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Bouloubasi Z, Karayiannis D, Papadopoulou A, Dimitrokallis N, Tsanasa A, Karveli E, Vougas V. Managing fluid balance and nutritional status in a short bowel syndrome patient awaiting intestinal transplant: a case report. Eur J Clin Nutr 2024:10.1038/s41430-024-01405-z. [PMID: 38267532 DOI: 10.1038/s41430-024-01405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Despite being a long-term therapy for patients with short bowel syndrome (SBS), subcutaneous injections of teduglutide promote the regeneration of the gastrointestinal tract. Such cases are particularly concerning for patients with residual small bowel. METHODS In this report, we present a case of an SBS patient with only 5 cm of remaining small bowel and a high-output duodenal stoma, who was treated with teduglutide. RESULTS The initiation of teduglutide injections in our patient resulted in a reduction of stoma output, improvement in the patient's nutritional status, regulation of fluid balance, and stabilization of their clinical condition. CONCLUSIONS This case suggests that subcutaneous injections of teduglutide, when combined with appropriate nutritional care, can effectively treat high-output stomas, even in cases where the small bowel is nearly absent.
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Affiliation(s)
- Zoi Bouloubasi
- Department of Clinical Nutrition, Evangelismos General Hospital, Athens, Greece
| | | | - Anna Papadopoulou
- Department of Clinical Nutrition, Evangelismos General Hospital, Athens, Greece
| | - Nikolaos Dimitrokallis
- 1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Aggeliki Tsanasa
- 1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Eleni Karveli
- 1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - Vasilios Vougas
- 1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital, Athens, Greece
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Bouloubasi Z, Karayiannis D, Pafili Z, Almperti A, Nikolakopoulou K, Lakiotis G, Stylianidis G, Vougas V. Re-assessing the role of peri-operative nutritional therapy in patients with pancreatic cancer undergoing surgery: a narrative review. Nutr Res Rev 2023:1-10. [PMID: 37668101 DOI: 10.1017/s0954422423000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Pancreatic cancer is the most common medical condition that requires pancreatic resection. Over the last three decades, significant improvements have been made in the conditions and procedures related to pancreatic surgery, resulting in mortality rates lower than 5%. However, it is important to note that the morbidity in pancreatic surgery remains r latively high, with a percentage range of 30-60%. Pre-operative malnutrition is considered to be an independent risk factor for post-operative complications in pancreatic surgery, such as impaired wound healing, higher infection rates, prolonged hospital stay, hospital readmission, poor prognosis, and increased morbidity and mortality. Regarding the post-operative period, it is crucial to provide the best possible management of gastrointestinal dysfunction and to handle the consequences of alterations in food digestion and nutrient absorption for those undergoing pancreatic surgery. The European Society for Clinical Nutrition and Metabolism (ESPEN) suggests that early oral feeding should be the preferred way to initiate nourishing surgical patients as it is associated with lower rates of complications. However, there is ongoing debate about the optimal post-operative feeding approach. Several studies have shown that enteral nutrition is associated with a shorter time to recovery, superior clinical outcomes and biomarkers. On the other hand, recent data suggest that nutritional goals are better achieved with parenteral feeding, either exclusively or as a supplement. The current review highlights recommendations from existing evidence, including nutritional screening and assessment and pre/post-operative nutrition support fundamentals to improve patient outcomes. Key areas for improvement and opportunities to enhance guideline implementation are also highlighted.
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Affiliation(s)
- Zoi Bouloubasi
- Department of Clinical Nutrition, Evangelismos General Hospital, Athens, Greece
| | | | - Zoe Pafili
- Department of Clinical Nutrition, Evangelismos General Hospital, Athens, Greece
| | - Avra Almperti
- Department of Clinical Nutrition, Evangelismos General Hospital, Athens, Greece
| | | | - Grigoris Lakiotis
- 2nd Department of Surgery, Evangelismos General Hospital, Athens, Greece
| | - George Stylianidis
- 2nd Department of Surgery, Evangelismos General Hospital, Athens, Greece
| | - Vasilios Vougas
- 1st Department of Surgery and Transplantation, Evangelismos General Hospital, Athens, Greece
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Kakavas S, Karayiannis D, Bouloubasi Z, Poulia KA, Kompogiorgas S, Konstantinou D, Vougas V. Global Leadership Initiative on Malnutrition Criteria Predict Pulmonary Complications and 90-Day Mortality after Major Abdominal Surgery in Cancer Patients. Nutrients 2020; 12:nu12123726. [PMID: 33287107 PMCID: PMC7761640 DOI: 10.3390/nu12123726] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
Although several studies have reported an association between malnutrition and the risk of severe complications after abdominal surgery, there have been no studies evaluating the use of Global Leadership Initiative on Malnutrition (GLIM) criteria for predicting postoperative pulmonary complications (PPCs) following major abdominal surgery in cancer patients. This study aimed to investigate the association among the diagnosis of malnutrition by GLIM criteria, PPCs risk and 90-day all-cause mortality rate following major abdominal surgery in cancer patients. We prospectively analyzed 218 patients (45% male, mean age 70.6 ± 11.2 years) with gastrointestinal cancer who underwent major abdominal surgery at our hospital between October 2018 and December 2019. Patients were assessed preoperatively using GLIM criteria of malnutrition, and 90-day all-cause mortality and PPCs were recorded. In total, 70 patients (32.1%) were identified as malnourished according to GLIM criteria, of whom 41.1% fulfilled the criteria for moderate and 12.6% for severe malnutrition. PPCs were detected in 48 of 218 patients (22%) who underwent major abdominal surgery. Univariate logistic regression analysis revealed that the diagnosis of malnutrition was significantly associated with the risk of PPCs. Furthermore, in multivariate model analysis adjusted for other clinical confounding factors, malnutrition remained an independent factor associated with the risk of PPCs (RR = 1.82; CI = 1.21–2.73) and 90-day all-cause mortality (RR = 1.97; CI = 1.28–2.63, for severely malnourished patients). In conclusion, preoperative presence of malnutrition, diagnosed by the use of GLIM criteria, is associated with the risk of PPCs and 90-day mortality rate in cancer patients undergoing major abdominal surgery.
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Affiliation(s)
- Sotirios Kakavas
- 1st Pulmonary Department, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (S.K.); (S.K.)
| | - Dimitrios Karayiannis
- Department of Clinical Nutrition, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece;
- Correspondence: ; Tel.: +3-021-320-450-35; Fax: +3-021-320-413-85
| | - Zoi Bouloubasi
- Department of Clinical Nutrition, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece;
| | - Kalliopi Anna Poulia
- Department of Nutrition and Dietetics, Laiko General Hospital, 11527 Athens, Greece;
| | - Steven Kompogiorgas
- 1st Pulmonary Department, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (S.K.); (S.K.)
| | - Dimitrios Konstantinou
- Transplant Unit, 1st Department of Surgery, Evangelismos General Hospital of Athens, 10676 Athens, Greece; (D.K.); (V.V.)
| | - Vasileios Vougas
- Transplant Unit, 1st Department of Surgery, Evangelismos General Hospital of Athens, 10676 Athens, Greece; (D.K.); (V.V.)
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Bouloubasi Z, Karagiannis D, Evangelatou I, Katralis P, Lapatsanis D, Kapiris S. Bioimpedance phase angle is associated with hand grip strength and serum albumin levels in patients undergoing bariatric surgery. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Karagiannis D, Katralis P, Pafili Z, Bouloubasi Z, Evangelatou I, Almperti A, George S. Bioelectrical impedance analysis-derived phase angle as a predictor of 30 day postoperative complication incidence among patients with pancreatic cancer undergoing pancreaticoduodenectomy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karagiannis D, Katralis P, Kakavas S, Bouloubasi Z, Almperti A, Constantinou D, Baschali A, Mastora Z, Stylianidis G. MON-PO601: Total Parenteral Nutrition Effects Among Patients with Pancreatic Cancer Undergoing Pancreaticoduodenectomy. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32434-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Karayiannis D, Bouloubasi Z, Baschali A, Constantinou D, Daskalaki E, Kalatzis V, Voulgaris S, Botsakis C, Magganas D, Vougas V. Postoperative C-reactive protein to albumin ratio as a diagnostic tool for predicting complications after abdominal surgery. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vanhelst J, Béghin L, Duhamel A, Manios Y, Molnar D, De Henauw S, Moreno LA, Ortega FB, Sjöström M, Widhalm K, Gottrand F, Moreno LA, Gottrand F, De Henauw S, González-Gross M, Gilbert C, Kafatos A, Moreno LA, Libersa C, De Henauw S, Sánchez J, Gottrand F, Kersting M, Sjöstrom M, Molnár D, González-Gross M, Dallongeville J, Gilbert C, Hall G, Maes L, Scalfi L, Meléndez P, Moreno LA, Fleta J, Casajús JA, Rodríguez G, Tomás C, Mesana MI, Vicente-Rodríguez G, Villarroya A, Gil CM, Ara I, Revenga J, Lachen C, Alvira JF, Bueno G, Lázaro A, Bueno O, León JF, Garagorri JM, Bueno M, Rey López JP, Iglesia I, Velasco P, Bel S, Marcos A, Wärnberg J, Nova E, Gómez S, Díaz EL, Romeo J, Veses A, Puertollano MA, Zapatera B, Pozo T, Martínez D, Beghin L, Libersa C, Gottrand F, Iliescu C, Von Berlepsch J, Kersting M, Sichert-Hellert W, Koeppen E, Molnar D, Erhardt E, Csernus K, Török K, Bokor S, Angster M, Nagy E, Kovács O, Repásy J, Kafatos A, Codrington C, Plada M, Papadaki A, Sarri K, Viskadourou A, Hatzis C, Kiriakakis M, Tsibinos G, Vardavas C, Sbokos M, Protoyeraki E, Fasoulaki M, Stehle P, Pietrzik K, González-Gross M, Breidenassel C, Spinneker A, Al-Tahan J, Segoviano M, Berchtold A, Bierschbach C, Blatzheim E, Schuch A, Pickert P, Castillo MJ, Gutiérrez Á, Ortega FB, Ruiz JR, Artero EG, España-Romero V, Jiménez-Pavón D, Chillón P, Cuenca-García M, Arcella D, Azzini E, Barrison E, Bevilacqua N, Buonocore P, Catasta G, Censi L, Ciarapica D, D'Acapito P, Ferrari M, Galfo M, Le Donne C, Leclercq C, Maiani G, Mauro B, Mistura L, Pasquali A, Piccinelli R, Polito A, Spada R, Sette S, Zaccaria M, Scalfi L, Vitaglione P, Montagnese C, De Bourdeaudhuij I, De Henauw S, De Vriendt T, Maes L, Matthys C, Vereecken C, de Maeyer M, Ottevaere C, Huybrechts I, Widhalm K, Phillipp K, Dietrich S, Kubelka B, Boriss-Riedl M, Manios Y, Grammatikaki E, Bouloubasi Z, Cook TL, Eleutheriou S, Consta O, Moschonis G, Katsaroli I, Kraniou G, Papoutsou S, Keke D, Petraki I, Bellou E, Tanagra S, Kallianoti K, Argyropoulou D, Kondaki K, Tsikrika S, Karaiskos C, Dallongeville J, Meirhaeghe A, Sjöstrom M, Bergman P, Hagströmer M, Hallström L, Hallberg M, Poortvliet E, Wärnberg J, Rizzo N, Beckman L, Wennlöf AH, Patterson E, Kwak L, Cernerud L, Tillgren P, Sörensen S, Sánchez-Molero J, Picó E, Navarro M, Viadel B, Carreres JE, Merino G, Sanjuán R, Lorente M, Sánchez MJ, Castelló S, Gilbert C, Thomas S, Allchurch E, Burguess P, Hall G, Astrom A, Sverkén A, Broberg A, Masson A, Lehoux C, Brabant P, Pate P, Fontaine L, Sebok A, Kuti T, Hegyi A, Maldonado C, Llorente A, García E, von Fircks H, Hallberg ML, Messerer M, Larsson M, Fredriksson H, Adamsson V, Börjesson I, Fernández L, Smillie L, Wills J, González-Gross M, Meléndez A, Benito PJ, Calderón J, Jiménez-Pavón D, Valtueña J, Navarro P, Urzanqui A, Albers U, Pedrero R, Gómez Lorente JJ. Physical Activity Is Associated with Attention Capacity in Adolescents. J Pediatr 2016; 168:126-131.e2. [PMID: 26480921 DOI: 10.1016/j.jpeds.2015.09.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 08/13/2015] [Accepted: 09/08/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents. STUDY DESIGN The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity. RESULTS After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA. CONCLUSION These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.
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Affiliation(s)
- Jérémy Vanhelst
- University of Lille, INSERM, CHU Lille, LIRIC, UMR995, F-59000, Lille, France; CHU Lille, INSERM, CIC-PT-1403, F-59000, Lille, France.
| | - Laurent Béghin
- University of Lille, INSERM, CHU Lille, LIRIC, UMR995, F-59000, Lille, France; CHU Lille, INSERM, CIC-PT-1403, F-59000, Lille, France
| | - Alain Duhamel
- Department of Biostatistics, University of Lille, Lille, France
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Denes Molnar
- Department of Pediatrics, Pécs University, Pécs, Hungary
| | - Sefaan De Henauw
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Luis A Moreno
- Growth, Exercise, Nutrition, and Development Research Group, Escuela Universitaria de Ciencias de la Salud, Zaragoza University, Zaragoza, Spain
| | - Francisco B Ortega
- School of Sport Sciences, University of Granada, Granada, Spain; Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Michael Sjöström
- Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Kurt Widhalm
- Department of Pediatrics, Paracelsus Private Medical University of Salzburg, Salzburg, Austria
| | - Frédéric Gottrand
- University of Lille, INSERM, CHU Lille, LIRIC, UMR995, F-59000, Lille, France
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Karagiannis D, Bouloubasi Z, Baschali A, Poulia KA, Constantinou D, Drakopoulos S, Chourdakis M. SUN-PP187: The Efficacy of Nutritional Screening and Assessment in Prediction of Post Operative Complications and Hospital Readmission in Patients Undergoing Abdominal Surgery. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Karayiannis D, Bouloubasi Z, Konstantinou D, Chourdakis M, Magganas D, Drakopoulos S. PP162-MON: Preoperative Nutritional Assessment for Predicting Complications Risk in Patients Undergoing Abdominal Surgery. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Manios Y, Angelopoulos PD, Kourlaba G, Kolotourou M, Grammatikaki E, Cook TL, Bouloubasi Z, Kafatos AG. Prevalence of obesity and body mass index correlates in a representative sample of Cretan school children. ACTA ACUST UNITED AC 2010; 6:135-41. [PMID: 20528105 DOI: 10.3109/17477161003792572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to estimate the prevalence of overweight and obesity and investigate associated factors in a representative sample of Cretan school children. METHODS As part of a cross-sectional study in children aged 10-12 years (n = 481, 48% boys) in 27 (urban and rural) schools in Crete, Greece, the rates of overweight and obesity were estimated and multiple logistic regression was used to explore the relationship between several factors and body mass index (BMI). RESULTS It was shown that 28% and 13% of children were overweight and obese, respectively. Factors affecting children's BMI classification included: gender (95% CI: 0.21 to 0.56); birth weight (95% CI: 1.33 to 3.46); parental overweight or obesity (95% CI: 1.11 to 6.5 and 95% CI: 4.37 to 30.7 for one and both overweight or obese parents, respectively), paternal educational level (95% CI: 0.89 to 3.48 and 95% CI: 1.49 to 6.13 for low and high educational level, respectively); and cardiovascular fitness levels (95% CI: 0.87 to 0.92). CONCLUSION The combined prevalence of overweight and obesity was alarmingly high in the current population (41%); several physiological, behavioural and social factors were shown to affect children's BMI status. These findings highlight the extent of the child obesity problem in Crete and support the need for actions to be taken at a national level to tackle the obesity epidemic.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, Kallithea, Athens, Greece.
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Manios Y, Moschonis G, Kourlaba G, Bouloubasi Z, Grammatikaki E, Spyridaki A, Hatzis C, Kafatos A, Fragiadakis GA. Prevalence and independent predictors of insulin resistance in children from Crete, Greece: the Children Study. Diabet Med 2008; 25:65-72. [PMID: 18028438 DOI: 10.1111/j.1464-5491.2007.02318.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND It has been proposed that insulin resistance (IR) is associated with the development of Type 2 diabetes mellitus and cardiovascular disease. The aim of this study is to determine the prevalence of IR in Greek schoolchildren and to investigate factors associated with IR. METHODS Between October 2005 and March 2006, 522 children were recruited from Crete. Physical activity and dietary habits, anthropometric and biochemical characteristics, as well as medical history of pupils' parents were recorded. IR was estimated using the homeostasis model assessment (HOMA-IR), fasting glucose-to-insulin ratio (FGIR) and quantitative insulin sensitivity check index (QUICKI). Multiple linear regression was used to determine independent predictors for IR. RESULTS Fasting insulin levels and HOMA-IR scores were higher in obese children and girls compared with their normal-weight peers (P < 0.001). Moreover, the former had lower values in FGIR and QUICKI indices compared with the latter, indicating that obese children and girls are more insulin resistant compared with their counterparts (P < 0.001). The prevalence of IR was 9.2% (2.9% in normal-weight, 10.5% in overweight and 31.0% in obese children), using as a threshold HOMA-IR > 2.10 97.5th percentile of normal-weight participants). Multiple linear regression revealed that central adiposity, female gender and intake of simple carbohydrates is associated positively with HOMA-IR values, even after controlling for many other factors. CONCLUSION These findings demonstrate that girls and obese children, particularly those with central adiposity, are at high risk of developing IR. Therefore, these groups should be targets of Type 2 diabetes mellitus and cardiovascular disease preventive interventions.
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Affiliation(s)
- Y Manios
- Department of Dietetics-Nutrition, Harokopio University, Athens, Greece.
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