Prevalence of insulin resistance in obese adolescents
Keywords:
Obese adolescents, insulin resistance, metabolic syndrome
Abstract
Background Childhood obesity is a global health problem, withthe prevalence is differed in each country and affected by many
factors, such as lifestyle and physical activity. Insulin resistance
(IR) as a basic mechanism of several metabolic diseases in obesity,
is related with metabolic syndrome (MetS) along with its long
term complications, such as type 2 diabetes mellitus (T2DM).
Several factors are known to be associated with IR, and the
presence of acanthosis nigricans (AN) has an important meaning
in predicting IR.
Objectives To assess the prevalence of IR, MetS in obese
adolescents and its potentially associated factors, such as gender,
signs of AN, and family history of metabolic diseases.
Methods A cross-sectional study was performed in obese
adolescents, aged 12-15 years, over a two-month period. Fasting
blood glucose, insulin, and lipid profiles were measured. Obesity
was defined using body mass index (BMI). Insulin resistance
was quantified by the homeostasis model assessment for IR
(HOMA-IR) . Metabolic syndrome was defined according to the
International Diabetes Federation (IDF) 2007 criteria.
Results Of92 obese adolescents, IR was found in 38% of subjects,
with females predominating (57.2%). Signs of AN were seen in
71. 4% of subj ects and a positive family history of metabolic diseases
was found in 82.8% of subjects, including family history of obesity,
type 2 diabetes mellitus (T2DM), and hypertension. Less than
10% of subjects were considered to be in a prediabetic state, and
none had T2DM. No statistical significance was found between
gender, family history, or signs of AN and IR (P>0.05). Metabolic
syndromes was found in 19.6% of subjects, with the fo llowing
prevalences for each component: 34.8% for hypertension, 78.3%
for central obesity, 8.7% for impaired fasting glucose (IFG), 22.8%
for low levels of HDL, and 2 1. 7% for high triglyceride levels. A
strong correlation was found between IR and IFG with OR= 5 .69
(95%CI 1.079 ~ 29.993, P= D.04).
Conclusion We find a high prevalence ofIRin obese adolescents,
and IR increases the risk of prediabetes. Thus, prevention strategies are needed to overcome the long term impact of obesity on health.
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pubertal periods. J Clin Res Pediatr Endocrinol.2010;2: 100-
6.
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Hong C, et al. Changes in insulin resistance and cardiovascular
risk during adolescence: establishment of differential
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24. Shalitin S, Abrahami M, Lilos P, Philip M. Insulin resistance
and impaired glucose tolerance in obese children and
adolescents referred to a tertiary care in Israel. Int J Obes.
2005;29:571-8.
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Acanthosis nigricans and insulin resistan ce in obese children.
Paediatr Indones. 2010;50:274-7.
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Hyperinsulinemia and acanthosis nigricans in African
Americans. J Natl Med Assoc. 1997 ;89:523-7.
2 7. Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M,
Caprio S. Predictors of changes in glucose tolerance status
172 • Paediatrlndones, Vol. 53, No. 3, May 2013
in obese youth. Diabetes Care. 2005;28:902- 9.
28. Amemiya S, Dobashi K, Urukami T, Sugihura S, Ohzeki T,
Tajima N. Metabolic syndrome in youths. Pediatr Diabetes.
2007;8:48-54.
29. Tsay J, Pomeranz C, Hassoun A, Zandieh SO, Rutledge J,
Vogiatzi MG, et al. Screening markers of impaired glucose
tolerance in the obese pediatric population. Horm Res
Paediatr. 2010;73:102-7.
30. Urakami T, Suzuki], Yoshida A, Saito H, Wada M, Takahashi
S, et al. Prevalence of components of the metabolic syndrome
in school children with newly diagnosed type 2 diabetes
mellitus. Pediatr Diabetes. 2009;10:508-12.
31. Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes,
and cardiovascular risk in children: an American Heart
Association Scientific Statement from the Atherosclerosis,
Hypertension, and Obesity in the Young Committee (Council
on Cardiovascular Disease in the Young) and the Diabetes
Committee (Council on Nutrition, Physical Activity, and
Metabolism). Circulation. 2003; 107; 1448-53.
32. Reinehr T, Toschke AM. Onset of puberty and cardiovascular
risk factors in untreated obese children and adolescents:
a 1-year fo llow-up study. Arch Pediatr Adolesc Med.
2009;163:709-15.
33. Ghergerehchi R. Dyslipidemia in Iranian overweight and
obese children. Ther Clin Risk Manag. 2009;5:739--43.
34. Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet
C, Marcovecchio ML, et al. Insulin resistance in children :
consensus, perspective, and future direction s. J Clin
Endocrinol Metab. 2010;95:5189-98.
Diabetes. 2007;8:76-87.
2. Chiarelli F, Marcovecchio ML. Insulin resistance and obesity
in childhood. Eur J Endocrinol. 2008;159:67-74.
3. Caceres M, Teran CG, Rodriguez S, Medina M. Prevalence of
insulin resistance and its association with metabolic syndrome
criteria among Bolivian children and adolescents with obesity.
BMC Pediatr. 2008;8:31.
4. Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG.
Prevalence and determinants of insulin resistance among
US adolescents: a population-based study. Diabetes Care.
2006;29:2427-32.
5. Eyzaguirre F, Mericq V Insulin resistan ce markers in children.
Horm Res. 2009;71 :65-74.
6. Leunissen RW, Oosterbeek P, Hol LK, Hellingman AA,
Stijnen T, Hokken-Koelega AC. Fat mass accumulation
during childhood determines insulin sensitivity in early
adulthood. J Clin Endocrinol Metab. 2008;93 :445-51.
7. Murtaugh MA, Jacobs DR Jr, Moran A, Steinberger J, Sinaiko
resistance, and body size in adolescence. Diabetes Care.
2003 ;26: 187-92.
8. Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ,
Goran MI. The metabolic syndrome in overweight Hispanic
youth and the role of insulin sensitivity. J Clin Endocrinol
Metab. 2004;89:108-13.
9. Poirer P, Giles TD, Bray GA, Hong Y, Stem JS. Obesity and
cardiovascular disease: pathophysiology, evaluation, and
effect of weight loss. Arterioscler Thromb Vase Biol. 2006;
26:968-76.
10. Ten S, Maclaren N. Insulin resistance syndrome in children.
J Clin Endocrinol Metab. 2004;89:2526-39.
11. Marques-Vidal P, Mazoyer E, Bongard V, Gourdy P, Ruidavets
J, Drouet L, et al. Prevalence of insulin resistance syndrome in
Southwestern France and its relationship with inflammatory
and hemostatic markers. Diabetes Care. 2002;25:1371-7.
12. Lewanczuk RZ, Paty BW, Toth EL. Comparison of the [ 13 CJ
glucose breath test to the hyperinsulinemic-euglycemic
clamp when determining insulin resistance. Diabetes Care.
2004;27:441-7.
13. Kobaissi HA, Weigensberg MJ, Ball GD, Cruz ML, Shaibi
GQ, Goran MI. Relation between acanthosis nigricans and
insulin sen sitivity in overweight Hispanic children at risk for
type 2 diabetes. Diabetes Care. 2004;27:141 2- 6.
14. NCHS 2004 CDC 2000 growth charts: United States.
National Center for Health Statistics. Available from:
http://www.cdc.gov/growthcharts/ Accessed on : October 15th,
2008.
15. Zimmet P, Alberti KOMM, Kaufman F, Tajima N, Silink
M, Arslanian S, et al. The metabolic syndrome in children
and adolescents: an IDF consensus report. Pediatr D1abetes.
2007;85:299-306 .
16. NCEP Expert Panel: Executive Summary of the Third Report
of the National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation , and Treatment of
high blood cholesterol in adults (Adult Treatment Panel III).
JAMA. 2001;285:2486-97.
17. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C.
Homeostasis model assessment is more reliable than the fasting
glucose/insulin ratio and quantitative insulin sensitivity check
index for assessing insulin resistance among obese children and
adolescents. Pediatrics. 2005;115:500-3.
18. Siddiqui SA, Bashir S, Shabbir I, Sherwani MK, Aasim M.
Association ofinsulin resistance with obesity in children. Pak
J Med Res. 2011;50:137-40.
19. Pateda V, Tirtamulia K. Hubungan indeks massa tubuh dan
resisten si insulin pada anak obes. Sari Pediatri. 2011; 12:3 15-
AR. Relation of birth weight to fasting insulin, insulin 8.20. Wolff C, Hoang S, Flannery D, Wermuth L. A preliminary
study of diet, overweight, elevated blood pressure, and
acanthosis nigricans among K-9th grade Native American
students. Californian] Health Promotion. 2006;4:77-87.
21. Ikezaki A, Miura N, Kikuoka N, Hye SK, Matsuoka H, Ito K,
et al. Clinical characteristics of obese Japanese children with
acanthosis nigricans. Clin Pediatr Endocrinol. 2001;10:47-
52.
22. Kurtoglu S, Hatipoglu N, Mazicioglu M, Kendirici M, Ke skin
M, Kondolot M. Insulin resistance in obese children and
adolescents: HOMA-IR cut-off levels in the prepubertal and
pubertal periods. J Clin Res Pediatr Endocrinol.2010;2: 100-
6.
23. Moran A, Jacobs DR, Steinberger J, Steffen LM, Pankow JS,
Hong C, et al. Changes in insulin resistance and cardiovascular
risk during adolescence: establishment of differential
risk in males and females. Circulation. 2008;117 :2361-8.
24. Shalitin S, Abrahami M, Lilos P, Philip M. Insulin resistance
and impaired glucose tolerance in obese children and
adolescents referred to a tertiary care in Israel. Int J Obes.
2005;29:571-8.
25. Tirtamulia KS, Umboh A, Warouw SM, Pateda V, Regina F.
Acanthosis nigricans and insulin resistan ce in obese children.
Paediatr Indones. 2010;50:274-7.
26. Stuart CA, Gilkison CR, Keenan BS, Nagamani M.
Hyperinsulinemia and acanthosis nigricans in African
Americans. J Natl Med Assoc. 1997 ;89:523-7.
2 7. Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M,
Caprio S. Predictors of changes in glucose tolerance status
172 • Paediatrlndones, Vol. 53, No. 3, May 2013
in obese youth. Diabetes Care. 2005;28:902- 9.
28. Amemiya S, Dobashi K, Urukami T, Sugihura S, Ohzeki T,
Tajima N. Metabolic syndrome in youths. Pediatr Diabetes.
2007;8:48-54.
29. Tsay J, Pomeranz C, Hassoun A, Zandieh SO, Rutledge J,
Vogiatzi MG, et al. Screening markers of impaired glucose
tolerance in the obese pediatric population. Horm Res
Paediatr. 2010;73:102-7.
30. Urakami T, Suzuki], Yoshida A, Saito H, Wada M, Takahashi
S, et al. Prevalence of components of the metabolic syndrome
in school children with newly diagnosed type 2 diabetes
mellitus. Pediatr Diabetes. 2009;10:508-12.
31. Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes,
and cardiovascular risk in children: an American Heart
Association Scientific Statement from the Atherosclerosis,
Hypertension, and Obesity in the Young Committee (Council
on Cardiovascular Disease in the Young) and the Diabetes
Committee (Council on Nutrition, Physical Activity, and
Metabolism). Circulation. 2003; 107; 1448-53.
32. Reinehr T, Toschke AM. Onset of puberty and cardiovascular
risk factors in untreated obese children and adolescents:
a 1-year fo llow-up study. Arch Pediatr Adolesc Med.
2009;163:709-15.
33. Ghergerehchi R. Dyslipidemia in Iranian overweight and
obese children. Ther Clin Risk Manag. 2009;5:739--43.
34. Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet
C, Marcovecchio ML, et al. Insulin resistance in children :
consensus, perspective, and future direction s. J Clin
Endocrinol Metab. 2010;95:5189-98.
Published
2013-06-30
How to Cite
1.
Pulungan A, Puspitadewi A, Sekartini R. Prevalence of insulin resistance in obese adolescents. PI [Internet]. 30Jun.2013 [cited 20Apr.2024];53(3):167-2. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/275
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-06-30
Accepted 2016-08-21
Published 2013-06-30
