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Al-Beltagi M, Bediwy AS, Saeed NK. Insulin-resistance in paediatric age: Its magnitude and implications. World J Diabetes 2022; 13:282-307. [PMID: 35582667 PMCID: PMC9052009 DOI: 10.4239/wjd.v13.i4.282] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Insulin resistance (IR) is insulin failure in normal plasma levels to adequately stimulate glucose uptake by the peripheral tissues. IR is becoming more common in children and adolescents than before. There is a strong association between obesity in children and adolescents, IR, and the metabolic syndrome components. IR shows marked variation among different races, crucial to understanding the possible cardiovascular risk, specifically in high-risk races or ethnic groups. Genetic causes of IR include insulin receptor mutations, mutations that stimulate autoantibody production against insulin receptors, or mutations that induce the formation of abnormal glucose transporter 4 molecules or plasma cell membrane glycoprotein-1 molecules; all induce abnormal energy pathways and end with the development of IR. The parallel increase of IR syndrome with the dramatic increase in the rate of obesity among children in the last few decades indicates the importance of environmental factors in increasing the rate of IR. Most patients with IR do not develop diabetes mellitus (DM) type-II. However, IR is a crucial risk factor to develop DM type-II in children. Diagnostic standards for IR in children are not yet established due to various causes. Direct measures of insulin sensitivity include the hyperinsulinemia euglycemic glucose clamp and the insulin-suppression test. Minimal model analysis of frequently sampled intravenous glucose tolerance test and oral glucose tolerance test provide an indirect estimate of metabolic insulin sensitivity/resistance. The main aim of the treatment of IR in children is to prevent the progression of compensated IR to decompensated IR, enhance insulin sensitivity, and treat possible complications. There are three main lines for treatment: Lifestyle and behavior modification, pharmacotherapy, and surgery. This review will discuss the magnitude, implications, diagnosis, and treatment of IR in children.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama 12, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
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Parcha V, Heindl B, Kalra R, Li P, Gower B, Arora G, Arora P. Insulin Resistance and Cardiometabolic Risk Profile Among Nondiabetic American Young Adults: Insights From NHANES. J Clin Endocrinol Metab 2022; 107:e25-e37. [PMID: 34473288 PMCID: PMC8684535 DOI: 10.1210/clinem/dgab645] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated (1) the prevalence and trends of IR and cardiometabolic risk factors and (2) the association between measures of adiposity and IR among adults 18 to 44 years of age without diabetes and preexisting cardiovascular disease. METHODS Cross-sectional survey data from six consecutive National Health and Nutrition Examination Survey (2007-2008 to 2017-2018) cycles were analyzed. IR was defined by the homeostatic model assessment for IR (HOMA-IR) of ≥2.5. The temporal trends of IR, cardiometabolic risk factors, and the relationship between IR and measures of adiposity were assessed using multivariable-adjusted regression models. RESULTS Among 6247 young adults 18 to 44 years of age, the prevalence of IR was 44.8% (95% CI: 42.0%-47.6%) in 2007-2010 and 40.3% (95% CI: 36.4%-44.2%) in 2015-2018 (P for trend = 0.07). There was a modest association of HOMA-IR with higher body mass index (BMI), waist circumference, total lean fat mass, and total and localized fat mass (all Ps < 0.001). Participants with IR had a higher prevalence of hypertension [31.3% (95% CI: 29.2%-33.5%) vs 14.7% (95% CI: 13.2%-16.2%)], hypercholesterolemia [16.0% (95% CI: 12.4%-19.5%) vs 7.0% (95% CI: 5.8%-8.5%)], obesity [56.6% (95% CI: 53.9%-59.3%) vs 14.7% (95% CI: 13.0%-16.5%)], and poor physical activity levels [18.3% (95% CI: 16.4%-20.2%) vs 11.7% (95%CI: 10.3-13.1%)] compared to participants without IR (all Ps < 0.05). CONCLUSIONS Four-in-10 young American adults have IR, which occurs in a cluster with cardiometabolic risk factors. Nearly half of young adults with IR are nonobese. Screening efforts for IR irrespective of BMI may be required.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittain Heindl
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Tagi VM, Samvelyan S, Chiarelli F. An update of the consensus statement on insulin resistance in children 2010. Front Endocrinol (Lausanne) 2022; 13:1061524. [PMID: 36465645 PMCID: PMC9709113 DOI: 10.3389/fendo.2022.1061524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
In our modern society, where highly palatable and calorie-rich foods are readily available, and sedentary lifestyle is common among children and adolescents, we face the pandemic of obesity, nonalcoholic fatty liver disease, hypertension, atherosclerosis, and T2D. Insulin resistance (IR) is known to be the main underlying mechanism of all these associated health consequences; therefore, the early detection of IR is fundamental for preventing them.A Consensus Statement, internationally supported by all the major scientific societies in pediatric endocrinology, was published in 2010, providing all the most recent reliable evidence to identify the definition of IR in children, its measurement, its risk factors, and the effective strategies to prevent and treat it. However, the 2010 Consensus concluded that further research was necessary to assess some of the discussed points, in particular the best way to measure insulin sensitivity, standardization of insulin measurements, identification of strong surrogate biomarkers of IR, and the effective role of lifestyle intervention and medications in the prevention and treatment of IR.The aim of this review is to update each point of the consensus with the most recent available studies, with the goal of giving a picture of the current state of the scientific literature regarding IR in children, with a particular regard for issues that are not yet fully clarified.
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Affiliation(s)
- Veronica Maria Tagi
- Department of Pediatrics, University of Chieti, Chieti, Italy
- *Correspondence: Veronica Maria Tagi,
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Mohammad A, Shahnaz T, Sorayya K. Effect of 8 weeks' supplementation grape seed extract on insulin resistance in iranian adolescents with metabolic syndrome: A randomized controlled trial. Diabetes Metab Syndr 2021; 15:197-203. [PMID: 33385766 DOI: 10.1016/j.dsx.2020.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Insulin resistance in adolescents is a major health concern. The aim of this study was to evaluate the effect of grape seed extract on insulin resistance in adolescents with metabolic syndrome (MetS). METHODS Participants were divided into grape seed extract (GSE) and placebo groups (n = 24 each) and received 100 mg/day of GSE or placebo and were placed on a weight loss diet for 8 weeks. Anthropometric and biochemical indices, blood pressure, dietary intake, and physical activity were measured before and after the intervention. RESULTS Forty-two participants completed the trial. After the intervention, the age, sex, baseline values, energy intake and physical activity as a covariate adjusted using ANCOVA for determine differences between groups. The MD (mean difference ±SEM) of HOMA-IR between the GSE group (-1.46 ± 0.45) and the placebo group (-0.48 ± 0.47), (p = 0.020), and the MD of insulin between the GSE group (-7.05 ± 2.11) and the placebo group (-1.71 ± 2.12), (p = 0.024), were significant. Although changes were observed in other variables, they were not statistically significant. CONCLUSIONS GSE improves insulin concentration and insulin resistance in adolescents with MetS and provides a basis for possible application of the GSE in the clinical management of MetS in adolescents. This study registered under Randomized Clinical Trials.gov Identifier no. IRCT2013112611288N7.
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Affiliation(s)
- Alizadeh Mohammad
- Department of Biochemistry and Diet Therapy, Faculty of Nutrition Tabriz University of Medical Sciences, Attar Nishabouri St., Tabriz, Iran, Postal code: 5166614711, POBOX: 14711.
| | - Taghizadeh Shahnaz
- Student Research Committee, Department of Biochemistry and Diet Therapy, Faculty of Nutrition Tabriz University of Medical Sciences, Attar Nishabouri St., Tabriz, Iran, Postal code: 5166614711, POBOX: 14711.
| | - Kheirouri Sorayya
- Department of Biochemistry and Diet Therapy, Faculty of Nutrition Tabriz University of Medical Sciences, Attar Nishabouri St., Tabriz, Iran, Postal code: 5166614711, POBOX: 14711.
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Abstract
Despite plenty of currently available information on metabolic syndrome (MetS) in children and adolescents, there are still uncertainties regarding definition, prevention, management and treatment of MetS in children. The first approach to MetS in children consists of lifestyle interventions (nutritional education, physical activity). These recommendations are often difficult to achieve, especially for adolescents, therefore, there is usually a lack of successful outcomes. A pharmacological intervention in obese children may be needed in some cases, with the aim to improve the effects of these primary prevention interventions. Metformin seems to be safe and presents evident positive effects on insulin sensitivity, but long-term and consistent data are still missing to establish its role in the pediatric population and the possible effectiveness of other emergent treatments such as glucagon-like peptide-1 analogues, dipeptidylpeptidase-4 inhibitors, dual inhibitors of SGLT1 and SGLT2 and weight loss drugs. Bariatric surgery might be helpful in selected cases. The aim of this review is to present the most recent available treatments for the main components of metabolic syndrome, with a focus on insulin resistance. A short mention of management of congenital forms of insulin resistance will be included too.
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García AG, Urbina Treviño MV, Villalpando Sánchez DC, Aguilar CA. Diagnostic accuracy of triglyceride/glucose and triglyceride/HDL index as predictors for insulin resistance in children with and without obesity. Diabetes Metab Syndr 2019; 13:2329-2334. [PMID: 31405638 DOI: 10.1016/j.dsx.2019.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/22/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate which of two indexes (TyG or TG/HDL) are the best predictors for insulin resistance (IR) and to evaluate the magnitude of each cardiometabolic risk factor in Mexican schoolchildren of 5-9 years with overweight-obesity and normal weight. MATERIAL AND METHODS We realized a comparative cross-sectional prospective study in accordance of STARD guidelines. Setting was Family Medicine Unit (FMU) No. 80 of Mexican Institute of Social Security(IMSS) of Morelia, Michoacán, Mexico. Children between 5 and 9 years, both genders, 104 with normal weight(NW), 97 with Overweight-Obesity(OO Group) were included. Once the informed consent was signed we obtained the BMI, waist circumference, blood pressure(BP) and 5 mL of blood collected for glucose, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, uric acid and insulin. As main outcome measures TyG or TG/HDL, HOMA-IR, and Receiving Operating Curves(ROC), sensitivity, specificity by ROC were obtained. RESULTS Cutoff point TyG: 8.5 by ROC had an area under curve (AUC):0.802 IC95% 0.77to0.893, P = 0.0001; diagnostic accuracy of 73%. TG/HDL 2.22; AUC:0.729 IC95% 0.622to0.837, P = 0.014; diagnostic accuracy of 52%. TyG can identify cardiometabolic alterations more than HOMA and TG/HDL. Cardiometabolic alterations in the OO group were hypertriglyceridemia:49.5%, low HDL:63.9%, IR:39.2% and in NW group were hypertriglyceridemia:30.8%, low HDL:60.6%, IR:9.6%. CONCLUSIONS We reported high frequency of hypertriglyceridemia and low HDL in Mexican children. TyG and TG/HDL are good predictors for IR. TyG has a better diagnostic accuracy. We need implementing TyG for identifying alterations and intervening in a timely manner to delay the onset of chronic diseases in children.
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Affiliation(s)
- Anel Gómez García
- Center of Biomedical Research of Michoacán, Clinic Investigation Division, Mexican Institute of Security Social, Mexico.
| | | | | | - Cleto Alvarez Aguilar
- Medical Auxiliary Coordination of Health Research, Michoacán, Mexican Institute of Security Social, Mexico
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Yoon DY, Lee YA, Lee J, Kim JH, Shin CH, Yang SW. Prevalence and Clinical Characteristics of Metabolically Healthy Obesity in Korean Children and Adolescents: Data from the Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2017; 32:1840-1847. [PMID: 28960038 PMCID: PMC5639066 DOI: 10.3346/jkms.2017.32.11.1840] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/29/2017] [Indexed: 12/21/2022] Open
Abstract
Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) are differentiated by the presence of cardiometabolic risk factors (CMRFs) and insulin resistance (IR). This study aimed to evaluate the prevalence and clinical characteristics of MHO in Korean children and adolescents and to investigate the anthropometric, laboratory, and lifestyle predictors of MHO. This study included data from 530 obese subjects, aged 10-19 years, obtained from the Fourth Korea National Health and Nutrition Examination Survey. Subjects were classified into MHO and MUO groups according to the presence of CMRF (MHO(CMRF)/MUO(CMRF)) and degree of IR (MHO(IR)/MUO(IR)). Demographic, anthropometric, cardiometabolic, and lifestyle factors were compared between the groups. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors that predicted MHO. The prevalence of MHO(CMRF) and MHO(IR) in obese Korean youth was 36.8% (n = 197) and 68.8% (n = 356), respectively. CMRF profiles were significantly less favorable in MUO children. Longer and more vigorous physical activity and less protein intake were associated with MHO(CMRF) phenotype. The best predictors of MHO(CMRF) and MHO(IR) were waist circumference (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.001) and body mass index (BMI) standard deviation score (OR, 0.24; 95% CI, 0.15-0.39; P < 0.001), respectively. The prevalence of MHO differed depending on how it was defined. To adequately manage obesity in youth, the approach to individuals with MHO and MUO should be personalized due to variation in clinical characteristics. Longitudinal studies are needed to evaluate long-term consequences of MHO.
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Affiliation(s)
- Da Young Yoon
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Heinzle S, Ball GDC, Kuk JL. Variations in the prevalence and predictors of prevalent metabolically healthy obesity in adolescents. Pediatr Obes 2016; 11:425-33. [PMID: 26643813 PMCID: PMC5065348 DOI: 10.1111/ijpo.12083] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is a heterogeneous condition, which includes a subset of individuals that can be classified as having metabolically healthy obesity (MHO), but there is no consensus on what constitutes MHO. Thus, the objective of the study is to examine the prevalence and predictors of prevalent MHO in adolescents using various definitions of MHO. METHODS Cross-sectional data from the 1999-2010 National Health and Nutrition Examination Surveys were used. Participants included 316 male and 316 female adolescents aged 12-19 years with a BMI ≥ 95th percentile. Two definitions were used to define MHO. First, MHO was defined as having ≤1 metabolic syndrome criteria (excluding waist) and being free of type 2 diabetes, hypertension and dyslipidemia. Second, MHO was defined as being free of all metabolic syndrome criteria, insulin resistance and inflammation. RESULTS The prevalence of MHO was 42% (male) and 74% (female) using the first definition and 7% (male) and 12% (female) using the second more conservative definition. Lower abdominal obesity (waist circumference) and lower insulin resistance predicted prevalent MHO in male and female adolescents for both definitions (p < 0.01). Associations between dietary components and MHO were weak and inconsistent, while physical activity and inflammation were not associated with MHO in male and female adolescents for both definitions (p > 0.05). CONCLUSIONS The prevalence of MHO in adolescents varied across definitions, with lower levels of abdominal obesity and insulin resistance as the most consistent predictors of prevalent MHO status.
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Affiliation(s)
- S. Heinzle
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - G. D. C. Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alebrta, Canada
| | - J. L. Kuk
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Rinaldi AEM, Gabriel GFCP, Moreto F, Corrente JE, McLellan KCP, Burini RC. Dietary factors associated with metabolic syndrome and its components in overweight and obese Brazilian schoolchildren: a cross-sectional study. Diabetol Metab Syndr 2016; 8:58. [PMID: 27559363 PMCID: PMC4995765 DOI: 10.1186/s13098-016-0178-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The metabolic syndrome (MS) has been assessed since childhood mainly because of the nutritional and epidemiological transition that has occurred worldwide. Our objectives were to explore the MS and its components according to anthropometric and demographic factors and to assess the relationship among MS components and dietary characteristics in overweight and obese schoolchildren. METHODS This was a cross-sectional study which included 147 schoolchildren (aged 6-10 years) from three elementary schools, with body mass index (BMI) higher than the 85th percentile. Sexual maturation stages, anthropometric measures (weight, height, skinfold thickness and waist circumference), biochemical data (glucose, HDL-C and triacylglycerol), blood pressure and dietary intake were assessed. The metabolic syndrome was diagnosed if three or more of the following components were presented: waist circumference ≥90th age and sex-specific cut-off, blood pressure ≥90th age, sex and height-specific cut-off, glucose ≥100 mg/dL, HDL-C ≥ 40 mg/dL and triacylglycerols ≥ 110 mg/dL. The dietary intake was assessed by three non-consecutive 24-h recalls. The T test, Kruskal-Wallis and multiple linear regression analysis were applied to assess MS components and dietary intake. RESULTS The MS percentage was 10.2 % and it was higher in obese children and ones with high body fat percentage. The waist circumference was the main altered component of MS and 62 % of overweight schoolchildren showed at least one altered component of MS. The components of metabolic syndrome associated with dietary intake were triacylglycerol (positive association with saturated and monounsaturated fat, whole-milk products and processed foods and negative associated with legumes and polyunsaturated fat), glycemia (positive association with processed foods and negative with cereals), HDL-C (positive association with vegetables and greens) and waist circumference was negative associated with protein. CONCLUSIONS The frequency of MS was higher in obese than overweight schoolchildren and the frequency of at least one MS component was high in more than half of our subjects. The waist circumference was the most frequent among all other components. The triacylglycerol and glycemia were the most frequent MS components associated with dietary intake. Unprocessed food was considered a protective dietary factor for MS metabolic components and processed food with high percentage of sugar and saturated fat was a risk factor for MS metabolic components.
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Affiliation(s)
- Ana Elisa Madalena Rinaldi
- School of Medicine, Federal University of Uberlândia (UFU), Rua Pará, nº 1720, Bloco 2U, Uberlândia, MG 38405-320 Brazil
| | | | - Fernando Moreto
- Member of the Exercise Metabolism and Nutrition Center (CeMENutri), Distrito de Rubião Júnior s/n, Botucatu, SP 18618-970 Brazil
| | - José Eduardo Corrente
- Department of Biostatistics, Institute of Biosciences, Distrito de Rubião Júnior, s/n, Botucatu, SP 18618-900 Brazil
| | - Kátia Cristina Portero McLellan
- Texas Institute for Kidney and Endocrine Disorders, Texas Institute for Kidney and Endocrine Disorders, 10 Medical Center Blvd, Ste A Medical Center, Lufkin, 75904 USA
| | - Roberto Carlos Burini
- Botucatu School of Medicine, Public Health Department and Exercise Metabolism and Nutrition Center, São Paulo State University, Distrito de Rubião Júnior, s/n, Botucatu, SP 18618-970 Brazil
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Karatzi K, Moschonis G, Barouti AA, Lionis C, Chrousos GP, Manios Y. Dietary patterns and breakfast consumption in relation to insulin resistance in children. The Healthy Growth Study. Public Health Nutr 2014; 17:2790-7. [PMID: 24477051 PMCID: PMC10282397 DOI: 10.1017/s1368980013003327] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/23/2013] [Accepted: 11/08/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Insulin resistance is a significant cross-point for the manifestation of several chronic diseases in children and adults. The aim of the present study was to investigate the possible relationship of certain dietary patterns and breakfast consumption habits with insulin resistance in children. SUBJECTS A representative sample of 1912 schoolchildren (aged 9-13 years) participated in a cross-sectional epidemiological study, the Healthy Growth Study, which was initiated in May 2007 and completed in June 2009. SETTING It was conducted in seventy-seven primary schools in four large regions in Greece. DESIGN Dietary intake, breakfast consumption, anthropometric and physical examination data, biochemical indices and socio-economic information collected from parents were assessed in all children. Principal components analysis was used to identify dietary patterns. RESULTS A dietary pattern of increased consumption of margarine, sweets (candies, lollipops, jellies, traditional fruit in heavy syrup) and savoury snacks (chips, cheese puffs and not home-made popcorn) was associated with homeostasis model assessment of insulin resistance index (HOMA-IR; β = 0·08, P < 0·001) in multivariate models. Children in the third tertile of this dietary pattern had a 2·51 (95 % CI 1·30, 4·90) times higher risk of insulin resistance (HOMA-IR > 3·16) than those in the first tertile. Breakfast consumption had an inverse correlation with insulin resistance, but the correlation lost its significance after adjustments for waist circumference, birth weight, parental BMI and socio-economic status. CONCLUSIONS Increased consumption of margarine, sweets and savoury snacks, which is a common dietary pattern in childhood, was positively associated with insulin resistance, while breakfast consumption had an inverse association with HOMA-IR, in schoolchildren (aged 9-13 years). Identification of dietary behaviours that might affect insulin resistance in children offers valuable advice in cardiometabolic risk prevention strategies.
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Affiliation(s)
- Kalliopi Karatzi
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El. Venizelou Avenue, 17671 Kallithea, Athens, Greece
| | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El. Venizelou Avenue, 17671 Kallithea, Athens, Greece
| | - Afroditi-Alexandra Barouti
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El. Venizelou Avenue, 17671 Kallithea, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El. Venizelou Avenue, 17671 Kallithea, Athens, Greece
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Prince RL, Kuk JL, Ambler KA, Dhaliwal J, Ball GDC. Predictors of metabolically healthy obesity in children. Diabetes Care 2014; 37:1462-8. [PMID: 24574347 DOI: 10.2337/dc13-1697] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status. RESEARCH DESIGN AND METHODS This cross-sectional study included 8-17 year olds with a BMI ≥85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005-2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR) and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs. RESULTS The prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [95% CI 0.18-0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [95% CI 0.31-0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24-2.62]; P = 0.002) was the strongest independent predictor of MHO-CR. CONCLUSIONS Up to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.
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Abstract
Metabolic syndrome is a clustering of several cardiovascular risk factors. Contrary to earlier thoughts, metabolic syndrome is no longer rare in Africa. The prevalence is increasing, and it tends to increase with age. This increase in the prevalence of metabolic syndrome in the continent is thought to be due to departure from traditional African to western lifestyles. In Africa, it is not limited to adults but is also becoming common among the young ones. Obesity and dyslipidemia seem to be the most common occurring components. While obesity appears more common in females, hypertension tends to be more predominant in males. Insulin resistance has remained the key underlying pathophysiology. Though pharmacologic agents are available to treat the different components of the syndrome, prevention is still possible by reverting back to the traditional African way of life.
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Affiliation(s)
- Christian I. Okafor
- Department of Physiology and Medicine, Faculty of Medical Sciences, University of Nigeria, Enugu Campus
- Department of Endocrine, Diabetes and Metabolism Unit, Department of Internal Medicine, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, Chiarelli F. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab 2010; 95:5189-98. [PMID: 20829185 PMCID: PMC3206517 DOI: 10.1210/jc.2010-1047] [Citation(s) in RCA: 279] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 08/06/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. PARTICIPANTS The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. EVIDENCE An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. CONSENSUS PROCESS The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. CONCLUSIONS Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.
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Affiliation(s)
- Claire Levy-Marchal
- Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France
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Bovell-Benjamin AC, Dawkin N, Pace RD, Shikany JM. Use of focus groups to understand African-Americans' dietary practices: Implications for modifying a food frequency questionnaire. Prev Med 2009; 48:549-54. [PMID: 19285101 PMCID: PMC5492884 DOI: 10.1016/j.ypmed.2009.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To generate information about dietary practices, food preferences and food preparation methods from African-Americans in Macon County, Alabama, as a precursor to an intervention designed to modify an existing dietary health questionnaire (DHQ). METHOD African-American males (30) and females (31) ages 20 to 75 years participated in eight focus groups in Macon County Alabama between June and July, 2007. RESULTS The core topics identified were dietary practices; food preferences; food preparation methods; fast food practices; and seasonal/specialty foods. The younger focus group participants reported consuming mostly fast foods such as hamburgers for lunch. Fruits, vegetables, salads, fish, chicken and sandwiches were the most common lunch foods for the older males and females. Across the groups, rice, cornbread and potatoes were reportedly the most commonly consumed starchy foods at dinner. Frying and baking were the most common cooking methods. Fewer participants reported removing the skin when cooking chicken versus those who did not remove. Traditional foods including fried green tomatoes and cracklings were selected for addition to the modified DHQ, while those not commonly consumed, were deleted. CONCLUSIONS Participants described high-fat traditional food preferences, common frying and addition of salted meats to vegetables, which informed the modification of a DHQ.
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Burns SF, Kelsey SF, Arslanian SA. Effects of an intravenous lipid challenge and free fatty acid elevation on in vivo insulin sensitivity in African American versus Caucasian adolescents. Diabetes Care 2009; 32:355-60. [PMID: 19017772 PMCID: PMC2628707 DOI: 10.2337/dc08-1102] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 11/09/2008] [Indexed: 02/03/2023]
Abstract
OBJECTIVE African American youth have lower insulin sensitivity than their Caucasian peers, but the metabolic pathways responsible for this difference remain unknown. Free fatty acids (FFAs) are associated with insulin resistance through the Randle cycle. The present investigation determined whether elevating FFA is more deleterious to insulin sensitivity in African American than in Caucasian adolescents. RESEARCH DESIGN AND METHODS Insulin sensitivity (3-h hyperinsulinemic-euglycemic clamp) was evaluated in 22 African American and 21 Caucasian adolescents on two occasions: 1) infusion of normal saline and 2) infusion of 20% intralipid. RESULTS During intralipid infusion, fasting insulin and C-peptide concentrations increased while fasting glucose and basal glucose turnover did not change in either group. Insulin sensitivity decreased similarly in African American (normal saline 7.65 +/- 0.61 vs. intralipid 5.15 +/- 0.52 micromol x kg(-1) x min(-1) per pmol/l) and Caucasian subjects (normal saline 8.97 +/- 0.85 vs. intralipid 5.96 +/- 0.56 micromol x kg(-1) x min(-1) per pmol/l) (P < 0.001). CONCLUSIONS African American and Caucasian adolescents respond to FFA elevation similarly through increased fasting insulin secretion to maintain fasting glucose homeostasis and reduced peripheral glucose uptake and insulin resistance. Thus, African American adolescents are not more susceptible to FFA-induced insulin resistance than Caucasian youth.
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Affiliation(s)
- Stephen F Burns
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Casazza K, Dulin-Keita A, Gower BA, Fernández JR. Relationships between reported macronutrient intake and insulin dynamics in a multi-ethnic cohort of early pubertal children. INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY : IJPO : AN OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF OBESITY 2009; 4:249-56. [PMID: 19922039 PMCID: PMC2918230 DOI: 10.3109/17477160902763366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Racial/ethnic differences in the pediatric population in insulin dynamics have been documented. Additionally, girls tend to be more insulin resistant than boys. Although the mechanism driving these differences is unclear, diet may be a contributor. OBJECTIVE(S) The objective of this study was to evaluate the contribution of reported macronutrient intake on insulin dynamics and determine if diet composition may account for racial/ethnic and sex differences in insulin response/action. METHODS Participants were 250 African- (n=84), European- (n=105), or Hispanic-American (n=61) children 7-12 years, pubertal stage < or =3. An intravenous glucose tolerance test was used to derive the insulin sensitivity index and acute insulin response to glucose (AIRg) diet by two 24 h recalls, and body composition by dual-energy x-ray absorptiometry (DXA). RESULTS Reported energy intake from fat was positively related to fasting insulin (P < 0.05) and AIRg (P=0.05). Reported energy from carbohydrate was inversely associated with fasting insulin (P < 0.05), and reported energy from protein was inversely associated with AIRg (P < 0.05). The interaction terms between ethnicity and diet, and sex and diet were not significant for any outcome variables. CONCLUSION Dietary intake influences insulin dynamics; however, the racial/ethnic and sex differences in insulin dynamics in this population are not accounted for by macronutrient intake. Pubertal status is likely to play a role in the interaction between diet, race/ethnicity, sex and insulin dynamics. Longitudinal studies are needed to determine if the contribution of diet to insulin dynamics strengthens with reproductive maturation.
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Affiliation(s)
- Krista Casazza
- Department of Nutrition Sciences and Clinical Nutrition Research Center, University of Alabama at Birmingham, Birmingham, AL 35294-3360, USA.
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Esmaillzadeh A, Azadbakht L. Consumption of hydrogenated versus nonhydrogenated vegetable oils and risk of insulin resistance and the metabolic syndrome among Iranian adult women. Diabetes Care 2008; 31:223-226. [PMID: 18000178 DOI: 10.2337/dc07-1256] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ahmad Esmaillzadeh
- Department of Nutrition, School of Public Health, Isfahan University of Medical Sciences, P.O. Box 81745, Isfahan, Iran.
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McGillis Bindler RC, Massey LK, Shultz JA, Mills PE, Short R. Metabolic syndrome in a multiethnic sample of school children: implications for the pediatric nurse. J Pediatr Nurs 2007; 22:43-58. [PMID: 17234497 DOI: 10.1016/j.pedn.2006.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is lack of translational work that may assist the pediatric nurse in identifying the child who is at risk for metabolic syndrome. Early identification of the syndrome could assist pediatric health care providers in intervening and in lowering child health risks. Fasting serum insulin, metabolic syndrome criteria, and dietary intake were examined in a multiethnic sample of children aged 9-15 years. Forty-seven percent had two or more risk factors for metabolic syndrome, and 28% had three or more risk factors. Insulin levels were negatively correlated with the recommended dietary allowance. A regression model, including gender, age, race, body mass index, serum glucose, high-density lipoprotein cholesterol, triglycerides, and blood pressure, explained 48% of insulin variance.
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Affiliation(s)
- Ruth C McGillis Bindler
- Intercollegiate College of Nursing, Washington State University, Spokane, WA 99224-5291, USA.
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Huang TTK, Ball GDC, Franks PW. Metabolic syndrome in youth: current issues and challenges. Appl Physiol Nutr Metab 2007; 32:13-22. [PMID: 17332781 DOI: 10.1139/h06-094] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The current paper reviews the important issues and challenges facing children and adolescents with the metabolic syndrome (MetS). Studies suggest that the MetS and its risk components may be on the rise in children along with rising rates of obesity; however, further study remains warranted. The topics reviewed encompass the definition of the syndrome, its prevalence, clustering and tracking of metabolic risk factors, the role of physical activity and diet in the development of the MetS, criticisms and utility of the MetS definition, and special considerations needed in the pediatric population. Physical activity and diet may play important roles in the MetS; however, research with precise measurements of activity, diet, and metabolic outcomes is needed. The paper concludes by emphasizing that regardless of one’s position in the ongoing debate about the MetS, the long-term risks attributable to each individual risk component are real. The abnormality of one component should automatically prompt the screening of other components. Among children and adolescents, lifestyle modification should always serve as the frontline strategy. Prevention during childhood is key to the largest possible impact on adult health at the population level.
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Affiliation(s)
- Terry T-K Huang
- Endocrinology, Nutrition and Growth Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, 6100 Executive Boulevard, 4B11, Rockville, MD 20852, USA.
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Bibliography. Current world literature. Growth and development. Curr Opin Endocrinol Diabetes Obes 2007; 14:74-89. [PMID: 17940424 DOI: 10.1097/med.0b013e32802e6d87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davis JN, Ventura EE, Weigensberg MJ, Ball GDC, Cruz ML, Shaibi GQ, Goran MI. The relation of sugar intake to beta cell function in overweight Latino children. Am J Clin Nutr 2005; 82:1004-10. [PMID: 16280431 PMCID: PMC2538439 DOI: 10.1093/ajcn/82.5.1004] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have investigated the association between sugar intake and insulin dynamics in children, and none have examined this association in overweight Latino youth. OBJECTIVE We aimed to examine the relation between dietary components, especially sugar intake, and insulin dynamics in overweight Latino youth. DESIGN We examined 63 overweight Latino children aged 9-13 y. Dietary intake was determined by 3-d records, and body composition was measured with dual-energy X-ray absorptiometry. Insulin sensitivity (S(I)), acute insulin response (AIR), and disposition index (an index of beta cell function) were measured by using a frequently sampled intravenous-glucose-tolerance test and minimal modeling. Hierarchical regression analysis ascertained the potential independent relation between insulin dynamics and dietary components. RESULTS The relation between macronutrient intake and any variable related to insulin dynamics was not significant. However, higher total sugar intake, although not related to S(I), was significantly associated with lower AIR (beta = -0.296, P = 0.045) and lower beta cell function (beta = -0.421, P = 0.043), independent of the covariates age, sex, body composition, Tanner stage, and energy intake. Sugar-sweetened beverage intakes trended toward inverse association with lower AIR (beta = -0.219, P = 0.072) and beta cell function (beta = -0.298, P = 0.077). CONCLUSIONS In overweight Latino children, higher intakes of sugar and sugar-sweetened beverages were associated with lower AIR and disposition index, which suggested that these children already have early signs of poor beta cell function. These results emphasize the need for early nutritional interventions to reduce daily sugar intake in overweight Latino children and potentially reduce their risk for type 2 diabetes.
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Affiliation(s)
- Jaimie N Davis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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