 (42, 54)	49 (43, 54)	49 (42, 55)	0.383	0.826
Male (n,%)	699	685	676	1.231	0.267
Han nationality (n,%)	939	925	934	1.546	0.214
BMI Z-score	1.00 (-0.58, 2.46)	0.91 (-0.58, 2.67)	1.17 (-0.35, 2.84)	5.054	0.080
Household income (yuan)^b b Household income indicated average monthly income per capita.	2900 (2000, 3900)	2900(1900,3900)	3000(1800,3800)	3.225	0.199
Clinical manifestations
Hyperpyrexia (n)	-	195	340	53.651	<0.001
Dehydration (n)	-	155	275	42.660	<0.001
Diarrhea (n)	-	225	295	12.734	<0.001
Hypoxemia (n)	-	78	231	89.601	<0.001
Serological data
WBC count (x 10⁹/l)	-	12.89(9.69, 16.06)	12.31 (9.41,15.93)	2.609	0.106
High creatinine (n)	-	75	235	97.729	<0.001
C-reactive protein (mg/l)	-	103.19(54.18,161.84)	137.10(63.03,198.04)	45.871	<0.001
Antibiotics
Cephalosporins	-	865	935	27.222	<0.001
Macrolides	-	625	490	36.939	<0.001
Other antibiotics	-	240	475	120.214	<0.001
Required to change antibiotics	-	310	575	142.332	<0.001

	Control	Common case	Severe case	H value	P value
Total(n)	1000	1000	1000
TG (mmol/l)^b b TG = Triglycerides; TC = Total cholesterol; LDL-C = Low-density lipoprotein cholesterol; VLDL-C = Very low-density lipoprotein cholesterol; HDL-C = High-density lipoprotein cholesterol; ApoA1 = Apolipoprotein A1; ApoB = Apolipoprotein B; Lp-a = Lipoprotein A.	0.83 (0.66, 0.96)	0.83 (0.67, 0.99)	0.98(0.76, 1.19)‡	298.258	<0.001
TC (mmol/l)	3.49 (2.73, 4.25)	3.63 (2.83, 4.38)†	4.09 (3.26, 4.87)‡	193.845	<0.001
LDL-C (mmol/l)	2.01 (1.77,2.26)	2.03(1.76,2.30)	2.19(1.85, 2.49)‡	110.759	<0.001
VLDL-C (mmol/l)	0.33 (0.20, 0.45)	0.33 (0.24, 0.46)	0.39(0.26, 0.53)‡	85.380	<0.001
HDL-C (mmol/l)	1.36(1.06, 1.67)	1.34(1.08, 1.60)	1.25(1.00, 1.49)‡	66.823	<0.001
Lp-a (mmol/l)	57.23 (32.77, 84.77)	58.26(31.32,87.33)	59.42(29.99,88.18)	1.675	0.433
ApoA1 (g/l)	1.17(0.87, 1.48)	1.16(0.88, 1.42)	1.07(0.84, 1.34)‡	39.981	<0.001
ApoB (g/l)	0.47(0.36,0.59)	0.48 (0.35, 0.62)	0.48 (0.36, 0.63)	8.524	0.014

Risk of common case	Univariate logistic regression		Multivariate logistic regression
Risk of common case	OR	95%CI	OR	95%CI
TG^b b TG = Triglycerides; TC = Total cholesterol; LDL-C = Low-density lipoprotein cholesterol; VLDL-C = Very low-density lipoprotein cholesterol; HDL-C = High-density lipoprotein cholesterol; ApoA1 = Apolipoprotein A1; ApoB = Apolipoprotein B; Lp-a = Lipoprotein A.	1.045	0.995 ~ 1.097	1.046	0.995 ~ 1.098
TC	1.109	1.013 ~ 1.214	1.110	1.014 ~ 1.214
LDL-C	1.028	0.999 ~ 1.059	1.028	0.999 ~ 1.059
VLDL-C	1.063	0.996 ~ 1.134	1.064	0.996 ~ 1.135
HDL-C	0.990	0.963 ~ 1.017	0.992	0.963 ~ 1.018
Lp-a	1.011	0.983 ~ 1.040	1.011	0.984 ~ 1.040
ApoA1	0.979	0.953 ~ 1.007	0.980	0.953 ~ 1.008
ApoB	1.039	0.979 ~ 1.102	1.039	0.979 ~ 1.103

Risk of severe case	Univariate logistic regression		Multivariate logistic regression
Risk of severe case	OR	95%CI	OR	95%CI
TG	1.406	1.336 ~ 1.479	1.407	1.336 ~ 1.480
TC	1.946	1.740 ~ 2.175	1.947	1.741 ~ 2.175
LDL-C	1.152	1.116 ~ 1.188	1.153	1.116 ~ 1.189
VLDL-C	1.309	1.221 ~ 1.403	1.310	1.222 ~ 1.404
HDL-C	0.902	0.873 ~ 0.932	0.903	0.873 ~ 0.933
Lp-a	1.011	0.979 ~ 1.045	1.012	0.979 ~ 1.046
ApoA1	0.921	0.891 ~ 0.951	0.921	0.891 ~ 0.952
ApoB	1.074	1.003 ~ 1.150	1.075	1.003 ~ 1.151

Risk of hypoxemia in common case	Univariate logistic regression		Multivariate logistic regression
Risk of hypoxemia in common case	OR	95%CI	OR	95%CI
TG^b TG = Triglycerides; TC = Total cholesterol; LDL-C = Low-density lipoprotein cholesterol; VLDL-C = Very low-density lipoprotein cholesterol; HDL-C = High-density lipoprotein cholesterol; ApoA1 = Apolipoprotein A1; ApoB = Apolipoprotein B; Lp-a = Lipoprotein A.	1.171	1.028 ~ 1.335	1.172	1.028 ~ 1.336
TC	0.982	0.773 ~ 1.249	0.983	0.774 ~ 1.249
LDL-C	1.050	0.976 ~ 1.130	1.051	0.976 ~ 1.131
VLDL-C	1.031	0.859 ~ 1.237	1.032	0.859 ~ 1.237
HDL-C	1.060	0.981 ~ 1.145	1.060	0.981 ~ 1.146
Lp-a	0.992	0.923 ~ 1.066	0.993	0.923 ~ 1.066
ApoA1	1.021	0.946 ~ 1.103	1.021	0.947 ~ 1.103
ApoB	0.971	0.831 ~ 1.135	0.972	0.831 ~ 1.136

Risk of hypoxemia in severe case	Univariate logistic regression		Multivariate logistic regression
Risk of hypoxemia in severe case	OR	95%CI	OR	95%CI
TG	1.141	1.072 ~ 1.214	1.142	1.072 ~ 1.215
TC	1.133	0.969 ~ 1.324	1.134	0.969 ~ 1.325
LDL-C	1.004	0.964 ~ 1.045	1.005	0.965 ~ 1.046
VLDL-C	1.033	0.940 ~ 1.135	1.034	0.940 ~ 1.135
HDL-C	1.032	0.979 ~ 1.087	1.033	0.979 ~ 1.088
Lp-a	0.960	0.917 ~ 1.004	0.961	0.917 ~ 1.005
ApoA1	1.013	0.962 ~ 1.066	1.013	0.963 ~ 1.066
ApoB	0.983	0.894 ~ 1.081	0.984	0.894 ~ 1.082

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[1] * Corresponding author. E-mail: qianhan789324@126.com (Q. Wang).