Biochemical markers of endothelial injury in children with obesity-from adhesion molecules to novel endothelium-specific biomarkers.

Introduction: Childhood obesity is no longer only a metabolic condition but an early vascular disease. Subclinical endothelial dysfunction develops long before overt cardiovascular complications and may contribute to the later emergence of atherosclerosis and hypertension. Detecting these early alterations remains a major challenge in pediatric care. Methods: This mini review integrates current evidence on circulating biochemical markers of endothelial injury in children with obesity, focusing on markers reflecting endothelial activation, hemostatic imbalance, and vascular dysfunction. Results: Multiple biomarkers are altered in pediatric obesity. Soluble adhesion molecules reflect early endothelial activation and low-grade inflammation. Hemostatic markers indicate a shift toward a prothrombotic state. Dysregulation of the NO-eNOS-ADMA axis contributes to reduced nitric oxide bioavailability and impaired vascular function. Emerging endothelium-specific biomarkers, including endocan and syndecan-1, offer greater specificity and appear to capture early vascular injury more sensitively than traditional inflammatory markers. Indirect markers further link metabolic, inflammatory, and oxidative pathways. Conclusions: Endothelial dysfunction represents an early, clinically silent but potentially reversible stage of obesity-related vascular disease in children. A multimarker approach may improve early risk identification and better reflect the complexity of underlying mechanisms. These findings support a shift toward earlier, multidisciplinary cardiovascular risk assessment in pediatric obesity and highlight the need for prospective studies to translate biomarkers into clinical practice.