The role of insulin in clustering of serum lipids and blood pressure in children and adolescents. The Cardiovascular Risk in Young Finns Study

Blood pressure and the risk of diabetes: A longitudinal observational study based on Chinese individuals

BACKGROUND

With lifestyle changes, the incidence of diabetes has been steadily increasing, and hypertension remains a significant risk factor impacting cardiovascular health. Understanding the potential effects of blood pressure on diabetes risk is, therefore, crucial. This study aims to comprehensively explore the relationship between blood pressure and diabetes risk.

METHODS

A total of 211,809 individuals undergoing health check-ups were included in this analysis. Participants were divided into four groups based on the quartiles of systolic and diastolic blood pressure, with the primary outcome being the incidence of new-onset diabetes.

RESULTS

Over an average follow-up period of 3.1 years (±0.94 years), 3,000 men (1.42%) and 1,173 women (0.55%) were newly diagnosed with diabetes. Multivariable Cox regression analysis demonstrated that blood pressure is an independent predictor of new-onset diabetes (systolic blood pressure HR 1.07 per SD increase, 95% CI: 1.01-1.12, P for trend <0.001; diastolic blood pressure HR 1.11 per SD increase, 95% CI: 1.06-1.17, P for trend 0.001). The optimal cutoff for systolic blood pressure in predicting new-onset diabetes was found to be 123 mmHg (area under the curve 0.7014, sensitivity 0.65, specificity 0.64), which was superior to the predictive efficacy of diastolic blood pressure (area under the curve 0.6645, sensitivity 0.63, specificity 0.62). Subgroup analyses indicated that the risk of blood pressure-related diabetes was significantly higher in middle-aged individuals compared to older adults (P for interaction <0.05). Additionally, women showed a higher risk of systolic blood pressure-related diabetes than men, and normal-weight individuals exhibited a higher risk than those with obesity (P for interaction <0.05).

CONCLUSIONS

This cohort study within a Chinese population highlights that, after adjusting for other confounding factors, blood pressure is an independent risk factor for diabetes. This association is particularly pronounced among middle-aged individuals, women, and those of normal weight. Moreover, systolic blood pressure demonstrates superior predictive efficacy for diabetes compared to diastolic blood pressure.

Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study

AIMS/HYPOTHESIS

The proportion of children with type 1 diabetes (T1D) who have experience with low-carbohydrate diet (LCD) is unknown. Our goal was to map the frequency of LCD among children with T1D and to describe their clinical and laboratory data.

METHODS

Caregivers of 1040 children with T1D from three centers were addressed with a structured questionnaire regarding the children's carbohydrate intake and experience with LCD (daily energy intake from carbohydrates below 26% of age-recommended values). The subjects currently on LCD were compared to a group of non-LCD respondents matched to age, T1D duration, sex, type and center of treatment.

RESULTS

A total of 624/1040 (60%) of the subjects completed the survey. A total of 242/624 (39%) subjects reported experience with voluntary carbohydrate restriction with 36/624 (5.8%) subjects currently following the LCD. The LCD group had similar HbA1c (45 vs. 49.5, p = 0.11), lower average glycemia (7.0 vs. 7.9, p = 0.02), higher time in range (74 vs. 67%, p = 0.02), lower time in hyperglycemia >10 mmol/L (17 vs. 20%, p = 0.04), tendency to more time in hypoglycemia <3.9 mmol/L(8 vs. 5%, p = 0.05) and lower systolic blood pressure percentile (43 vs. 74, p = 0.03). The groups did not differ in their lipid profile nor in current body height, weight or BMI. The LCD was mostly initiated by the parents or the subjects themselves and only 39% of the families consulted their decision with the diabetologist.

CONCLUSIONS/INTERPRETATION

Low carbohydrate diet is not scarce in children with T1D and is associated with modestly better disease control. At the same time, caution should be applied as it showed a tendency toward more frequent hypoglycemia.

Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents

BACKGROUND

Overweight (Ow) and obesity among adults and children increases the risk of metabolic consequences. Metabolic syndrome (MS) and impaired glucose metabolism are well-known risk factors for cardiovascular diseases and type 2 diabetes. The aim of this study was to evaluate the prevalence of MS and impaired glucose metabolism among Ow and obese (Ob) children and adolescents (aged 10-17 years) in Lithuania, and to evaluate the associations between insulin resistance (IR) indices and anthropometric parameters as well as metabolic disturbances.

METHODS

The study population consisted of 344 OwOb children and adolescents of all pubertal stages. Oral glucose tolerance tests (OGTTs), IR and β cell function indices, lipid profile, and anthropometric parameters of all subjects were analyzed. MS was defined according to the International Diabetes Federation consensus guidelines.

RESULTS

MS was found in 21.3% of the OwOb children and adolescents, and 12.1% had impaired glucose metabolism (6.9% with impaired fasting glucose, 4.5% with impaired glucose tolerance, and 0.6% with type 2 diabetes). IR was directly related to body mass index and waist circumference, waist-to-height and waist-to-hip ratios, and sum of skin-fold thicknesses. Children with MS were more insulin-resistant, had higher odds ratio for prediabetes and had a more disturbed lipid profile than subjects without MS. Moreover, total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the more mature OwOb adolescents.

CONCLUSION

MS and lipid profile disturbances are common in OwOb children and adolescents. MS is directly associated with IR. Therefore, OwOb children and adolescents should be carefully followed up for metabolic abnormalities during late childhood as these can persist into adulthood.

Metabolic Syndrome and Insulin Resistance in Schoolchildren From a Developing Country

Background: Overweight and obesity are prevalent in schoolchildren due to dietary habits and lack of exercise. These children are prone to metabolic syndrome (MS) and future risk of type 2 diabetes mellitus and cardiovascular diseases. Materials and Methods: This cross-sectional study was conducted in Bhubaneswar City, Eastern India, among schoolchildren. Obesity and overweight were determined by the Indian Academy of Pediatrics guideline. Fasting venous blood samples were taken for insulin, blood glucose, and lipid levels measurement. Blood pressure was measured as per the protocol. The International Diabetic Federation (IDF) criteria for the definition of MS were followed. Insulin resistance was determined by a homeostatic model assessment (HOMA-IR). Results: A total of 1,930 children were screened, of which 545 (28.2%) were overweight and obese. The male to female ratio was 1.27. The overall prevalence of MS was 21.8% (11% in 6 to ≤10 years old and 30.6% in 11 to 16 years old). A history of cardiovascular disease, diabetes, obesity, and hypertension in the family was present in 42.7%. Acanthosis nigricans was present in 46.4%. A history of exclusive breast feeding for 6 months was present in 68.1%. The mean HOMA-IR in children with MS was 5.46 compared to 2.18 in those without MS (insulin resistance was more common in children with MS). Conclusions: The present study found a higher prevalence of MS and insulin resistance in schoolchildren from Eastern India who are overweight/obese.

Obesity and insulin sensitivity effects on cardiovascular risk factors: Comparisons of obese dysglycemic youth and adults

BACKGROUND

Obesity and pubertal insulin resistance worsen cardiovascular (CV) risk factors in youth. It is unclear how the relationships of obesity and insulin resistance with CV risk compare to adults.

SUBJECTS AND METHODS

We evaluated 66 pubertal youth (mean ± SD: age 14.2 ± 2.0 years, body mass index [BMI] 36.6 ± 6.0 kg/m² , hemoglobin A1c [HbA1c] 38.5 ± 6.1 mmol/mol) and 355 adults with comparable BMI (age 52.7 ± 9.4 years, BMI 35.1 ± 5.1 kg/m² , HbA1c 39.8 ± 4.2 mmol/mol) participating in a multicenter study. Insulin sensitivity was quantified using hyperglycemic clamps. Assessment of CV risk factors was standardized across sites. Regression analyses compared the impact of insulin sensitivity and CV risk factors between youth and adults.

RESULTS

Obese pubertal youth were more insulin resistant than comparably obese adults (P < .001), but with similar slopes for the inverse relationship between insulin sensitivity and obesity. The impact of obesity on CV risk factors was explained by insulin sensitivity (P = NS after adjustment for sensitivity). The two age groups did not differ in relationships between insulin sensitivity and diastolic blood pressure, total cholesterol, and low-density lipoprotein (LDL) cholesterol, after adjusting for obesity. However, while systolic blood pressure (SBP) and high-density lipoprotein (HDL) cholesterol exhibited the expected direct and inverse relationships, respectively with insulin sensitivity in adults, these slopes were flat in youth across the range of insulin sensitivity (P ≤ .05 for group differences).

CONCLUSIONS

Effects of obesity on CV risk factors were attributable to insulin sensitivity in both groups. The relationships between insulin sensitivity and CV risk factors were similar in obese youth and adult groups except for SBP and HDL cholesterol.

CLINICAL TRIAL REGISTRATION

The RISE consortium studies are registered through Clinicaltrials.gov as NCT01779362 (Adult Medication Study); NCT01763346 (Adult Surgery Study); and NCT01779375 (Pediatric Medication Study). Clinical trial registration numbers: NCT01779362, NCT01779375 and NCT01763346 at clinicaltrials.gov.

One-year treatment with gonadotropin-releasing hormone analogues does not affect body mass index, insulin sensitivity or lipid profile in girls with central precocious puberty

Background Puberty is associated with a physiological decline in insulin sensitivity (IS). Overweight (OW) and obesity (OB) are common among girls with central precocious puberty (CPP). CPP is considered a risk factor for metabolic diseases. The aim of this study was to assess surrogate measures of IS, body mass index (BMI) and other metabolic parameters in CPP girls at diagnosis and during treatment with gonadotropin-releasing hormone analogues (GnRHa). Methods We present a prospective longitudinal study of CPP girls. The standard oral glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR), whole-body IS index (ISI) and fasting lipid profiles were evaluated at diagnosis, and at 6 and 12 months of treatment. Results Nineteen CPP girls were included; 17 were evaluable. At baseline, seven patients had normal weight (NW), five were OW and five were OB. During GnRHa treatment no significant changes were observed in BMI, HOMA-IR or ISI when considering the whole group. Whereas, when we analyzed patients according to BMI status, in NW patients, BMI increased significantly with no changes in HOMA-IR or ISI along treatment. In the OW/OB group, no significant differences were observed in BMI, HOMA-IR or ISI. Conclusions Girls with CPP showed a high frequency of OW/OB and a high prevalence of IR. GnRHa did not affect BMI, IS or the lipid profile when considering the whole cohort of patients. However, there was an increase in BMI in NW girls but not in OW/OB patients.

Frequency of insulin resistance in nondiabetic adult Bangladeshi individuals of different obesity phenotypes

Insulin resistance (IR) is the corner stone of metabolic obesity. This cross-sectional analytical study was aimed to find out the frequency of IR in non-diabetic adult individuals of different obesity phenotypes that would help to implement preventive measures to avoid the cardiometabolic catastrophes.

METHODS

Total 955 nondiabetic adult individuals were selected and categorized into six metabolic phenotypes by metabolic syndrome criteria in each BMI group (18.5-24.9-normal weight, 25-29.9-overweight, ≥30-obese). From them, metabolically obese normal weight, metabolically obese overweight, metabolically healthy obese and metabolically unhealthy obese were selected as Obesity phenotypes (N = 616).

RESULTS

The frequency of IR was found to be very high (60.2%) in total nondiabetic adult obese individuals (N = 616). Highest frequency of IR was found in MUO phenotype (76.3%), lowest frequency of IR was found in MONW phenotype (37.1%) and frequency of IR in MOOW and MHO phenotypes found to be identical but significantly (p < 0.0001) less than MUO and significantly (p < 0.0001) more than MONW phenotype. Among the obesity phenotypes, females were more insulin resistant than males (67.5% vs 48.1% respectively, p < 0.05). Frequency of IR found significantly (p < 0.05) more in female than male in all obesity phenotypes except in MUO phenotype where males found to show significantly (p < 0.05) higher frequency than females. Frequency of IR was significantly higher in younger (20-39 yrs) age group than 40-60 yrs age group (63.2% vs 53.5% respectively, p < 0.05).

CONCLUSION

IR is alarmingly high (60.2%) in nondiabetic adult obese individuals. Among different obesity phenotypes, it is highest (76.3%) in MUO and lowest (37.1%) in MONW.

Cardiovascular and Metabolic Complications - Diagnosis and Management in Obese Children

The world at present is facing a burden of rising prevalence of obesity in children and adolescents. The developing countries are particularly facing the dual burden on under-nutrition and obesity. This is associated with appearance and clustering of cardiometabolic abnormalities at an early age with development of chronic complications early and possible decrease in life span of these children and adolescents. In adults this clustering has been termed as 'metabolic syndrome' with definitions that can be used universally. However, in children and adolescents there is no consensus on a uniform definition of metabolic syndrome that can be applicable across the age groups and various ethnicities. Further, as childhood is a period of growth and development, changes in body composition and insulin sensitivity that occur with puberty may influence the thresholds of components used to define metabolic syndrome. Children of South Asian ethnicity appear to be more predisposed to develop abnormalities of metabolic syndrome, possible due to their adverse body fat patterning and genetic influences. The definition of pediatric metabolic syndrome proposed by International Diabetes Federation is useful across different ethnicities. Presence of at least one component of metabolic syndrome should lead to detailed screening for other components and complications. A multimodality approach including therapeutic lifestyle changes targeted at the individual, family and community is essential for management. Pharmacotherapy for individual components may be required if initial management strategies fail to achieve the goals.

Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?

Benign prostatic hyperplasia and hypertension are common age-related comorbidities. Although the etiology of benign prostatic hyperplasia (BPH) is still largely unresolved and poorly understood, a significant age-independent association was found between BPH and hypertension, indicating a common pathophysiological factor for both diseases. It has previously been suggested that the development of essential hypertension may be related to diet-induced hyperinsulinemia. This study follows the question, whether BPH may develop due to the same mechanism, thereby explaining the well-known comorbidity of these 2 disorders. The scientific evidence presented shows that BPH and hypertension share the same pathophysiological changes, with hyperinsulinemia as the driving force. It further shows that significant dietary changes during human history cause disruption of a finely tuned metabolic balance that has evolved over millions of years of evolution: high-insulinemic food, typical of current “Western” diets, has the potential to cause hyperinsulinemia and insulin resistance, as well as an abnormally increased activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, alterations that play a pivotal role in the pathogenesis of BPH and hypertension.

Relationship among age, insulin resistance, and blood pressure

The effect of age to modify the relationship between insulin resistance and hypertension is unclear. In this retrospective, cross-sectional study, median age was used to create two age groups (<52 vs. ≥52 years), and comparisons were made of metabolic characteristics, including steady-state plasma glucose (SSPG) concentrations measured during the insulin suppression test to quantify insulin resistance. Individuals were stratified into SSPG tertiles and categorized as having normal blood pressure (BP), prehypertension, or hypertension. SSPG concentrations were similar in the two age groups (161 vs. 164 mg/dL). In the most insulin-resistant tertile, distribution of normal BP, prehypertension, and hypertension was equal in those aged <52 years, whereas in those aged ≥52 years, prevalence of hypertension was increased approximately fivefold compared with those with normal BP. Multivariate regression analysis demonstrated significant interaction between age and SSPG in predicting systolic BP (P = .023). In stratified analysis, SSPG, but not age, was an independent predictor of systolic BP and diastolic BP in ≥52 years group, whereas the reverse was true in the younger group. The adverse impact of insulin resistance on BP was accentuated in older individuals and may have a greater impact than further aging.

Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty

PURPOSE

Gonadotropin-releasing hormone agonist (GnRHa) is used as a therapeutic agent for central precocious puberty (CPP); however, increased obesity may subsequently occur. This study compared body mass index (BMI) and insulin resistance during the first year of GnRHa treatment for CPP.

METHODS

Patient group included 83 girls (aged 7.0-8.9 years) with developed breasts and a peak luteinizing hormone level of ≥5 IU/L after GnRH stimulation. Control group included 48 prepubertal girls. BMI and insulin resistance-related indices (homeostasis model assessment of insulin resistance [HOMA-IR] and quantitative insulin sensitivity check index [QUICKI]) were used to compare the groups before treatment, and among the patient group before and after GnRHa treatment.

RESULTS

No statistical difference in BMI z-score was detected between the 2 groups before treatment. Fasting insulin and HOMA-IR were increased in the patient group; fasting glucose-to-insulin ratio and QUICKI were increased in the control group (all P<0.001). In normal-weight subjects in the patient group, BMI z-score was significantly increased during GnRHa treatment (-0.1±0.7 vs. 0.1±0.8, P<0.001), whereas HOMA-IR and QUICKI exhibited no differences. In overweight subjects in the patient group; BMI z-score and HOMA-IR were not significantly different, whereas QUICKI was significantly decreased during GnRHa treatment (0.35±0.03 vs. 0.33±0.02, P=0.044).

CONCLUSION

Girls with CPP exhibited increased insulin resistance compared to the control group. During GnRHa treatment, normal-weight individuals showed increased BMI z-scores without increased insulin resistance; the overweight group demonstrated increased insulin resistance without significantly altered BMI z-scores. Long-term follow-up of BMI and insulin resistance changes in patients with CPP is required.

Weight Status and Physical Activity: Combined Influence on Cardiometabolic Risk Factors Among Adolescents, Santiago, Chile

We tested the independent and combined influence of overweight/obesity and meeting moderate to vigorous physical activity (MVPA) guidelines (≥60 minutes per day) on cardiometabolic risk factors among healthy adolescents. We measured anthropometry, blood pressure, fasting lipids, and activity by accelerometer in 223 adolescents. They were categorized as overweight/obese versus normal weight and meeting the World Health Organization guidelines for MVPA per day. Adolescents were 16.8 years, 41% overweight/obese, 30% met MVPA guidelines, 50% low high-density lipoprotein, 22% high triglycerides, 12% high blood pressure, and 6% high fasting glucose. Controlling for sex, overweight/obese adolescents who did not meet MVPA guidelines had 4.0 and 11.9 increased odds for elevated triglycerides and systolic blood pressure, respectively, compared to normal weight adolescents who met MVPA guidelines. Overweight/obese and normal weight adolescents who met MVPA guidelines did not differ in cardiometabolic risk factors. Among overweight/obese adolescents, being physically active attenuated the likelihood of high triglycerides and systolic blood pressure.

Childhood cardiovascular risk factors, a predictor of late adolescent overweight

Background:

We conducted a prospective study to elucidate the effects of increased cardiovascular risk factors on future weight gain and also the relation between body mass index (BMI) and other cardiovascular risk factors in children and adolescents.

Materials and Methods:

This study was conducted on 1525 nonobese children and adolescents with an age range of 3-16 years old, participating in the 1^st phase and follow-up phases of Tehran Lipid and Glucose Study. The subjects were evaluated 4 times with a 3-year time interval regarding lipid profile status and BMI, and other cardiovascular disease (CVD) risk factors. All the cases had a BMI <85% and had been appraised in at least two evaluation points.

Results:

Cardiovascular risk factors, high-density lipoprotein (HDL) (P = 0.019), low-density lipoprotein (P = 0.016), triglyceride (TG) (P < 0.001), and blood pressure (BP) (P = 0.001); had significant effects on weight gain. There was also no difference between boys and girls and no age trend for increasing weight in both groups. The associations between BMI with cardiovascular risk factors were assessed cross-sectionally. For both sexes, BMI was significantly correlated to systolic and diastolic BP and TG (P = 0.05). For girls, BMI was significantly related to HDL (P = 0.05) regardless to age, but in boys, the relation of BMI with HDL only increased with age (P = 0.05).

Conclusion:

Increased CVD risk factors are predictors of future overweight in childhood and adolescent and increased weight is linked significantly with dyslipidemia and hypertension in this age group.

Metabolic markers associated with insulin resistance predict type 2 diabetes in Koreans with normal blood pressure or prehypertension

BACKGROUND

Questions remain as to the association between essential hypertension and increased incidence of type 2 diabetes (T2DM). The premise of this analysis is that insulin resistance/compensatory hyperinsulinemia is a major predictor of T2DM, and the greater the prevalence of insulin resistance within any population, normotensive or hypertensive, the more likely T2DM will develop. The hypothesis to be tested is that surrogate estimates of insulin resistance will predict incident T2DM to a significant degree in persons with normal blood pressure or prehypertension.

METHODS

Analysis of data from a population-based survey of 10, 038 inhabitants of rural and urban areas of Korea, ≥40 years-old, initiated in 2001, with measures of demographic and metabolic characteristics at baseline and 8-years later. Participants were classified as having normal blood pressure or prehypertension, and three simple manifestations of insulin resistance related to the pathophysiology of T2DM used to predict incident T2DM: (1) glycemia (plasma glucose concentration 2-hour after 75 g oral glucose challenge = 2-hour PG); (2) hyperinsulinemia (plasma insulin concentration 2-hour after 75 g oral glucose challenge = 2-hour PI); and (3) dyslipidemia (ratio of fasting plasma triglyceride/high/density lipoprotein cholesterol concentration = TG/HDL-C ratio).

RESULTS

Fully adjusted hazard ratios (HR, 95 % CI) for incident T2DM were highest (P < 0.001) in the quartile of individuals with the highest 2-hour PG concentrations, ranging from 5.84 (3.37-10.1) in women with prehypertension to 12.2 (7.12-21.00) in men with normal blood pressure. T2DM also developed to a significantly greater degree in subjects within the highest quartile of TG/HDL-C ratios, with HRs varying from 2.91 (1.63-2.58) in women with prehypertension (P < 0.001) to 1.77 (1.12-2.81, P < 0.05) in men with prehypertension. The least predictive index of insulin resistance was the 2-hour PI concentration. Subjects with normal blood pressure in the highest quartile of 2-hour PI concentrations were significantly associated with incident T2DM, with HRs of 1.5 (1.02-2.20, P = 0.25) and 2.02 (1.35-3.02, P < 0.001), in men and women, respectively. Finally, incidence of T2DM in the highest quartile was somewhat greater in patients with prehypertension, irrespective of predictor.

CONCLUSIONS

Metabolic variables associated with insulin resistance (glycemia, insulinemia, and dyslipidemia) predict the development of T2DM in patients with either normal blood pressure or prehypertension.

Prevalence of Dyslipidemia and Associated Factors in Obese Children and Adolescents

OBJECTIVE

Childhood-onset obesity is associated with increased mortality and morbidity related to cardiovascular diseases (CVD) during adulthood. Dyslipidemia has a fundamental role in the pathogenesis of CVD. This study aimed to evaluate the prevalence of dyslipidemia and related factors among obese children and adolescents.

METHODS

Obese patients aged between 2 and 18 years were included in the study. Serum concentrations of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), fasting glucose levels, insulin, thyroid-stimulating hormone (TSH), free thyroxine (fT4), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and liver ultrasound findings were evaluated retrospectively.

RESULTS

Among 823 obese patients, 353 (42.9%) met the dyslipidemia criteria: 21.7% had hypertriglyceridemia, 19.7% had low levels of HDL-C, 18.6% had hypercholesterolemia, and 13.7% had high levels of LDL-C. Older age and/or high body mass index (BMI) were related to increased prevalence of dyslipidemia. Hepatosteatosis was more common among dyslipidemic patients. The frequency of insulin resistance (IR) and of higher levels of ALT and TSH were also detected in dyslipidemic patients. Patients with both dyslipidemia and grade 2-3 hepatosteatosis had higher levels of ALT, AST and TSH and lower levels of fT4.

CONCLUSION

Prevalence of dyslipidemia is high in obese children, and hypertriglyceridemia is in the foreground. Higher levels of IR and more apparent abnormal liver function test results are observed in the context of dyslipidemia and hepatosteatosis coexistence. Metabolic and hormonal alterations related with thyroid functions may also be associated with dyslipidemia and hepatosteatosis in obese patients.

Importance of both fatness and aerobic fitness on metabolic syndrome risk in Japanese children

Associations between body mass index (BMI), peak oxygen consumption (VO(2peak)), and metabolic syndrome (MetS) risk factors have not been adequately studied in Japanese children. Here the relationships between these parameters and the threshold aerobic fitness level necessary for low MetS risk were determined. The participants (299 children; 140 boys and 159 girls, aged 9.1 ± 0.3 years) were divided into four groups using the medians of predicted VO(2peak) (pVO(2peak)) and BMI. MetS risk scores were calculated using z-scores. Receiver Operating Characteristic analysis was used to determine the threshold aerobic fitness level necessary for low MetS risk. The MetS risk score of the High BMI group was significantly higher than that of the Low BMI group for both sexes (p < 0.0001). However, the High BMI/High Fitness group had a significantly lower MetS risk score than the High BMI/Low Fitness group for both sexes. The (p)VO(2peak )cut-off values for low MetS risk were 47.9 and 44.9 ml/kg/min for boys and girls, respectively. Our results suggest that improvements in both fatness and aerobic fitness are important for decreasing MetS risk. We also confirmed the (p)VO(2peak) of cut-off values necessary for low MetS risk in Japanese children.

The imperative to prevent and treat childhood obesity: why the world cannot afford to wait

In the past 20 years, the prevalence of obesity in the United States increased almost 50% among adults and by 300% in children. Today, 9.7% of all U.S. infants up to 2 years old have abnormally high weight-for-recumbent length; 25% of children under age 5 are either overweight or obese; and 17% of adolescents are obese. Ethnic disparities in the rates of obesity are also large and apparent in childhood. Further, 44% of obese adolescents have metabolic syndrome. Obese children tend to become obese adults; thus, in a decade, young adults will likely have much higher risks of chronic disease, which has tremendous implications for the healthcare system. However, early childhood may be the best time to prevent obesity. Teachers' healthy eating choices are positively associated with changes in body mass index percentiles for children, for example. In addition, 8 million children attend afterschool programs, which can successfully promote health and wellness and successfully treat obesity. This childhood epidemic of obesity and its health-related consequences in adolescents should be a clinical and public health priority. However, this major public health problem cannot be managed solely in clinical settings. Rather, public health strategies must be integrated into home and family, school and community-based settings.

A high school-based voluntary cardiovascular risk screening program: issues of feasibility and correlates of electrocardiographic outcomes

Risk factors for adult cardiovascular events can be identified from the prenatal period through childhood. We performed a cardiovascular risk-screening program in students from grades 9-12 in 7 high schools in Hillsborough County, FL. We obtained blood pressure (BP) measurements and calculated body mass index (BMI) as risk factors for future cardiovascular events as well as obtained an electrocardiogram (ECG) for the purposes of detecting possible life-threatening arrhythmias. Of ~14,000 students contacted, 600 (4 %) participated in the screening. Of these, 517 (86 %) were diagnosed with normal, 71 (12 %) with borderline, and 12 (1 %) with abnormal ECGs. Although no participant had any cardiac history, two of the abnormal ECGs indicated a cardiac diagnosis associated with the potential for sudden cardiac death. Both systolic and diastolic BP increased as the ECG diagnosis moved from normal (115.6/73.8) through borderline (121.0/75.9) to an abnormal (125.0/80.7) diagnosis (all P ≤ .0016). An increase in BMI was only observed when an ECG diagnosis was abnormal (P = .0180). Boys had a greater prevalence (18.97 %) of borderline or abnormal ECGs compared with girls (6.75 %), whereas no discernible differences were seen in ECG diagnosis between white and nonwhite individuals (15.09 and 12.26 %, respectively). Although participation rates were low, a high school-based cardiovascular risk-screening program including ECG is feasible. Although ECG diagnosis tended to be related to other known cardiovascular risk factors (BP, BMI), the utility of an abnormal ECG in adolescence as a predictor of future cardiovascular risk will require further evaluation in more controlled settings.

Skim milk, whey, and casein increase body weight and whey and casein increase the plasma C-peptide concentration in overweight adolescents

In adults, dietary protein seems to induce weight loss and dairy proteins may be insulinotropic. However, the effect of milk proteins in adolescents is unclear. The objective was to test whether milk and milk proteins reduce body weight, waist circumference, homeostatic model assessment, plasma insulin, and insulin secretion estimated as the plasma C-peptide concentration in overweight adolescents. Overweight adolescents (n = 203) aged 12-15 y with a BMI of 25.4 ± 2.3 kg/m(2) (mean ± SD) were randomized to 1 L/d of skim milk, whey, casein, or water for 12 wk. All milk drinks contained 35 g protein/L. Before randomization, a subgroup of adolescents (n = 32) was studied for 12 wk before the intervention began as a pretest control group. The effects of the milk-based test drinks were compared with baseline (wk 0), the water group, and the pretest control group. Diet and physical activity were registered. Outcomes were BMI-for-age Z-scores (BAZs), waist circumference, plasma insulin, homeostatic model assessment, and plasma C-peptide. We found no change in BAZ in the pretest control and water groups, whereas it was greater at 12 wk in the skim milk, whey, and casein groups compared with baseline and with the water and pretest control groups. The plasma C-peptide concentration increased from baseline to wk 12 in the whey and casein groups and increments were greater than in the pretest control (P < 0.02). There were no significant changes in plasma C-peptide in the skim milk or water group. These data suggest that high intakes of skim milk, whey, and casein increase BAZs in overweight adolescents and that whey and casein increase insulin secretion. Whether the effect on body weight is primary or secondary to the increased insulin secretion remains to be elucidated.

Relationship between Plasma Adiponectin Levels and Metabolic Risk Profiles in Taiwanese Children

OBJECTIVE

Adiponectin, a novel adipokine with antiinflammatory and insulin-sensitizing properties, has an important role in glucose metabolism and is negatively correlated with body fat amount in adults. The purpose of this study was to evaluate the association of plasma adiponectin level with metabolic risk profiles and insulin resistance status among Taiwanese children.

RESEARCH METHODS AND PROCEDURES

We enrolled 1,248 children (608 boys and 640 girls) to ascertain their demographic, anthropometric, and cardiovascular risk factors distribution in Taipei. We measured plasma insulin, adiponectin, and leptin levels by radioimmunoassay (Linco Research Inc, St. Charles, MO). We calculated an insulin resistance index (IRI) using the Homeostasis Model Assessment model and also calculated an insulin resistance syndrome (IRS) summary score for each individual by adding the quartile ranks from the distribution of systolic blood pressure, serum triglyceride, high-density lipoprotein-cholesterol (HDL-C) (inverse), and insulin levels.

RESULTS

In general, the boys had larger BMI, higher systolic blood pressure, serum total cholesterol, and triglyceride, and lower plasma leptin and adiponectin levels than girls. Plasma adiponectin levels were correlated negatively with BMI, leptin, insulin, IRI, and IRS summary score but positively correlated with HDL-C in both boys and girls. In multivariate regression analyses, adiponectin was negatively associated with insulin (girls only), IRI (girls only), and IRS score, and positively associated with HDL-C in both genders even after adjusting for age, BMI, plasma leptin level, and other potential confounders.

DISCUSSION

These data suggest that plasma adiponectin levels were negatively associated with metabolic risk profiles that may have played a protective role in the development of insulin resistance among Taiwanese school children.

How are physical activity, fitness, and sedentary behavior associated with insulin sensitivity in children?

OBJECTIVE

To describe the associations among moderate-to-vigorous physical activity (MVPA), fitness, sedentary behavior (SB), and insulin sensitivity (IS).

RESEARCH DESIGN AND METHODS

Data were drawn from the baseline assessment of the QUALITY cohort, which included 630 white youth (aged 8-10 years at recruitment), with at least one obese biological parent. IS was measured by two fasting indices (insulin, homeostasis model assessment of insulin resistance) and an oral glucose tolerance test (OGTT)-based index (Matsuda IS index [Matsuda-ISI]). Fitness was measured by Vo(2peak); percent fat mass (PFM) was measured by dual-energy X-ray absorptiometry; 7-day MVPA was measured with accelerometry. SB indicators included average hours daily of self-report screen time (SBst), and average minutes daily at <100 counts/min from accelerometry (SBacc). Multivariable linear regression models were adjusted for age, sex, season, and puberty.

RESULTS

MVPA and SBacc were independently associated with IS, but this was no longer statistically significant after accounting for PFM. SBst was negatively associated with IS in girls only, even after controlling for physical activity (PA), fitness, and adiposity; for each additional hour of SBst daily, IS decreased by 4.6-5.6% across all IS indices. Fitness was positively associated with IS (measured by Matsuda-ISI) after accounting for PA, SB, and PFM; for every 1 unit increase in Vo(2peak), Matsuda-ISI increased by approximately 1.0% (P < 0.05).

CONCLUSIONS

In children with an obese parent, PA and SBacc are associated with IS, but this association is mediated by adiposity. SBst is negatively associated with IS in girls, beyond its known impact on adiposity. Finally, fitness is independently associated with better IS measured by OGTT.

Metabolic signatures of insulin resistance in 7,098 young adults

Metabolite associations with insulin resistance were studied in 7,098 young Finns (age 31 ± 3 years; 52% women) to elucidate underlying metabolic pathways. Insulin resistance was assessed by the homeostasis model (HOMA-IR) and circulating metabolites quantified by high-throughput nuclear magnetic resonance spectroscopy in two population-based cohorts. Associations were analyzed using regression models adjusted for age, waist, and standard lipids. Branched-chain and aromatic amino acids, gluconeogenesis intermediates, ketone bodies, and fatty acid composition and saturation were associated with HOMA-IR (P < 0.0005 for 20 metabolite measures). Leu, Ile, Val, and Tyr displayed sex- and obesity-dependent interactions, with associations being significant for women only if they were abdominally obese. Origins of fasting metabolite levels were studied with dietary and physical activity data. Here, protein energy intake was associated with Val, Phe, Tyr, and Gln but not insulin resistance index. We further tested if 12 genetic variants regulating the metabolites also contributed to insulin resistance. The genetic determinants of metabolite levels were not associated with HOMA-IR, with the exception of a variant in GCKR associated with 12 metabolites, including amino acids (P < 0.0005). Nonetheless, metabolic signatures extending beyond obesity and lipid abnormalities reflected the degree of insulin resistance evidenced in young, normoglycemic adults with sex-specific fingerprints.

Central adiposity and protein intake are associated with arterial stiffness in overweight children

Being overweight is associated with vascular abnormalities, which are important in the development of atherosclerosis. However, little is known about dietary and lifestyle determinants of vascular function in overweight children. In adults, dietary protein and milk intake are associated with reduced blood pressure and reduced risk of metabolic syndrome. This study examined the associations between dietary protein, milk intake, physical activity, and adiposity on arterial stiffness in overweight children. In a cross-sectional study, overweight children with habitual milk intakes ≤ 250 mL/d were examined by DXA scans, pedometer counts, anthropometry, and metabolic variables. Dietary intake was registered for 4 d. The outcomes were arterial stiffness measured by pulse wave velocity (PWV) (n = 182) and augmentation index (Aix) (n = 183). The PWV (mean ± SD) was 4.78 ± 0.72 m/s and the Aix was -0.77 ± 9.44%. In multivariate models, the android fat:gynoid fat and android fat:body fat ratios were positively associated with PWV (β = 1.49 and β = 10.3, both P < 0.05) and Aix (β = 28.3, P < 0.01 and β = 153, P < 0.05), whereas the gynoid fat:body fat ratio was negatively associated with the Aix (β = -134; P < 0.001). Protein intake (percentage energy) was positively associated with PWV (β = 0.05; P < 0.01). Milk intake (L/d) tended to be negatively associated with PWV (β = -0.64; P = 0.05). Pedometer counts were negatively associated with the Aix; however, the association became nonsignificant after controlling for HOMA, which was positively associated with the Aix (β = 0.95; P < 0.01). In conclusion, central adiposity and protein intake are associated with increased arterial stiffness measured as PWV in overweight children independent of blood pressure and heart rate. The effect of protein intake may be caused by meat, because the milk intake was low.

Novel modeling of reference values of cardiovascular risk factors in children aged 7 to 20 years

BACKGROUND AND OBJECTIVE

Most of the cardiovascular risk factors strongly associated with obesity and overweight vary with age and gender. However, few reference values are available for healthy European children. Our objective was to establish pediatric reference ranges for waist circumference, systolic and diastolic blood pressures, fasting lipid levels (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides), glucose, and insulin.

METHODS

A representative sample of 1976 healthy French individuals (1004 female participants and 972 male participants) aged 7 to 20 years was used to obtain age- and gender-specific normal ranges for each of the above-listed cardiovascular risk factors, based on the Royston and Wright method.

RESULTS

Mean waist circumference increased with age in both genders and was slightly higher in males than in females. Whereas systolic blood pressure increased gradually with age, with the increase being steeper in males than in females, no gender effect was found for diastolic blood pressure, which was therefore modeled after pooling males and females. Total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride values varied little with age and gender. Glucose and insulin levels revealed pubertal peaks, which were sharper in females than in males, reflecting the normal insulin resistance during puberty.

CONCLUSIONS

These ranges can be used as references for European children to monitor cardiovascular risk factors and to plan interventions and education programs.

Nebivolol improves insulin sensitivity in the TGR(Ren2)27 rat

Hypertension is often associated with increased oxidative stress and systemic insulin resistance. Use of β-adrenergic receptor blockers in hypertension is limited because of potential negative influence on insulin sensitivity and glucose homeostasis. We sought to determine the impact of nebivolol, a selective vasodilatory β₁-adrenergic blocker, on whole-body insulin sensitivity, skeletal muscle oxidative stress, insulin signaling, and glucose transport in the transgenic TG(mRen2)27 rat (Ren2). This rodent model manifests increased tissue renin angiotensin expression, excess oxidative stress, and whole-body insulin resistance. Young (age, 6-9 weeks) Ren2 and age-matched Sprague-Dawley control rats were treated with nebivolol 10 mg/(kg d) or placebo for 21 days. Basal measurements were obtained for glucose and insulin to calculate the homeostasis model assessment. In addition, insulin metabolic signaling, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, reactive oxygen species, and ultrastructural changes as evaluated by transmission electron microscopy were examined ex vivo in skeletal muscle tissue. The Ren2 rat demonstrated systemic insulin resistance as examined by the homeostasis model assessment, along with impaired insulin metabolic signaling in skeletal muscle. This was associated with increased oxidative stress and mitochondrial remodeling. Treatment with nebivolol was associated with improvement in insulin resistance and decreased NADPH oxidase activity/levels of reactive oxygen species in skeletal muscle tissue. Nebivolol treatment for 3 weeks reduces NADPH oxidase activity and improves systemic insulin resistance in concert with reduced oxidative stress in skeletal muscle in a young rodent model of hypertension, insulin resistance, and enhanced tissue RAS expression.

Relationships among insulin resistance, type 2 diabetes, essential hypertension, and cardiovascular disease: similarities and differences

Insulin resistance plays a major role in the pathogenesis and clinical course of patients with type 2 diabetes (2DM) and essential hypertension. However, the syndromes differ in prevalence of insulin resistance, and associated insulin secretory response. Essentially all patients with type 2 diabetes are insulin resistant, whereas only approximately 50% of those with essential hypertension are insulin resistant. Furthermore, 2DM develops when the pancreatic β-cell can no longer maintain the degree of compensatory hyperinsulinemia needed to prevent hyperglycemia. In contrast, the compensatory hyperinsulinemia that prevents most insulin resistant individuals from developing 2DM acts on normally insulin sensitive tissues in a manner that predisposes to the development of essential hypertension. This review will discuss these similarities and differences in some detail, as well as exploring the relationship among insulin resistance and related metabolic abnormalities in the pathogenesis of cardiovascular disease in patients with 2DM and essential hypertension.

Childhood obesity and cardiovascular disease: links and prevention strategies

The prevalence and severity of pediatric obesity have dramatically increased since the late 1980s, raising concerns about a subsequent increase in cardiovascular outcomes. Strong evidence, particularly from autopsy studies, supports the concept that precursors of adult cardiovascular disease (CVD) begin in childhood, and that pediatric obesity has an important influence on overall CVD risk. Lifestyle patterns also begin early and impact CVD risk. In addition, obesity and other CVD risk factors tend to persist over time. However, whether childhood obesity causes adult CVD directly, or does so by persisting as adult obesity, or both, is less clear. Regardless, sufficient data exist to warrant early implementation of both obesity prevention and treatment in youth and adults. In this Review, we examine the evidence supporting the impact of childhood obesity on adult obesity, surrogate markers of CVD, components of the metabolic syndrome, and the development of CVD. We also evaluate how obesity treatment strategies can improve risk factors and, ultimately, adverse clinical outcomes.

Prevalence of metabolic syndrome in obese children and adolescents using three different criteria and evaluation of risk factors

OBJECTIVE

To compare the prevalence of the metabolic syndrome (MS) in Turkish obese children and adolescents by using three different definitions and to assess the risk factors through a retrospective evaluation of anthropometric and laboratory parameters.

METHODS

Sixty hundred and fourteen obese patients (307 male, 307 female; mean age: 11.3±2.5 years) were included in the study. Medical history, physical examination, anthropometric measurements, results of biochemical and hormonal assays were obtained from the hospital records. MS was diagnosed according to the modified World Health Organization (WHO), Cook and the International Diabetes Federation (IDF) consensus criteria.

RESULTS

The prevalence of MS was found to be 39%, 34% and 33% according to the modified WHO, Cook and the IDF consensus criteria, respectively. MS prevalence in patients aged 12-18 years was significantly higher than that in patients between 7 and 11 years of age (p<0.05). Pubertal patients had a significantly higher MS prevalence than the non-pubertal cases (p<0.05). MS prevalence was also significantly higher in children who had a family history of heart disease, diabetes, obesity and hypertension as well as in those who had not been breast-fed (p<0.05).

CONCLUSION

The use of the modified WHO criteria was found to result in a slightly higher prevalence rate for MS as compared to the other criteria. The prevalence of MS in our study population was higher than that reported in most previous studies in Turkey. A positive family history, puberty and not being breastfed in infancy were shown to be significant risk factors for MS in childhood.

Metabolic syndrome, adipokines and ghrelin in overweight and obese schoolchildren: results of a 1-year lifestyle intervention programme

The aim of this study was to evaluate the effect of a lifestyle intervention programme (nutrition and exercise counselling) on metabolic syndrome (MS) components, adipokines (leptin, adiponectin) and ghrelin levels in overweight children. A total of 61 overweight children aged 7-9 years (≥ 85th body mass index (BMI) percentile; 27 boys/34 girls) were randomly assigned and completed a 1-year individual (IT) or group-based treatment (GT). Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. Twenty-two normal weight children (<85th BMI percentile; 7-9 years old; 13 boys/nine girls) were also evaluated at baseline. Insulin resistance (IR) was determined by the homeostasis model assessment of IR (HOMA-IR). Overweight children presented significantly higher blood pressure, triglycerides, apolipoprotein B, insulin, HOMA-IR, leptin, C-reactive protein and homocysteine levels, while apolipoprotein A-I was significantly lower. At baseline, MS was present in ten overweight children, of which only five maintained it at 1 year. Leptin and ghrelin levels were associated with IR and MS components. MS was predicted by apolipoprotein A-I, insulin and pre-puberty. The lifestyle intervention led to a significant improvement in standard deviation score of BMI, waist circumference/height ratio and lipid profile. Changes in insulin, HOMA-IR, leptin and adiponectin were not significant. Ghrelin behaved differently between IT and GT. The GT intervention seems to be more successful, with a decrease in BMI Z-score and an improvement of metabolic parameters. In conclusion, overweight children have multiple risk factors associated with MS. A lifestyle intervention programme seems to be an effective mean for reducing obesity and MS components and improving adipokines concentrations.

Effects of short-term chromium supplementation on insulin sensitivity and body composition in overweight children: randomized, double-blind, placebo-controlled study

Excessive body weight is inversely associated with insulin sensitivity in children and adults. Chromium supplementation produces modest improvement in insulin sensitivity in adults. The aim of this study was to examine the beneficial effects of chromium supplementation on insulin sensitivity and body composition in overweight children simultaneously modifying lifestyle. Twenty-five overweight children aged 9-12 years were randomized to receive either 400 μg of chromium chloride or placebo in double-blind fashion, during a 6-week lifestyle modification regimen that included nutritional education and 3×90 min of aerobic physical activity weekly. Insulin sensitivity was demonstrated using homeostasis model assessment-insulin resistance and quantitative insulin sensitivity check index (QUICKI). Changes in body mass index (BMI; kg/m(2)), BMI Z-score, waist circumference, body composition and fasting plasma glucose were measured. Although no significant benefit of chromium supplementation over placebo was evident for BMI, BMI Z-score and fasting insulin level, children who received chromium chloride demonstrated more positive changes versus the placebo group in HOMA (-1.84±1.07 vs. 0.05±0.42, P=.05), QUICKI (0.02±0.01 vs. -0.002±0.01, P=.05), lean body mass (2.43±0.68 kg vs. 1.36±1.61 kg, P=.02) and percentage body fat (-3.32±1.29% vs. 0.65±1.05%, P=.04). The desirable effects of chromium supplementation on insulin sensitivity and body composition were more apparent in pre-pubertal children. These results suggest that short-term chromium supplementation can improve insulin sensitivity and body composition in overweight children.

Long-term follow-up of cardiovascular risk factors after exercise training in obese children

OBJECTIVE

We previously demonstrated beneficial effects of physical activity on cardiovascular disease (CVD) risk factors, body mass index (BMI) and fat mass in pre-pubescent obese children. The aim of this study was to determine whether these changes were maintained 2 years later.

METHODS

Two years after the Randomised Controlled Trial, we performed a follow-up study with 20 of 38 subjects (11.4 ± 1.8 years). Outcomes included blood pressure (BP) by ambulatory monitoring; arterial function and structure using high-resolution ultrasound, BMI, body composition by dual-energy x-ray absorptiometry (DXA), physical activity using accelerometer, and biological markers.

RESULTS

During the 2-year follow-up period, mean 24-hour diastolic BP z-score significantly decreased (1.4 ± 1.2 vs. 0.3 ± 1.4, p = 0.04), while systolic BP z-score was slightly reduced (2.4 ± 1.5 vs. 1.4 ± 1.7, p = 0.067). Blood pressure changes were greater in children who diminished their BMI z-score compared with the ones who did not. Systolic hypertension rates dropped from 50 to 28% and diastolic hypertension from 42 to 6%. In addition, arterial intima-media thickness (0.51 ± 0.03 vs. 0.51 ± 0.06, p = 0.79), BMI z-score (2.9 ± 0.8 vs. 2.9 ± 1.1 kg.cm(-2), p = 0.27), body fat (41.9 ± 6.9 vs. 42.8 ± 6.7%; p = 0.39) and physical activity count (703 ± 209 vs. 574 ± 244 cpm, p = 0.30) were stable.

CONCLUSION

To our knowledge, this is the first study reporting that beneficial effects on adiposity and CVD risk factors of a physical activity centred intervention are sustained 2 years after the cessation of training in obese children. Subjects stabilized BMI z-score and maintained physical activity with further improvement of BP and stabilization of arterial wall remodelling. We conclude that it is important to encourage physical activity in this population. Effects of Aerobic Exercise Training on Arterial Function and Insulin Resistance Syndrome in Obese Children: A Randomised Controlled Trial: NCT00801645.

Metabolic Syndrome and Its Individual Components among Jordanian Children and Adolescents

This study aimed to determine the prevalence of metabolic syndrome (MeS) and its individual components in Jordanian children and adolescents aged 7-18 years and determine the factors that are associated with clustering of metabolic abnormalities. MeS was defined using the International Diabetes Federation (IDF) definition. The prevalence of MeS was estimated from 512 subjects who had complete information on all MeS components. The prevalence of MeS according to IDF criteria was 1.4% in subjects aged between 10 and 15.9 years and 3.6% in subjects aged between 16 and 18 years. When categorized according to body mass index (BMI), the prevalence of the MeS was 15.1% in obese subjects, compared to 0.3% in subjects with normal BMI, and 3.0% in overweight subjects. In conclusion, our results indicate that although the prevalence of MeS is low in Jordanian children and adolescents, a large proportion of them had one or two metabolic abnormalities.

Impact of intensive school-based nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index, and subclinical inflammation among Asian Indian adolescents: a controlled intervention study

OBJECTIVE

The present study was designed to assess the impact of intensive and repetitive nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index (DI), and subclinical inflammation in Asian Indian adolescents (15-17 years) residing in North India.

METHOD

In this prospective study, two matched schools were randomly allocated to the intervention (n = 56; 31 boys and 25 girls) or control group (n = 50; 30 boys and 20 girls). The intervention consisted of seven components: (1) Dissemination of health-related information through lectures and focused group discussions, (2) planning of activities such as quizzes, (3) individual counseling of students, (4) promotion of physical activity, (5) change in the canteen menu to healthier alternatives, (6) conducting health camps involving parents and teachers, and (7) training of student volunteers for sustainability of the program in school. Impact of intervention was studied on surrogate markers of insulin resistance, β-cell function, disposition index, and subclinical inflammation.

RESULTS

At 6 months follow-up, significantly higher (P = 0.037) mean value of homeostasis model assessment denoting β-cell function (HOMA-βCF) was seen in the intervention group compared to the control group, whereas high sensitivity C-reactive protein (hs-CRP) was significantly lowered (P < 0.001). The increase (30.3 ± 73.4; P < 0.037) observed in the DI in adolescents in the intervention group was significantly higher compared to the control group. The Pearson's coefficient of correlation in the intervention group showed that the Δ-decrease in mean waist circumference was significantly correlated (r = 0.267, P < 0.05) with Δ-decrease in homeostasis model assessment of insulin resistance (HOMA-IR).

CONCLUSION

The intervention model developed by us could be used for amelioration of insulin resistance with potential of preventing type 2 diabetes mellitus in Asian Indian adolescents.

Insulin sensitivity and lipid profiles in girls with central precocious puberty before and during gonadal suppression

CONTEXT

Early menarche is associated with increased risk of cardiovascular disease in adulthood. It is unknown whether metabolic risk factors are adversely affected in girls with central precocious puberty (CPP) already at time of diagnosis.

OBJECTIVE

The objective of the study was to evaluate metabolic profiles in girls with early normal puberty (EP) and CPP.

DESIGN AND SETTING

This was a combined cross-sectional and longitudinal study at a tertiary center of pediatric endocrinology.

PATIENTS AND INTERVENTION

Twenty-three girls with EP or CPP and 115 controls with normal pubertal timing were evaluated by oral glucose tolerance test, dual-energy x-ray absorptiometry scan, and fasting blood samples. Fifteen girls (13 CPP) were treated with GnRH agonists (GnRHa) and reevaluated after 12 and 52 wk of treatment.

MAIN OUTCOME MEASURES

Insulin and glucose levels during oral glucose tolerance test and fasting lipid levels were measured.

RESULTS

At the time of diagnosis, girls with CPP had higher fasting insulin, triglyceride, and low-density lipoprotein-cholesterol levels as well as lower insulin sensitivity and high-density lipoprotein/total cholesterol ratios (all P<0.05) compared with controls after adjustment for pubertal stage and body fat percentage. Age at pubertal onset positively predicted insulin sensitivity for a given pubertal stage (P=0.04) in girls with EP and CPP. Insulin sensitivity decreased significantly during 1 yr of GnRHa treatment (P=0.04).

CONCLUSIONS

Girls with CPP had adverse metabolic profiles at the time of diagnosis compared with puberty-matched controls. In addition, those with the earliest onset of puberty had the most adverse metabolic profiles. Surprisingly, metabolic profiles deteriorated even further after withdrawal of sex steroids by GnRHa treatment.

Pediatric nonalcoholic fatty liver disease: A clinical and laboratory challenge

The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determining the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nature of the study design. The natural history of pediatric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk population, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninvasive alternatives that will allow the prognosis of pediatric NAFLD to be followed in large community or population-based studies.

Determination of the BMI threshold that predicts cardiovascular risk and insulin resistance in late childhood

AIMS

Body mass index (BMI, kg/m(2)) thresholds of children predicting cardiovascular risk, reported in previous studies were inconsistent and that predicting increased insulin resistance is lacking. We determined the BMI threshold that predicts increased cardiovascular risk and insulin resistance in children.

METHODS

The entire 4th grade students (187 boys and 218 girls) from 5 schools were included. Cardiovascular risk was defined as the presence of three or more of cardiovascular risk factors. Increased insulin resistance was estimated using homeostasis model assessment of insulin resistance and fasting insulin level.

RESULTS

The BMI percentile predicting cardiovascular risk was the 71.3th percentile for boys and the 77.1th percentile for girls. The BMI value was 21.4 kg/m(2) for boys and 20.6 kg/m(2) for girls. 34% of boys and 42% of girls with a BMI above the cut-off values had cardiovascular risk. The BMI percentile predicting increased insulin resistance was the 66.3th percentile for boys and the 67.9th percentile for girls. The children with cardiovascular risk had significantly greater (P<0.01) insulin resistance than those without risk.

CONCLUSION

This study demonstrated that the BMI thresholds at which cardiovascular risk and insulin resistance begin to increase in Korean children were lower than current definition of childhood obesity, proposed by the international obesity task force.

Dietary and lifestyle counselling reduces the clustering of overweight-related cardiometabolic risk factors in adolescents

AIM

The aim of this study was to evaluate the impact of individualised dietary and lifestyle counselling, primarily aimed to decrease serum low-density lipoprotein cholesterol, on the clustering of overweight-related cardiometabolic risk factors in children.

DESIGN AND PARTICIPANTS

The 7-month-old study children were randomized either to counselling (n = 540) or control group (n = 522).

MAIN OUTCOME MEASURES

The 5- to 15-year-old participants who fulfilled the international criteria were classified as overweight. Being in the highest [lowest for high-density lipoprotein (HDL) cholesterol] age- and gender-specific quintile of body mass index (BMI), blood pressure, serum triglycerides, HDL cholesterol or glucose was considered a risk factor. A cluster was defined as having high BMI and > or = 2 other risk factors.

RESULTS

The counselling did not reduce the prevalence of overweight in 5- to 15-year-old participants. From age 7 onwards, the proportion of children with > or = 2 risk factors was lower in the intervention than in the control group (p = 0.005). At the age of 15 years, 13.0% of girls and 10.8% of boys in the intervention group and 17.5% of girls and 18.8% of boys in the control group had the risk factor cluster (p = 0.046 for main effect of the study group). Having even one risk factor at the age of 5 years predicted the clustering of risk factors at the age of 15 years (OR: 3.8, p < 0.001).

CONCLUSION

Repeated, individualized dietary and lifestyle counselling may reduce the clustering of overweight-related cardiometabolic risk factors in adolescents even though the counselling is not intense enough to prevent overweight.

Prevalence of components of the metabolic syndrome in schoolchildren with newly diagnosed type 2 diabetes mellitus

OBJECTIVE

To examine the prevalence of components of the metabolic syndrome (MS) other than hyperglycemia at diagnosis in schoolchildren with type 2 diabetes mellitus (T2DM).

DESIGN

The study involved 112 Japanese schoolchildren, 45 males and 67 females aged 12.9 +/- 1.5 yr, who were diagnosed as having T2DM. The body weight, blood pressure and fasting serum triglyceride (TG), and high-density lipoprotein cholesterol cholesterol (HDL-C) levels were also measured at diagnosis. The criteria adopted for the diagnosis of MS were as follows; i.e., TG > or =150 mg/dL, HDL-C <40 mg/dL, systolic blood pressure > or =130 mmHg, and/or diastolic blood pressure > or =85 mmHg. Obesity was defined as percent overweight > or =20.0%.

RESULTS

As much as 83.0% of the patients had obesity. The prevalence of increased TG was 33.0% and that of decreased HDL-C was 21.4% among the patients. Elevated blood pressure was identified in 11.6% of the patients. Of the total, 15.2% of the patients had no other components of MS besides hyperglycemia; 49.1% had only one other component, which was obesity in the majority; 17.0% had two other components of MS besides hyperglycemia, which were obesity and elevated TG in the majority; 18.8% of the patients had three or more components of MS besides hyperglycemia.

CONCLUSIONS

We found a high prevalence of other components of MS besides hyperglycemia in the patients even at the time of diagnosis. Early detection of other components of MS would appear to be of importance for preventing the development of cardiovascular disease in children with T2DM.

Sex hormones and metabolic syndrome in children and adolescents

Cardiovascular risk starts early in life, yet the patterns of changes in metabolic syndrome (MS) during puberty and normal development have not been completely defined. Sex hormones are shown to play a pivotal role in the modulation of insulin resistance and MS. Our aim is to clarify the relation between sex hormones and MS in normal children and adolescents. This is a cross-sectional study of 365 (8-12 and 14-18 years old) school students. We analyzed the associations of sex hormones (testosterone, free androgen index, estradiol, free estradiol index [FEI], and sex hormone-binding globulin [SHBG]) with cardiovascular risk factors and MS. Prevalence of MS varied depending on the definition, and 33 (9%) students had MS based on at least 1 definition of MS. Frequency of MS doubled among 14- to 18-year-old adolescents compared with 8- to 12-year-old children (12.4% vs 5.6%, P = .02). Adolescent boys and girls with MS had significantly lower SHBG levels compared with controls. Adolescent boys with MS also had significantly higher FEI levels compared with controls. Logistic regression analysis was performed to find the predictors of MS. Among covariates of age, estradiol, testosterone, free androgen index, and FEI, SHBG was the only significant predictor of MS (B = -0.3, odds ratio = 0.8, 95% confidence interval for odds ratio are 0.64 and 0.92, P = .005, Nagelkarke R(2) = 0.48) in adolescent boys. In conclusion, sex hormone levels and androgen/estrogen balance may play an important role in determining MS and future cardiovascular risk among children and adolescents.

Sustained participation in youth sport decreases metabolic syndrome in adulthood

OBJECTIVE

to explore the effect of organized youth sport on metabolic syndrome (MetS) in adulthood.

DESIGN

Longitudinal study data from the cardiovascular risk in young Finns study.

SUBJECTS

A total of 1493 males (n=704) and females (n=789) aged 3, 6, 9, 12, 15 and 18 years were randomly selected from five university towns and their rural surroundings in 1980. They were followed up for 21 years. In 2001 they were 24, 27, 30, 33, 36 and 39 years old.

MEASUREMENTS

Youth sports participation data (participation in sport-club training and competitions) were assessed in 1980 and 1983 using a self-report questionnaire completed in connection with a medical examination. Participants were divided into athletes and non-athletes at each measurement point, and then classified into four groups: Persistent athlete, Starter, Leaver and Non-athlete. A mean score of youth sport was assessed by calculating the average of four consecutive measurements (1980-1989). MetS risk in 2001 was defined as a categorical variable based on the guidelines of the European Group for the Study of Insulin Resistance (EGIR) and as a continuous MetS-score variable by summing the z-scores of individual metabolic variables.

RESULTS

In males and females, intense participation in youth sports over 3 years was inversely and significantly associated with clustered MetS score and prevalence of MetS defined by EGIR in adulthood (P<0.05). The association remained significant after adjustment for age, baseline clustered MetS score, smoking and total caloric intake and after additional adjustments for adult leisure-time physical activity. Starters during 3 years were less likely to have MetS than non-athletes. Leavers were at a higher risk for MetS than persistent athletes. These associations were attenuated in males by adjustment for all potential confounders. Similar associations were found using EGIR MetS as an outcome.

CONCLUSIONS

Sustained participation in organized sport lasting at least 3 years in youth is associated with reduced risk for developing MetS in adulthood.