Diversity of metabolic syndrome risk factors in obese children and adolescents

The aim of this study was to investigate the frequency of metabolic syndrome (MS) variables in a group of spanish obese children and adolescents, to asses MS prevalence in this population and to describe it's relationship with other metabolic risk factors. 103 children were studied : 54 male and 49 female, mean age 10.08+/-2.3 with exogenous obesity. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m(2) in adults. MS variables considered were waist circumference, blood pressure, fasting blood triglycerides, fasting glucose/insulin and HDL-cholesterol. The children were considered as having the MS when three or more characteristics showed abnormal values according to Cook and De Ferranti definitions. HOMA index, ApoB and ApoA1 were studied too. The most frequent features of the metabolic syndrome were excess waist circumference and hypertension. The MS markers with the lowest frequency were dyslipidemia and fasting hyperglicemia. MS prevalence was 29,9% (Cook et al. criteria) and 50% (De Ferranti et al. criteria). Fasting insulin and HOMA index values increased significantly (p < 0.05) when three or more abnormalities of the MS variables were present. Apo B increased significantly only in females (p < 0.05) and Apo Al decreased significantly (p < 0.05) in both sexes when MS was present. Adequate metabolic syndrome risk factors criteria, mainly cut-off values, need to be defined in the European paediatric population.     

非肥胖者发生非酒精性脂肪肝的预测指标

目的：探讨能够预测非肥胖者是否发生非酒精性脂肪肝（Nonalcohohc fatty liver disease,NAFLD）的临床指标。方法：从广州社区人群中选取体重指数〈25且年龄、性别相匹配的NAFLD和非NAFLD个体分别为38和82例,测量其身高、体重、腰围、臀围及空腹血糖、甘油三脂、胆固醇、低密度脂蛋白、高密度脂蛋白、HBsAg和空腹胰岛素,计算体重指数、腰臀比、腰围身高比和HOMA胰岛素抵抗指数。先采用t检验和x^2检验对上述临床指标进行分析,对两组间存在显著差异者进行Logisde回归以发现独立的预测指标,再针对各预测指标进行受试者工作特征（reciever operating charactefistic,ROC）曲线分析判断各指标的预测准确度,并确定最佳的预测截断值。结果：NAFLD和非NAFLD的体重、腰围、臀围、体重指数、腰臀比、腰围身高比及空腹血糖、甘油三脂、低密度脂蛋白、胰岛素、HOMA胰岛素抵抗指数均有显著差异,但仅腰围、低密度脂蛋白和HOMA胰岛素抵抗指数进入Logistic回归方程,且其ROC曲线下面积均大于0．5（分别是0．821,0．665和0、722）。以腰围的预测准确度最高,且在80．5cm处敏感性和特异性之和最大。结论：腰围是预测非肥胖者是否发生NAFLD的合适指标,80．5cm为其最佳预测截断值。     

Metabolic risk-factor clustering estimation in obese children

The purpose of this study was to apply the new approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) score in a group of Spanish obese children and adolescents and to describe its relationship with other metabolic risk factors. 153 children with simple obesity were studied: 79 males and 74 females, mean age 11.2 +/- 2.2. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MIRACLE score included: family history (early cardiovascular disease, type 2 diabetes, and hypertension), individual history (small for gestational age and ethnic origin), clinical features (BMI, waist circumference > 90th percentile and blood pressure > 95th percentile) and metabolic abnormalities (glucose intolerance or type 2 diabetes). It was assigned a value of 1 to "presence" and 0 to" absence" in every patient. The children were considered as having metabolic risk when at least 5 items were present. Triglycerides, HDL-cholesterol, apolipoprotein B, apolipoprotein A1, glucose and HOMA index, were measured too. The most frequent clinical features of MIRACLE score were: excess waist circumference (95.4%) and hypertension (41.8%). Family history criteria were frequent (55.3% for type 2 diabetes, 39.1% for hypertension and 31.3% for early cardiovascular disease). Individual risk factors were not frequent. Glucose intolerance was detected in 22.2% of the obese patients. A MIRACLE score > or = 5 was found in 37.4% of the children studied, being associated with a significant risk of dyslipidemia (triglycerides, p = 0.040; HDL-cholesterol, p = 0.006; LDL-cholesterol p = 0.038; apolipoprotein B, p = 0.008) only in females. In conclusion, the MIRACLE score is useful in order to detect metabolic risk in obese children but it seems necessary to improve the score, by including other features of the metabolic syndrome like lipid profile or indirect indicators of insulin resistance.     

Serum transaminases concentrations in obese children and adolescents

The aim of the study was to investigate the relationship between liver transaminase levels and metabolic syndrome (MS) features in obese children and adolescents. A total of 132 children and adolescents (73 males and 59 females) aged 8–16, participated in the study. All were studied at the department of Paediatrics, University Hospital of Zaragoza (Spain). Inclusion criteria were the existence of obesity as defined by body mass index (BMI) according to Cole cut-off values (when BMI was higher than the age and sex specific equivalent to 30 kg/m²). The definition of metabolic syndrome was according to the International Diabetes Federation criteria. Weight (kg), height (cm), waist circumference (cm), blood pressure and BMI were measured. Laboratory determinations after overnight fasting included: transaminases (ALT, AST, GGT), fasting glucose, insulin, triglycerides and HDL-C. The MS was found in 21.6% of the obese children and adolescents and the prevalence was higher in males (25.9%) than in females (15.9%). Serum transaminases (ALT, AST and GGT) mean concentrations were higher in males than in females, and decreased during pubertal development. The obese children and adolescents with the MS did not show higher transaminases concentrations when compared with those without the MS. Some MS manifestations (mainly waist circumference) showed a correlation with ALT, although all transaminases values were normal according to adult references. Liver transaminases, a surrogate marker of NAFLD, did not show an early and consistent manifestation of abnormalities in the obese children and adolescents studied. In order to define the presence of the disease, it would be necessary to obtain aminotransferase reference standards for children and adolescents, considering pubertal stage and gender.     

Prevalencia de alteraciones del metabolismo hidrocarbonado en una población infanto-juvenil con obesidad grave

IntroductionThere is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism.ObjectiveTo establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes.Material and methodsA cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA_1c), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure.ResultsA total of 133 patients were included: 67 boys (50.4%) and 66 girls (49.6%), with a mean age of 12.17±3.27 years. Fourteen patients (10.52%) had prediabetes (10 IFG, 3 IGT, 1 IFG+IGT): 7 girls and 8 boys, with a mean age of 13.2±3.3 years. One patient had DM2 (0.75%). Patients with prediabetes had significantly higher concentrations of fasting glucose (98±10.76 vs 88.53±6.3 mg/d; p=0.001), insulinemia (35.38±14.22 vs 22.95±14.30 μU/ml; p=0.009) and HOMA index (8.10±3.24 vs 4.89±3.27; p=0.004) than patients without impaired carbohydrate metabolism. These patients also had higher values of HbA_1c, triglycerides, blood pressure and HDL concentrations, although differences were not statistically significant.ConclusionsThe prevalence of prediabetes (IFG/IGT) in children with severe obesity was high (10.52%). These patients should therefore be investigated to establish early diagnosis and appropriate treatment. Obese patients with prediabetes have significantly higher levels of insulin and insulin resistance than individuals without impaired carbohydrate metabolism.     

BMI and waist circumference in predicting cardiovascular risk factor clustering in Chinese adolescents

Objective: To derive the optimal BMI and waist circumference (WC) cut‐off values to predict clustering of cardiovascular risk factors in Hong Kong Chinese adolescents. Research Methods and Procedures: A total of 2102 Hong Kong Chinese 12 to 19 years of age were recruited. Participants were considered to have clustering of risk factors if at least three of the following risk factors were present: 1) high‐density lipoprotein cholesterol (HDL‐C) ≤1.03 mM, 2) low‐density lipoprotein cholesterol (LDL‐C) ≥2.6 mM, 3) triglyceride (TG) ≥1.24 mM, 4) fasting plasma glucose (FPG) ≥6.1 mM, and 5) age‐, sex‐, and height‐adjusted systolic or diastolic blood pressure (BP) ≥ 90th percentile. Receiver operating characteristics (ROC) curves were generated to identify the optimal age‐adjusted BMI and WC cut‐off values to predict clustering of risk factors in boys and girls separately. These age‐adjusted BMI and WC cut‐offs were transformed to percentile values. Cole's lambda‐mu‐sigma (LMS) method was used to obtain smoothed age‐specific BMI and WC at these percentile values. Results: The areas under ROC curves for BMI in girls and boys were 0.85 [95% confidence interval (CI), 0.77 to 0.92] and 0.76 (95% CI, 0.66 to 0.85), respectively. The respective areas under ROC curves for WC in girls and boys were 0.82 (95% CI, 0.74 to 0.91) and 0.78 (95% CI, 0.68 to 0.87). The optimal BMI thresholds were at the 78th percentile for girls and the 72nd percentile for boys. The respective values for WC were at the 77th percentile for girls and the 76th percentile for boys. The sensitivities and specificities of these cut‐off values ranged from 72% to 80%. Discussion: Age‐ and sex‐specific BMI and WC cut‐off values can be used to identify adolescents with clustering of cardiovascular risk factors.     

Insulin resistance and whole body energy homeostasis in obese adolescents with fatty liver disease

Obese adolescents are at risk of developing NAFLD and type 2 diabetes. We measured noninvasively the IHF content of obese adolescents to ascertain whether it is associated with insulin resistance and abnormal energy homeostasis. IHF content, whole body energy homeostasis, insulin sensitivity, and body composition were measured using localized hepatic (1)H-MRS, indirect calorimetry, fasting-derived and 3-h-OGTT-derived surrogate indexes (HOMA2 and WBISI), and DEXA, respectively, in 54 obese adolescents (24 female and 30 male, age 13 +/- 2 yr, BMI >99th percentile for their age and sex). NAFLD (defined as IHF content >5% wet weight) was found in 16 individuals (30%) in association with higher ALT (P < 0.006), Hb A(1c) (P = 0.021), trunk fat content (P < 0.03), and lower HDL cholesterol (P < 0.05). Individuals with NAFLD had higher fasting plasma glucose (89 +/- 8 vs. 83 +/- 9 mg/dl, P = 0.01) and impaired insulin sensitivity (HOMA2 and WBISI, P < 0.05). Meanwhile, parameters of insulin secretion were unaffected. Their reliance on fat oxidation in the fasting state was lower (RQ 0.83 +/- 0.08 vs. 0.77 +/- 0.05, P < 0.01), and their ability to suppress it during the oral glucose challenge was impaired (P < 0.05) vs. those with normal IHF content. When controlling for trunk fat content, the correlation between IHF content and insulin sensitivity was weakened, whereas the correlation with fasting lipid oxidation was maintained. In conclusion, NAFLD is common in childhood obesity, and insulin resistance is present in association with increased trunk fat content. In contrast, the rearrangement of whole body substrate oxidation in these youngsters appeared to be an independent feature.     

Weight Loss Reduces Liver Fat and Improves Hepatic and Skeletal Muscle Insulin Sensitivity in Obese Adolescents

Obesity in adolescents is associated with metabolic risk factors for type 2 diabetes, particularly insulin resistance and excessive accumulation of intrahepatic triglyceride (IHTG). The purpose of this study was to evaluate the effect of moderate weight loss on IHTG content and insulin sensitivity in obese adolescents who had normal oral glucose tolerance. Insulin sensitivity, assessed by using the hyperinsulinemic–euglycemic clamp technique in conjunction with stable isotopically labeled tracer infusion, and IHTG content, assessed by using magnetic resonance spectroscopy, were evaluated in eight obese adolescents (BMI ≥95th percentile for age and sex; age 15.3 ± 0.6 years) before and after moderate diet‐induced weight loss (8.2 ± 2.0% of initial body weight). Weight loss caused a 61.6 ± 8.5% decrease in IHTG content (P = 0.01), and improved both hepatic (56 ± 18% increase in hepatic insulin sensitivity index, P = 0.01) and skeletal muscle (97 ± 45% increase in insulin‐mediated glucose disposal, P = 0.01) insulin sensitivity. Moderate diet‐induced weight loss decreases IHTG content and improves insulin sensitivity in the liver and skeletal muscle in obese adolescents who have normal glucose tolerance. These results support the benefits of weight loss therapy in obese adolescents who do not have evidence of obesity‐related metabolic complications during a standard medical evaluation.     

血清视黄醇结合蛋白-4同儿童肥胖和代谢综合征组分的关系

目的:探讨儿童血清视黄醇结合蛋白-4(retinol-binding protein4,RBP-4),视黄醇,甲状腺素运载蛋白(transthyretin,TTR)等维生素A相关指标与肥胖、胰岛素抵抗以及代谢综合征组分之间的关系。方法:分别随机选取本地区13-15岁体检学生,其中正常对照组和单纯性肥胖组儿童各50例,测定其血清RBP-4、视黄醇、TTR水平;利用空腹胰岛素和定量胰岛索敏感性检测指标评价其胰岛素抵抗;同时测定代谢综合征部分组分水平和亚临床炎症指标。结果:仅5%的青少年存在维生素A营养不足状态。排除年龄、性别、感染等因素的影响后,血清RBP-4水平、视黄醇、RBP-4/TTR摩尔比值以及RBP-4/视黄醇摩尔比值与体重指数、体脂含量以及体脂的中心分布(WHR)等密切相关;RBP-4与代谢综合征组分的甘油三酯水平则存在明显的正相关,而RBP-4/视黄醇摩尔比值则与空腹胰岛素水平存在显著的正相关。结论:RBP-4可能通过视黄醇依赖和/或非视黄醇依赖的方式参与肥胖和代谢综合征的病理过程。     

High prevalence of the metabolic syndrome in Iranian adolescents

Objective : No evidence exists regarding the prevalence of the metabolic syndrome in adolescents in Middle Eastern countries. We aimed to evaluate the prevalence of the metabolic syndrome in a representative sample of Iranian adolescents. Research Methods and Procedures : Anthropometry, biochemical measurements, and blood pressure were assessed in a population‐based cross‐sectional study of 3036 Iranian adolescents (1413 boys and 1623 girls) 10 to 19 years of age. Metabolic syndrome was defined according to modified Adult Treatment Panel III definition. Overweight (≥95th percentile) and at risk for overweight (≥85th to <95th percentile) was defined based on the standardized percentile curves of BMI suggested for Iranian adolescents. Results : The prevalence of the metabolic syndrome was 10.1% (95% confidence interval: 9.0 to 11.1) among Iranian adolescents (boys: 10.3%, 8.6 to 11.8; girls: 9.9%, 8.4 to 11.3). Overall, low serum high‐density lipoprotein‐cholesterol and high serum triglycerides were the most common components of the metabolic syndrome (42.8% and 37.5%, respectively). Overweight subjects had the highest proportion of metabolic syndrome compared with those at risk for overweight and those with normal weight (boys: 41.1% vs. 11.4% and 3.0%, respectively, p < 0.01; girls: 43% vs. 15.2% and 5.0%, respectively, p < 0.01). Discussion : This study provides evidence showing a high prevalence of the metabolic syndrome in Iranian adolescents, particularly among overweight adolescents.     

Insulin resistance in adolescents with Down syndrome: a cross-sectional study

Background

The prevalence of diabetes mellitus is higher in individuals with Down syndrome (DS) than in the general population; it may be due to the high prevalence of obesity presented by many of them. The aim of this study was to evaluate the insulin resistance (IR) using the HOMA (Homeostasis Model Assessment) method, in DS adolescents, describing it according to the sex, body mass index (BMI) and pubertal development.

Methods

15 adolescents with DS (8 males and 7 females) were studied, aged 10 to 18 years, without history of disease or use of medication that could change the suggested laboratory evaluation. On physical examination, the pubertal signs, acanthosis nigricans (AN), weight and height were evaluated. Fasting plasma glucose and insulin were analysed by the colorimetric method and RIA-kit LINCO, respectively. IR was calculated using the HOMA method. The patients were grouped into obese, overweight and normal, according to their BMI percentiles. The EPIINFO 2004 software was used to calculate the BMI, its percentile and Z score.

Results

Five patients were adults (Tanner V or presence of menarche), 9 pubertal (Tanner II – IV) and 1 prepubertal (Tanner I). No one had AN. Two were obese, 4 overweight and 9 normal. Considering the total number of patients, HOMA was 1.7 ± 1.0, insulin 9.3 ± 4.8 μU/ml and glucose 74.4 ± 14.8 mg/dl. The HOMA values were 2.0 ± 1.0 in females and 1.5 ± 1.0 in males. Considering the nutritional classification, the values of HOMA and insulin were: HOMA: 3.3 ± 0.6, 2.0 ± 1.1 and 1.3 ± 0.6, and insulin: 18.15 ± 1.6 μU/ml, 10.3 ± 3.5 μU/ml and 6.8 ± 2.8 μU/ml, in the obese, overweight and normal groups respectively. Considering puberty, the values of HOMA and insulin were: HOMA: 2.5 ± 1.3, 1.4 ± 0.6 and 0.8 ± 0.0, and insulin: 13.0 ± 5.8 μU/ml, 7.8 ± 2.9 μU/ml and 4.0 ± 0.0 μU/ml, in the adult, pubertal and prepubertal groups respectively.

Conclusion

The obese and overweight, female and adult patients showed the highest values of HOMA and insulin.     

FOXO 1a and FOXO 3a gene polymorphisms in association with metabolic syndrome

The prevalence and magnitude of childhood and adult obesity and diabetes are increasing dramatically. FOXO 1a and FOXO 3a will be evaluated in this study, in an effort to identify genetic polymorphisms in potential candidate genes that may be associated with body mass index (BMI), and metabolic syndrome (MS). Also to assess whether there is a relation between insulin sensitivity, and genotype, we will test the relation between fasting insulin, glucose, insulin resistance, insulin secretion and genotype.A total number of 248 presenting normal, overweight and obese individuals were recruited; 100 children and 148 adults of both sexes. They were divided by body mass index as follows, normal, overweight and obese. Lipid profile, fasting glucose and insulin HOMA-IR and HOMA-β index and RT-PCR for FOXO 1a and FOXO 3a were performed.An association was found among the studied group (children and adults) as regards foxo3a gene polymorphism and HOMA IR, HOMA B index and T-cholesterol (P = 0.022, 0.011 and 0.028, respectively), while there was only an association between LDL-C and foxo1a gene polymorphism among the studied group of children and adults (P = 0.023).In this study we demonstrated that FOXO3a mutant is correlated with HOMA-IR (marker of insulin resistance), HOMA-B index (marker of insulin secretion) and total cholesterol while as regards FOXO1a there was only an association between LDL cholesterol and mutant type of FOXO1a.     

Insulin resistance and impaired glucose tolerance in obese children and adolescents

In developed countries, obesity prevalence has strongly increased in the last decades. This has also been observed in children and adolescents. Until recently, type 2 diabetes mellitus was considered very rare among children and adolescents; however, in the last decades, some cases have been observed mainly in obese adolescents of some minority populations. The aim of our study was to assess the prevalence of type 2 diabetes, impaired glucose tolerance (IGT) and insulin resistance, and the metabolic features, in obese children and adolescents. We have studied 95 obese children and adolescents, 53 males and 42 females, aged 4-16 years. The prevalence of IGT in obese children and adolescents studied was 7.4%; there was not any child with type 2 diabetes. Fasting glucose and insulin serum concentrations did not show significant differences between obese children with or without IGT; however, 120 minutes after an oral glucose tolerance test, glucose and insulin serum concentrations showed statistically significant differences between both groups. Insulin resistance is defined as a HOMA index higher than 4. The prevalence of insulin resistance in obese children studied was 35.8%. Trygliceride serum concentrations were higher and HDL-C serum concentrations were lower in obese children with IGT than in those without IGT, but the differences were not statistically significant. IGT and insulin resistance are frequent in obese children and adolescents; early treatment in obese children and adolescents with IGT constitutes a strategy of reversing progression to beta-cell failure and in preventing type 2 diabetes.     

Baseline Correlates of Insulin Resistance in Inner City High‐BMI African‐American Children

To characterize the influence of diet‐, physical activity–, and self‐esteem‐related factors on insulin resistance in 8–10‐year‐old African‐American (AA) children with BMI greater than the 85th percentile who were screened to participate in a community‐based type 2 diabetes mellitus (T2DM) prevention trial. In 165 subjects, fasting glucose‐ and insulin‐derived values for homeostasis model assessment of insulin resistance (HOMA‐IR) assessed insulin resistance. Body fatness was calculated following bioelectrical impedance analysis, and fitness was measured using laps from a 20‐m shuttle run. Child questionnaires assessed physical activity, dietary habits, and self‐esteem. Pubertal staging was assessed using serum levels of sex hormones. Parent questionnaires assessed family demographics, family health, and family food and physical activity habits. Girls had significantly higher percent body fat but similar anthropometric measures compared with boys, whereas boys spent more time in high‐intensity activities than girls. Scores for self‐perceived behavior were higher for girls than for boys; and girls desired a more slender body. Girls had significantly higher insulin resistance (HOMA‐IR), compared with boys (P < 0.01). Adjusting for age, sex, pubertal stage, socioeconomic index (SE index), and family history of diabetes, multivariate regression analysis showed that children with higher waist circumference (WC) (P < 0.001) and lower Harter's scholastic competence (SC) scale (P = 0.044) had higher insulin resistance. WC and selected self‐esteem parameters predicted insulin resistance in high‐BMI AA children. The risk of T2DM may be reduced in these children by targeting these factors.     

Effects of creatine supplementation on glucose tolerance and insulin sensitivity in sedentary healthy males undergoing aerobic training

Recent findings have indicated that creatine supplementation may affect glucose metabolism. This study aimed to examine the effects of creatine supplementation, combined with aerobic training, on glucose tolerance in sedentary healthy male. Subjects (n = 22) were randomly divided in two groups and were allocated to receive treatment with either creatine (CT) ( approximately 10 g . day over three months) or placebo (PT) (dextrose). Administration of treatments was double blind. Both groups underwent moderate aerobic training. An oral glucose tolerance test (OGTT) was performed and both fasting plasma insulin and the homeostasis model assessment (HOMA) index were assessed at the start, and after four, eight and twelve weeks. CT demonstrated significant decrease in OGTT area under the curve compared to PT (P = 0.034). There were no differences between groups or over time in fasting insulin or HOMA. The results suggest that creatine supplementation, combined with aerobic training, can improve glucose tolerance but does not affect insulin sensitivity, and may warrant further investigation with diabetic subjects.     

多囊卵巢综合征患者体重指数、内分泌、代谢指标的相关性分析

目的:探讨多囊卵巢综合征患者的体重指数、内分泌及代谢指标的相互关系。方法:选取2016年10月至2017年7月的收治多囊卵巢综合征患者53例作为研究对象,分别根据BMI、HOMA-IR和睾酮水平进行分组,检测和比较体重指数(BMI)、血生化、胰岛素、C肽及性激素等内分泌和代谢指标。结果:根据BMI水平进行分组,空腹胰岛素、60分钟胰岛素、120分钟胰岛素、空腹C肽、60分钟C肽、120分钟C肽、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白差异有统计学意义(P0.05);根据HOMA-IR指数进行分组,空腹血糖、60分钟血糖、120分钟血糖、空腹胰岛素、60分钟胰岛素、120分钟胰岛素、空腹C肽、60分钟C肽、120分钟C肽、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、黄体生成素、黄体生成素/卵泡刺激素、睾酮和雌二醇差异有统计学意义(P0.05);根据睾酮水平进行分组,BMI、空腹胰岛素、60分钟胰岛素、120分钟胰岛素、HOMA指数、黄体生成素、黄体生成素/卵泡刺激素、睾酮、雌二醇差异有统计学意义(P0.05)。结论:多囊卵巢综合征表现复杂多变,应根据不同的体质指数、内分泌和代谢特点进行对症对因治疗,以提高患者治愈水平和生存质量。     

Final Height and Cardiometabolic Outcomes in Young Adults with Very Low Birth Weight (<1500 g)

Objective

Individuals with very low birth weight (VLBW; <1500 g) are known to be predisposed to both short final height and cardiometabolic disorders. However, associations between final height and cardiometabolic outcomes including glucose metabolism in VLBW individuals in young adulthood are not fully investigated.

Methods

We investigated glucose metabolism and other cardiometabolic outcomes such as lipid profiles, blood pressure, renal function, urinary albumin, and thyroid function in young adults with VLBW born between 1980 and 1990. Short stature was defined as a final height <10th percentile. Glucose intolerance [diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG)] was determined using 75-g oral glucose tolerance tests. Associations between final height and cardiometabolic outcomes were examined using logistic or multiple linear regression.

Results

A total of 628 VLBW individuals were screened and 111 young adults with VLBW (19–30 years) participated in the study. Of the participants, 40 subjects (36%) had short stature with a final height <10th percentile. Eight subjects (7.2%) had glucose intolerance (1, diabetes; 6, IGT; 1, IFG). Short stature was correlated with glucose intolerance (odds ratio 11.1; 95% CI 1.92, 99.7; P = 0.006). Final height was inversely associated with the homeostatic model assessment (HOMA) of insulin resistance, HOMA-β, insulinogenic index, and total/LDL-cholesterol. The associations of final height with insulin sensitivity and lipid profiles remained after adjustment for target height and age at puberty onset.

Conclusions

Shorter final height was associated with less favorable metabolic profiles in young adults with VLBW, and may be partly mediated by reduced insulin sensitivity. These associations were independent of target height or age at puberty onset.     

Metabolic Syndrome in Overweight and Obese Japanese Children

Objective: To determine the prevalence of and sex differences related to the metabolic syndrome among obese and overweight elementary school children. Research Methods and Procedures: Subjects were 471 overweight or obese Japanese children. Children meeting at least three of the following five criteria qualified as having the metabolic syndrome: abdominal obesity, elevated blood pressure, low high‐density lipoprotein‐cholesterol levels, high triglyceride levels, and high fasting glucose levels. Fasting insulin levels were also examined. Results: Japanese obese children were found to have a significantly lower prevalence (17.7%) of the metabolic syndrome than U.S. obese adolescents (28.7%, p = 0.0014). However, Japanese overweight children had a similar incidence (8.7%) of the metabolic syndrome compared with U.S. overweight adolescents (6.8%). Hyperinsulinemia in girls and abdominal obesity in boys are characteristic features of individual metabolic syndrome factors in Japanese children. Discussion: The prevalence of the metabolic syndrome is not lower in preteen Japanese overweight children than in U.S. overweight adolescents, although it is significantly lower in Japanese obese preteen children than in U.S. obese adolescents. Primary and secondary interventions are needed for overweight preteen children in Japan.     

Simple fasting methods to assess insulin sensitivity in childhood

The 'gold standard' techniques used to measure insulin sensitivity in children are the hyperinsulinaemic-euglycaemic clamp and Bergman's minimal model. Although precise, these techniques are complex, invasive and time consuming. Alternative indirect measures of insulin sensitivity have been developed that utilize fasting glucose and insulin data in algorithms or computer programs. These methods include homeostatic model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI) and the glucose to insulin ratio (G:I). Each of these three fasting techniques has been developed and validated in adults, with little or no validation in children. Increasingly, HOMA and QUICKI are being used in childhood studies to assess insulin sensitivity. In a group of 79 pre-pubertal children, we found that the correlation between the minimal model and RHOMA (r = -0.4) was no better than that between the minimal model and fasting insulin (r = 0.4), with an even weaker correlation between the minimal model and QUICKI (r = 0.2). In addition, neither HOMA nor QUICKI were able to detect a reduction in insulin sensitivity with obesity or during growth hormone therapy, unlike the minimal model. In children with normal glucose levels, neither HOMA nor QUICKI was superior to fasting insulin. Validation of the derivation formulae for these methods in children is needed before they are more widely used. The potential benefits of these simple fasting techniques is that they are useful in large field studies. However, if the study groups are small or longitudinal changes in insulin sensitivity are sought, more precise techniques such as the clamp or minimal model should be used.     

Insulin resistance (HOMA) in relation to plasma cortisol,IGF-I and IGFBP-3. A study in normal short-statured and GH-deficient children

OBJECTIVE: To investigate the possible contribution of plasma cortisol and growth hormone (GH) as reflected by insulin-like growth factor-I (IGF-I)/insulin-like growth factor-binding protein-3 (IGFBP-3) on insulin action in short-statured children. METHODS: In this study, insulin resistance (HOMA) was determined in 34 normal short-statured (age 9.4 +/- 3.5 years) and in 19 GH-deficient children (age 10.4 +/- 2.2 years). HOMA was examined in relation to fasting plasma cortisol, IGF-I, IGFBP-3 and in addition to birthweight and body mass index (BMI). RESULTS: Birthweight was not correlated to insulin resistance. In GH-deficient children, BMI was significantly augmented and was associated with HOMA (p < 0.02). In both groups of patients, fasting plasma cortisol was related to HOMA (normal: r = 0.295, p < 0.05, GH-deficient: r = 0.495, p < 0.02). Only in normal short-statured children IGF-I (r = 0.338, p < 0.03) and IGFBP-3 (r = 0.493, p < 0.002) were associated with insulin resistance. CONCLUSION: The results indicated that at a young age cortisol contributed to insulin resistance in short-statured children. In normal short-statured children HOMA was associated with IGF-I and IGFBP-3. Possibly GH, a known cause of insulin resistance, contributed to HOMA as IGF-I and IGFBP-3 do not mediate insulin resistance but reflect growth hormone secretion. The results in GH-deficient children supported this conclusion as in the absence of GH insulin resistance was not associated with IGF-I/IGFBP-3.