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La Valle A, d'Annunzio G, Campanello C, Tantari G, Pistorio A, Napoli F, Patti G, Crocco M, Bassi M, Minuto N, Piccolo G, Maghnie M. Are glucose and insulin levels at all time points during OGTT a reliable marker of diabetes mellitus risk in pediatric obesity? J Endocrinol Invest 2023:10.1007/s40618-023-02030-6. [PMID: 36763246 DOI: 10.1007/s40618-023-02030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Childhood overweight and obesity associated with insulin resistance and metabolic syndrome represent the new global pandemic and the main causative factors for dysglycemia, prediabetes, and Type 2 Diabetes Mellitus (T2DM). Predictors, such as HOMA-IR, HOMA-β%, and QUICKI lack specific reference values in children. OGTT is a gold standard for glycometabolic assessment. Recently, a glycemic level higher than 155 mg/dl at + 60' after glucose ingestion has been defined as a risk factor for T2DM in obese adolescents. We aim to analyze and correlate fasting insulin-resistance markers with OGTT results in overweight/obese children and adolescents. METHODS We retrospectively evaluated glucose and insulin values during a 2-h OGTT every 30 min in 236 overweight/obese patients. Glucose values and insulin sum during OGTT were compared to glycometabolic indexes and different cut-off values for insulin sum. RESULTS A 1-h glucose > 155 mg/dl and insulin sum > 535 microU/ml at all times during OGTT are the best predictors of diabetes risk in obese youths. A1-h glucose > 155 mg/dl is significantly associated with HbA1c > 5.7%, while no association was observed between HbA1c > 5.7% and glucose levels at baseline and 2 h. The ability of the standardized HOMA-IR to predict the prediabetes status is clearly lower than the total insulin sum at OGTT. CONCLUSION Our study demonstrates that also 1-h post-OGTT glucose, together with HbA1c, is an effective diabetes predictor.
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Affiliation(s)
- A La Valle
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G d'Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Campanello
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Tantari
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Pistorio
- Epidemiology and Biostatistics Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - F Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Patti
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - M Crocco
- Gastroenterology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Bassi
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - N Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Piccolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
- Neurooncology Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
| | - M Maghnie
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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Calcaterra V, Verduci E, Vandoni M, Rossi V, Fiore G, Massini G, Berardo C, Gatti A, Baldassarre P, Bianchi A, Cordaro E, Cavallo C, Cereda C, Bosetti A, Zuccotti G. The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review. Nutrients 2022; 14:4692. [PMID: 36364954 PMCID: PMC9657567 DOI: 10.3390/nu14214692] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/07/2023] Open
Abstract
Childhood obesity is characterized by an increased risk of several metabolic derangements including insulin resistance (IR). The strongest recommendations to prevent obesity and related complications are a balanced and adequate diet and practicing physical activity from early childhood. In this review, we propose to present the effects of healthy lifestyle strategies, including physical exercise and dietary approaches, on the management of IR and related metabolic derangements. All types of exercise (aerobic, resistance and combined training) effectively reduce IR in pediatric patients with obesity; it seems that aerobic and combined training stimulate greater improvements in IR compared to resistance training. Balanced normocaloric or hypocaloric dietary approaches are also valid strategies to address IR; it is not possible to assess the long-term impact of varying macronutrients on cardiometabolic risk. The glycemic index/load evaluation is a useful dietary approach to glucose metabolism control. Similarly, they should adopt the principle of the Mediterranean diet. Randomized studies with longer monitoring are needed to define the benefits of nutritional supplementation on IR. Considering that healthy style acquisition could track to later ages, programs of healthy lifestyle starting with children offer a better preventive strategy to preserve metabolic control and children's health.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milan, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Giulia Fiore
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Giulia Massini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Clarissa Berardo
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Paola Baldassarre
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Alice Bianchi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Erika Cordaro
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Caterina Cavallo
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Cristina Cereda
- Neonatal Screening and Metabolic Disorders Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Alessandra Bosetti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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Passaro AP, Marzuillo P, Guarino S, Scaglione F, Miraglia del Giudice E, Di Sessa A. Omics era in type 2 diabetes: From childhood to adulthood. World J Diabetes 2021; 12:2027-2035. [PMID: 35047117 PMCID: PMC8696648 DOI: 10.4239/wjd.v12.i12.2027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/01/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
Parallel to the dramatic rise of pediatric obesity, estimates reported an increased prevalence of type 2 diabetes (T2D) already in childhood. The close relationship between obesity and T2D in children is mainly sustained by insulin resistance (IR). In addition, the cardiometabolic burden of T2D including nonalcoholic fatty liver disease, cardiovascular disease and metabolic syndrome is also strictly related to IR. Although T2D pathophysiology has been largely studied in an attempt to improve therapeutic options, molecular mechanisms are still not fully elucidated. In this perspective, omics approaches (including lipidomics, metabolomics, proteomics and metagenomics) are providing the most attractive therapeutic options for T2D. In particular, distinct both lipids and metabolites are emerging as potential therapeutic tools. Of note, among lipid classes, the pathogenic role of ceramides in T2D context has been supported by several data. Thus, selective changes of ceramides expression might represent innovative therapeutic strategies for T2D treatment. More, distinct metabolomics pathways have been also found to be associated with higher T2D risk, by providing novel potential T2D biomarkers. Taken together, omics data are responsible for the expanding knowledge of T2D pathophysiology, by providing novel insights to improve therapeutic strategies for this tangled disease. We aimed to summarize the most recent evidence in the intriguing field of the omics approaches in T2D both in adults and children.
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Affiliation(s)
- Antonio Paride Passaro
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
| | - Federica Scaglione
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
| | - Emanuele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
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Obesity and insulin sensitivity effects on cardiovascular risk factors: Comparisons of obese dysglycemic youth and adults. Pediatr Diabetes 2019; 20:849-860. [PMID: 31301210 PMCID: PMC6786916 DOI: 10.1111/pedi.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Obesity and pubertal insulin resistance worsen cardiovascular (CV) risk factors in youth. It is unclear how the relationships of obesity and insulin resistance with CV risk compare to adults. SUBJECTS AND METHODS We evaluated 66 pubertal youth (mean ± SD: age 14.2 ± 2.0 years, body mass index [BMI] 36.6 ± 6.0 kg/m2 , hemoglobin A1c [HbA1c] 38.5 ± 6.1 mmol/mol) and 355 adults with comparable BMI (age 52.7 ± 9.4 years, BMI 35.1 ± 5.1 kg/m2 , HbA1c 39.8 ± 4.2 mmol/mol) participating in a multicenter study. Insulin sensitivity was quantified using hyperglycemic clamps. Assessment of CV risk factors was standardized across sites. Regression analyses compared the impact of insulin sensitivity and CV risk factors between youth and adults. RESULTS Obese pubertal youth were more insulin resistant than comparably obese adults (P < .001), but with similar slopes for the inverse relationship between insulin sensitivity and obesity. The impact of obesity on CV risk factors was explained by insulin sensitivity (P = NS after adjustment for sensitivity). The two age groups did not differ in relationships between insulin sensitivity and diastolic blood pressure, total cholesterol, and low-density lipoprotein (LDL) cholesterol, after adjusting for obesity. However, while systolic blood pressure (SBP) and high-density lipoprotein (HDL) cholesterol exhibited the expected direct and inverse relationships, respectively with insulin sensitivity in adults, these slopes were flat in youth across the range of insulin sensitivity (P ≤ .05 for group differences). CONCLUSIONS Effects of obesity on CV risk factors were attributable to insulin sensitivity in both groups. The relationships between insulin sensitivity and CV risk factors were similar in obese youth and adult groups except for SBP and HDL cholesterol. CLINICAL TRIAL REGISTRATION The RISE consortium studies are registered through Clinicaltrials.gov as NCT01779362 (Adult Medication Study); NCT01763346 (Adult Surgery Study); and NCT01779375 (Pediatric Medication Study). Clinical trial registration numbers: NCT01779362, NCT01779375 and NCT01763346 at clinicaltrials.gov.
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Affiliation(s)
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- RISE Coordinating Center, Rockville, Maryland
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Collins SM, Broadney MM, Ghane N, Davis EK, Jaramillo M, Shank LM, Brady SM, Yanovski JA. Free Fatty Acids as an Indicator of the Nonfasted State in Children. Pediatrics 2019; 143:peds.2018-3896. [PMID: 31053621 PMCID: PMC6564057 DOI: 10.1542/peds.2018-3896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ensuring children are fasting for blood draws is necessary to diagnose abnormalities in glucose homeostasis. We sought to determine if serum free fatty acid (FFA) concentrations might be a useful marker to differentiate the fed and fasted states among children. METHODS A total of 442 inpatient (fasting) and 323 (postglucose load) oral glucose tolerance test samples of glucose, insulin, and FFA from children (age 5-18 years) who had healthy weight, overweight, or obesity were examined by receiver operating characteristic (ROC) curve analysis to identify a cut point for nonfasting. In a cross-sectional study, we compared mean FFA and percentage of FFA values below this cut point as a function of inpatient (n = 442) versus outpatient (n = 442) setting. RESULTS The area under the curve of FFA was significantly better (P values < .001) than the area under the curve of glucose or insulin for identifying nonfasting. FFA <287 mEq/mL had 99.0% sensitivity and 98.0% specificity for nonfasting. Mean FFA was lower in outpatients than inpatients (P < .001); only 1.6% inpatient but 9.7% outpatient FFA values were consistent with nonfasting (P < .001). CONCLUSIONS Clinicians cannot assume that pediatric patients are adequately fasted on arrival for fasting blood work. On the basis of having significantly lower outpatient than inpatient FFA values and more frequently suppressed FFA, children appeared less likely to be fasting at outpatient appointments. FFA value <287 mEq/mL was a sensitive and specific cutoff for nonfasting in children that may prove clinically useful.
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Affiliation(s)
- Shavonne M. Collins
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Meharry Medical College, Nashville, Tennessee; and
| | - Miranda M. Broadney
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Nejla Ghane
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and
| | - Elisabeth K. Davis
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and
| | - Manuela Jaramillo
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Lisa M. Shank
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Sheila M. Brady
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and
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Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGDM, Torres W, Fernandes RA. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (B Aires) 2018. [DOI: https:/doi.org/10.3390/medicina54060096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective: To analyze the association of potential risk factors to health with body fatness and insulin resistance. Baseline measures of the ongoing longitudinal Analysis of Behaviors of Children During (ABCD) Growth Study. Materials and Methods: The sample was composed of 280 adolescents of both sexes (198 boys and 82 girls) aged from 10 to 18 years. Four risk factors were considered, as follows: no sports practice, skipping breakfast, poor sleep quality, and TV viewing. The outcomes considered were insulin resistance (HOMA-IR) and body fatness (densitometer scanner). Age, sex, maturity offset, and ethnicity were treated as covariates. Results: No sports practice and skipping breakfast were associated with higher body fatness (Sports practice: Wald: 8.786; p = 0.003. Breakfast: Wald: 9.364; p = 0.002). Poor sleep quality was related to a greater HOMA-IR index (Wald: 6.013; p = 0.014). Adolescents with ≥3 risk factors presented a higher risk of high HOMA-IR (OR = 4.89 (95%CI: 1.61 to 14.84)) than their counterparts with no risk factors. Conclusion: Lifestyle risk factors seem relevant to affect obesity and insulin resistance, while the aggregation of these risk factors affects insulin resistance, independent of adiposity.
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Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGDM, Torres W, Fernandes RA. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (B Aires) 2018. [DOI: https://doi.org/10.3390/medicina54060096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To analyze the association of potential risk factors to health with body fatness and insulin resistance. Baseline measures of the ongoing longitudinal Analysis of Behaviors of Children During (ABCD) Growth Study. Materials and Methods: The sample was composed of 280 adolescents of both sexes (198 boys and 82 girls) aged from 10 to 18 years. Four risk factors were considered, as follows: no sports practice, skipping breakfast, poor sleep quality, and TV viewing. The outcomes considered were insulin resistance (HOMA-IR) and body fatness (densitometer scanner). Age, sex, maturity offset, and ethnicity were treated as covariates. Results: No sports practice and skipping breakfast were associated with higher body fatness (Sports practice: Wald: 8.786; p = 0.003. Breakfast: Wald: 9.364; p = 0.002). Poor sleep quality was related to a greater HOMA-IR index (Wald: 6.013; p = 0.014). Adolescents with ≥3 risk factors presented a higher risk of high HOMA-IR (OR = 4.89 (95%CI: 1.61 to 14.84)) than their counterparts with no risk factors. Conclusion: Lifestyle risk factors seem relevant to affect obesity and insulin resistance, while the aggregation of these risk factors affects insulin resistance, independent of adiposity.
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Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. ACTA ACUST UNITED AC 2018; 54:medicina54060096. [PMID: 30513771 PMCID: PMC6306888 DOI: 10.3390/medicina54060096] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022]
Abstract
Objective: To analyze the association of potential risk factors to health with body fatness and insulin resistance. Baseline measures of the ongoing longitudinal Analysis of Behaviors of Children During (ABCD) Growth Study. Materials and Methods: The sample was composed of 280 adolescents of both sexes (198 boys and 82 girls) aged from 10 to 18 years. Four risk factors were considered, as follows: no sports practice, skipping breakfast, poor sleep quality, and TV viewing. The outcomes considered were insulin resistance (HOMA-IR) and body fatness (densitometer scanner). Age, sex, maturity offset, and ethnicity were treated as covariates. Results: No sports practice and skipping breakfast were associated with higher body fatness (Sports practice: Wald: 8.786; p = 0.003. Breakfast: Wald: 9.364; p = 0.002). Poor sleep quality was related to a greater HOMA-IR index (Wald: 6.013; p = 0.014). Adolescents with ≥3 risk factors presented a higher risk of high HOMA-IR (OR = 4.89 (95%CI: 1.61 to 14.84)) than their counterparts with no risk factors. Conclusion: Lifestyle risk factors seem relevant to affect obesity and insulin resistance, while the aggregation of these risk factors affects insulin resistance, independent of adiposity.
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Agreement of body adiposity index (BAI) and paediatric body adiposity index (BAIp) in determining body fat in Brazilian children and adolescents. Public Health Nutr 2018; 22:132-139. [DOI: 10.1017/s1368980018002458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo evaluate agreement of the body adiposity index (BAI) and paediatric body adiposity index (BAIp) in estimating body fat compared with dual-energy X-ray absorptiometry (DXA) and to propose cut-off points for these indices to classify excess adiposity in Brazilian children and adolescents.DesignCross-sectional study. Measures of weight, height, hip circumference, BMI and body fat percentage (%BF) assessed by DXA were taken, and BAI and BAIp were calculated. The Bland–Altman plot was used to estimate agreement between the methods, and the receiver-operating characteristic curve to determine the cut-off points for BAI and BAIp per age and sex in comparison with DXA.SettingViçosa, Minas Gerais, Brazil.SubjectsChildren and adolescents aged 8–19 years (n 1049).ResultsOf the children and adolescents, 52·4 % were girls. BAI and BAIp had satisfactory performance by the receiver-operating characteristic curve, except for the 18–19 years age group, whose BAIp had better predictive capacity than BAI. The agreement analysis showed that BAI overestimated %BF by 2·64 %, on average, using DXA; while BAIp underestimated %BF by 3·37 %.ConclusionsBAI and BAIp showed low agreement with the body fat obtained by DXA, requiring caution when interpreting body composition data in children and adolescents.
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Wang Y, Li M, Ni Z. Primary study on the hypoglycemic mechanism of 5rolGLP-HV in STZ-induced type 2 diabetes mellitus mice. J Biosci 2018. [DOI: 10.1007/s12038-018-9809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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de Assunção Bezerra MK, Freese de Carvalho E, Souza Oliveira J, Pessoa Cesse EÂ, Cabral de Lira PI, Galvão Tenório Cavalcante J, Sá Leal V. Health promotion initiatives at school related to overweight, insulin resistance, hypertension and dyslipidemia in adolescents: a cross-sectional study in Recife, Brazil. BMC Public Health 2018; 18:223. [PMID: 29415700 PMCID: PMC5803886 DOI: 10.1186/s12889-018-5121-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background The emergence of diseases such as dyslipidemia, systemic arterial hypertension, insulin resistance and metabolic syndrome in children and adolescents has brought about a change in the epidemiologic profile of the pediatric population. As action to promote health in the school environment is a useful tool for changing the pattern of health/disease in the young population, the present study aimed to identify schools that promote healthy eating and physical activity and to study the relationship between these practices and the prevalence of overweight, hypertension, insulin resistance and hypercholesterolemia in adolescents. Methods A cross-sectional population-based study was conducted with 2400 adolescents aged from 12 to 17 years old and participating in the “Study of Cardiovascular Risk in Adolescents” (ERICA – Estudo de Riscos Cardiovasculares em Adolescente). The association between dependent (overweight, insulin resistance, hypertension and dyslipidemia) and independent variables (implementation of health promoting initiative in schools) was investigated using the chi-square test and prevalence ratio (PR) with a confidence index (CI) of 95%. Results The unsatisfactory implementation of a “health promoting environment” (PR = 1.02; CI 95%: 1.0; 1.04) and “partnerships with the health sector” (PR = 1.03; CI 95%: 1.01; 1.05) were linked to a high prevalence of overweight in adolescents. Hypercholesterolemia was found to be higher in the schools with unsatisfactory implementation of “healthy eating and health on the scholar curriculum” (PR = 1.71; CI 95%: 1.22; 2.44) and those lacking a “healthy-eating promoting environment” (PR = 1.29; CI 95%: 1.10; 1.54). Schools with unsatisfactory implementation of a “health-eating promoting environment” (PR = 1.36; CI 95%: 1.04; 1.79) and those lacking “partnership with the health sector” (PR = 2.12; CI 95%: 1.38; 3.24) had more adolescents with insulin resistance. There was no association between hypertension and any other component studied. Conclusion Schools which have implemented adequate health promotion in their curriculums showed a lower prevalence of overweight, insulin resistance and hypercholesterolemia in adolescents.
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Affiliation(s)
- Myrtis Katille de Assunção Bezerra
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz (Fiocruz): Instituto Aggeu Magalhães, Av Prof. Moraes Rego, s.n. Campus UFPE, Cidade Universitária, Recife, PE, CEP: 50.740-465, Brazil.
| | - Eduardo Freese de Carvalho
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz (Fiocruz): Instituto Aggeu Magalhães, Av Prof. Moraes Rego, s.n. Campus UFPE, Cidade Universitária, Recife, PE, CEP: 50.740-465, Brazil
| | | | - Eduarda Ângela Pessoa Cesse
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz (Fiocruz): Instituto Aggeu Magalhães, Av Prof. Moraes Rego, s.n. Campus UFPE, Cidade Universitária, Recife, PE, CEP: 50.740-465, Brazil
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Smith JD, Berkel C, Jordan N, Atkins DC, Narayanan SS, Gallo C, Grimm KJ, Dishion TJ, Mauricio AM, Rudo-Stern J, Meachum MK, Winslow E, Bruening MM. An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness-implementation trial (Raising Healthy Children study). Implement Sci 2018; 13:11. [PMID: 29334983 PMCID: PMC5769381 DOI: 10.1186/s13012-017-0697-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pediatric obesity is a multi-faceted public health concern that can lead to cardiovascular diseases, cancers, and early mortality. Small changes in diet, physical activity, or BMI can significantly reduce the possibility of developing cardiometabolic risk factors. Family-based behavioral interventions are an underutilized, evidence-based approach that have been found to significantly prevent excess weight gain and obesity in children and adolescents. Poor program availability, low participation rates, and non-adherence are noted barriers to positive outcomes. Effective interventions for pediatric obesity in primary care are hampered by low family functioning, motivation, and adherence to recommendations. METHODS This (type II) hybrid effectiveness-implementation randomized trial tests the Family Check-Up 4 Health (FCU4Health) program, which was designed to target health behavior change in children by improving family management practices and parenting skills, with the goal of preventing obesity and excess weight gain. The FCU4Health is assessment driven to tailor services and increase parent motivation. A sample of 350 families with children aged 6 to 12 years who are identified as overweight or obese (BMI ≥ 85th percentile for age and gender) will be enrolled at three primary care clinics [two Federally Qualified Healthcare Centers (FQHCs) and a children's hospital]. All clinics serve predominantly Medicaid patients and a large ethnic minority population, including Latinos, African Americans, and American Indians who face disparities in obesity, cardiometabolic risk, and access to care. The FCU4Health will be coordinated with usual care, using two different delivery strategies: an embedded approach for the two FQHCs and a referral model for the hospital-based clinic. To assess program effectiveness (BMI, body composition, child health behaviors, parenting, and utilization of support services) and implementation outcomes (such outcomes as acceptability, adoption, feasibility, appropriateness, fidelity, and cost), we use a multi-method and multi-informant assessment strategy including electronic health record data, behavioral observation, questionnaires, interviews, and cost capture methods. DISCUSSION This study has the potential to prevent excess weight gain, obesity, and health disparities in children by establishing the effectiveness of the FCU4Health and collecting information critical for healthcare decision makers to support sustainable implementation of family-based programs in primary care. TRIAL REGISTRATION NCT03013309 ClinicalTrials.gov.
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Affiliation(s)
- Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Cady Berkel
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Shrikanth S. Narayanan
- Department of Electrical Engineering and Computer Science, University of Southern California, CA, Los Angeles USA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Kevin J. Grimm
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Thomas J. Dishion
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Anne M. Mauricio
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Jenna Rudo-Stern
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Mariah K. Meachum
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Emily Winslow
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Meg M. Bruening
- Department of Nutrition, Arizona State University, Tempe, AZ USA
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Payab M, Hasani-Ranjbar S, Merati Y, Esteghamati A, Qorbani M, Hematabadi M, Rashidian H, Shirzad N. The Prevalence of Metabolic Syndrome and Different Obesity Phenotype in Iranian Male Military Personnel. Am J Mens Health 2016; 11:404-413. [PMID: 28201955 PMCID: PMC5675284 DOI: 10.1177/1557988316683120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity, especially when concentrated in the abdominal area, is often associated with the presence of metabolic syndrome. Stress, particularly occupational stress, is one of the most important factors contributing to the increased prevalence of metabolic syndrome components among different populations. This study aimed to investigate the prevalence of overweight and obesity as well as the criteria for metabolic syndrome and its risk factors and different obesity phenotype in a population of military personnel aged 20 to 65 years. This study is a retrospective cross-sectional study in which data are extracted from the database of a military hospital (2,200 participants). The records of participants contained information such as age, marital status, educational level, weight, height, body mass index, blood pressure, waist circumference, history of drug use and smoking, as well as the results of tests including lipid profile and fasting blood glucose. The Adult Treatment Panel III criteria as well as two national criteria were used to identify metabolic syndrome among participants. Data analysis was p1erformed using SPSS version 16. The average age of participants was 33.37 (7.75) years. The prevalence of metabolic syndrome according to Iranian cutoff was 26.6% for the waist circumference >90 cm (585 persons) and 19.6% for the waist circumference >95 cm (432 persons). The rate of metabolic syndrome was identified as 11.1% (432 cases) according to Adult Treatment Panel III criteria. Results of the current study identified that the prevalence of metabolic syndrome among military individuals is less than other populations, but the prevalence of the syndrome is higher than other military personnel in other countries.
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Affiliation(s)
- Moloud Payab
- 1 Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- 1 Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,2 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Merati
- 3 Internal Medicine Resident,Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- 4 Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- 5 Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahboobeh Hematabadi
- 6 Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Rashidian
- 2 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Shirzad
- 2 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,6 Department of Endocrinology, Vali-Asr Hospital, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Cai M, Kappelman MD, Girman CJ, Jain N, Stürmer T, Brookhart MA. Trends and Determinants of Oral Anti-Diabetic Initiation in Youth with Suspected Type 2 Diabetes. PLoS One 2015; 10:e0140611. [PMID: 26509706 PMCID: PMC4624874 DOI: 10.1371/journal.pone.0140611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/27/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate trends and identify predictors of treatment initiation of oral anti-diabetic drugs (OAD) in youth. PATIENTS AND METHODS We identified a select population of children, ages 8-18 years, with at least 13 months of continuous health plan coverage within the years 2001-2012 in a large US commercial insurance claims database. New use of an OAD was defined as the first claim for an outpatient dispensing following a 12-month wash out period. Treatment incidence was estimated monthly over the study period, and stratified by age, gender, geographic region, and provider specialty. RESULTS The median size of the source population during the study period was 2.2 million children. A total of 13,824 initiators (mean monthly incidence of 4.6 (95% CI = 3.6, 5.5) per 100,000 youths) were identified. Initiators were more likely to be females, age 15-18, from the southern region, and have visited a family practitioner (versus a general pediatrician) prior to initiation. Time trends demonstrate a 43% increase in initiation from 2002-2012, with a gradual decrease starting from early 2008. CONCLUSION Incidence of filled OAD medications in youth increased over time, especially for patients treated by family practitioners. Additional research is needed into factors influencing prescribing by family practitioners and pediatricians.
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Affiliation(s)
- Mona Cai
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Michael D. Kappelman
- Department of Pediatrics, Division of Pediatric Gastroenterology, UNC School of Medicine, Chapel Hill, NC, United States of America
| | | | - Nina Jain
- Department of Pediatrics, Division of Pediatric Endocrinology, UNC School of Medicine, Chapel Hill, NC, United States of America
| | - Til Stürmer
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Maurice Alan Brookhart
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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Brown CL, Halvorson EE, Cohen GM, Lazorick S, Skelton JA. Addressing Childhood Obesity: Opportunities for Prevention. Pediatr Clin North Am 2015; 62:1241-61. [PMID: 26318950 PMCID: PMC4555982 DOI: 10.1016/j.pcl.2015.05.013] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The overweight and obesity epidemic among children and adolescents in the United States continues to worsen, with notable racial, ethnic, and socioeconomic disparities. Risk factors for pediatric obesity include genetics; environmental and neighborhood factors; increased intake of sugar-sweetened beverages (SSBs), fast-food, and processed snacks; decreased physical activity; shorter sleep duration; and increased personal, prenatal, or family stress. Pediatricians can help prevent obesity by measuring body mass index at least yearly and providing age- and development-appropriate anticipatory guidance to families. Public policies and environmental interventions aim to make it easier for children to make healthy nutrition and physical activity choices. Interventions focused on family habits and parenting strategies have also been successful at preventing or treating childhood obesity.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, University of North Carolina at Chapel Hill, 301B, S. Columbia Street, Chapel Hill, NC 27599, USA
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gail M Cohen
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Suzanne Lazorick
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; Department of Public Health, East Carolina University, Greenville, NC 27834, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Peterson RG, Jackson CV, Zimmerman K, de Winter W, Huebert N, Hansen MK. Characterization of the ZDSD Rat: A Translational Model for the Study of Metabolic Syndrome and Type 2 Diabetes. J Diabetes Res 2015; 2015:487816. [PMID: 25961053 PMCID: PMC4415477 DOI: 10.1155/2015/487816] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/05/2014] [Accepted: 09/16/2014] [Indexed: 12/16/2022] Open
Abstract
Metabolic syndrome and T2D produce significant health and economic issues. Many available animal models have monogenic leptin pathway mutations that are absent in the human population. Development of the ZDSD rat model was undertaken to produce a model that expresses polygenic obesity and diabetes with an intact leptin pathway. A lean ZDF rat with the propensity for beta-cell failure was crossed with a polygenetically obese Crl:CD (SD) rat. Offspring were selectively inbred for obesity and diabetes for >30 generations. In the current study, ZDSD rats were followed for 6 months; routine clinical metabolic endpoints were included throughout the study. In the prediabetic metabolic syndrome phase, ZDSD rats exhibited obesity with increased body fat, hyperglycemia, insulin resistance, dyslipidemia, glucose intolerance, and elevated HbA1c. As disease progressed to overt diabetes, ZDSD rats demonstrated elevated glucose levels, abnormal oral glucose tolerance, increases in HbA1c levels, reductions in body weight, increased insulin resistance with decreasing insulin levels, and dyslipidemia. The ZDSD rat develops prediabetic metabolic syndrome and T2D in a manner that mirrors the development of metabolic syndrome and T2D in humans. ZDSD rats will provide a novel, translational animal model for the study of human metabolic diseases and for the development of new therapies.
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Affiliation(s)
- Richard G. Peterson
- PreClinOmics, Inc., 7918 Zionsville Road, Indianapolis, IN 46268, USA
- *Richard G. Peterson:
| | | | - Karen Zimmerman
- PreClinOmics, Inc., 7918 Zionsville Road, Indianapolis, IN 46268, USA
| | - Willem de Winter
- Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - Norman Huebert
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
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Astiz S, Gonzalez-Bulnes A, Astiz I, Barbero A, Perez-Solana M, Garcia-Real I. Advanced onset of puberty after metformin therapy in swine with thrifty genotype. Exp Physiol 2014; 99:1241-52. [DOI: 10.1113/expphysiol.2014.081455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- S. Astiz
- Departamento de Reproducción Animal; INIA, Avda. Puerta de Hierro s/n. 28040 Madrid Spain
| | - A. Gonzalez-Bulnes
- Departamento de Reproducción Animal; INIA, Avda. Puerta de Hierro s/n. 28040 Madrid Spain
| | - I. Astiz
- Unidad de Pediatría; Atención Primaria; Centro de Salud Ciudad San Pablo; Avenida de Madrid; 13 Coslada 28022 Madrid Spain
| | - A. Barbero
- Departamento Medicina y Cirugía Animal; Facultad de Veterinaria; Universidad Complutense de Madrid; Ciudad Universitaria s/n; 28040 Madrid Spain
| | - M.L. Perez-Solana
- Departamento de Reproducción Animal; INIA, Avda. Puerta de Hierro s/n. 28040 Madrid Spain
| | - I. Garcia-Real
- Departamento Medicina y Cirugía Animal; Facultad de Veterinaria; Universidad Complutense de Madrid; Ciudad Universitaria s/n; 28040 Madrid Spain
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Faria ERD, Faria FRD, Franceschini SDCC, Peluzio MDCG, Sant?Ana LFDR, Novaes JFD, Ribeiro SMR, Ribeiro AQ, Priore SE. Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência. ACTA ACUST UNITED AC 2014; 58:610-8. [DOI: 10.1590/0004-2730000002613] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 05/05/2014] [Indexed: 11/22/2022]
Abstract
Objetivo: Analisar a influência dos componentes da síndrome metabólica na resistência à insulina, por sexo e fase da adolescência. Sujeitos e métodos: Avaliaram-se dados bioquímicos, clínico, de estilo de vida e composição corporal de 800 adolescentes de 10 a 19 anos, de ambos os sexos, de Viçosa-MG/Brasil, divididos em fases: inicial (10 a 13 anos), intermediária (14 a 16 anos) e final (17 a 19 anos). Resultados: 10,3 e 3,4% apresentavam, respectivamente, resistência à insulina e síndrome metabólica. Na fase inicial, observaram-se maior prevalência de dislipidemia e na intermediária, de hiperuricemia e excesso de gordura corporal. O sexo feminino apresentou maior prevalência de dislipidemia, excesso de gordura corporal e resistência à insulina e o masculino, maior prevalência de HDL baixo, hiperuricemia e pressão arterial alterada. Os da fase inicial apresentaram maiores valores de colesterol total, LDL, HDL, triglicerídeos, glicemia de jejum e relação cintura/quadril, ficaram menos tempo sentados e realizavam maior número de refeições (p < 0,05) em relação às outras fases. O modelo final, ajustado por sexo, foi diferente para cada fase da adolescência. Conclusões: A resistência à insulina está associada à inadequação na composição corporal, nos níveis bioquímicos e no estilo de vida, sendo os fatores associados diferentes em cada fase da adolescência. Arq Bras Endocrinol Metab. 2014;58(6):610-8
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Baselga Torres E, Torres-Pradilla M. Cutaneous Manifestations in Children with Diabetes Mellitus and Obesity. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.adengl.2014.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cutaneous manifestations in children with diabetes mellitus and obesity. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:546-57. [PMID: 24698434 DOI: 10.1016/j.ad.2013.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/03/2013] [Accepted: 11/06/2013] [Indexed: 01/21/2023] Open
Abstract
Obesity and diabetes are chronic diseases that affect people all over the world, and their incidence is increasing in both children and adults. Clinically, they affect a number of organs, including the skin. The cutaneous manifestations caused or aggravated by obesity and diabetes are varied and usually bear some relation to the time that has elapsed since the onset of the disease. They include soft fibromas, acanthosis nigricans, striae, xerosis, keratosis pilaris, plantar hyperkeratosis, fungal and bacterial skin infections, granuloma annulare, necrobiosis lipoidica, psoriasis, and atopic dermatitis. In this review article we present the skin changes found in children with diabetes mellitus and obesity and related syndromes and highlight the importance of the skin as a tool for establishing clinical suspicion and early diagnosis of systemic disease.
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Coskun ZM, Bolkent S. Biochemical and immunohistochemical changes in delta-9-tetrahydrocannabinol-treated type 2 diabetic rats. Acta Histochem 2014; 116:112-6. [PMID: 23845579 DOI: 10.1016/j.acthis.2013.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 11/27/2022]
Abstract
The regulation of glucose, lipid metabolism and immunoreactivities of insulin and glucagon peptides by delta-9-tetrahydrocannabinol (Δ(9)-THC) in diabetes were examined in an experimental rat model. Male Sprague-Dawley rats were divided into four groups: (1) control, (2) Δ(9)-THC treated, (3) diabetic, and (4) diabetic+Δ(9)-THC. The type 2 diabetic rat model was established by intraperitoneal (i.p.) injection of nicotinamide (85 mg/kg body weight) followed after 15 min by i.p. injection of streptozotocin (STZ) at 65 mg/kg of body weight. Δ(9)-THC and Δ(9)-THC treated diabetic groups received 3mg/kg/day of Δ(9)-THC for 7 days. The immunolocalization of insulin and glucagon peptides was investigated in the pancreas using a streptavidin-biotin-peroxidase technique. High density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL), triglycerides (TG), total cholesterol (TC) and total protein (TP) levels were measured in serum. Total islet area percent of insulin immunoreactive cells slightly changed in diabetic+Δ(9)-THC rats compared to diabetic animals. However, the area percent of glucagon immunoreactive cells showed a decrease in diabetic+Δ(9)-THC rats compared to that of diabetic animals alone. Serum TC, HDL and LDL levels of diabetes+Δ(9)-THC group showed a decrease compared to the diabetic group. These results indicate that Δ(9)-THC may serve a protective role against hyperlipidemia and hyperglycemia in diabetic rats.
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Affiliation(s)
- Zeynep Mine Coskun
- Health Services Vocational School, Istanbul Bilim University, Istanbul, Turkey; Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sema Bolkent
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
On the basis of strong research evidence and consensus, type 1 diabetes mellitus (DM) remains the most common form of DM in children and adolescents. The incidence of type 2 DM in the pediatric population is rapidly increasing because of the obesity epidemic, and minority groups are disproportionately affected. (2) (10) (19) On the basis of some research evidence and consensus, it can be challenging to initially differentiate between type 2 DM and type 1 DM clinically because of the increased prevalence of obesity, the complex interplay of autoimmunity and obesity, and common symptoms at presentation. (1) (10) (19) Significant evidence and consensus support a genetic basis for the development of type 2 DM in children. Physicians should routinely screen at risk children older than age 10 years for DM. Screening criteria include obesity, a family history of type 2 DM, a minority racial or ethnic background, acanthosis nigricans, or other diseases associated with insulin resistance, including polycystic ovary syndrome, hypertension, or dyslipidemia. (1) (10) (18) (19) On the basis of consensus, diagnosis of type 2 DM can be confirmed by an elevated fasting blood glucose level greater than 126 mg/dl (7.0 mmol/L), an elevated 2-hour plasma glucose greater than 200 mg/dL (11.1 mmol/L) on an oral glucose tolerance test, an elevated random blood glucose greater than 200 mg/dL (11.1 mmol/L), or a hemoglobin A1c level greater than 6.5% with suggestive symptoms. (10) According to strong research evidence and consensus, once the diagnosis has been made, treatment should be based on the acuity of presentation and should focus on lifestyle modification and on normalizing hyperglycemia to minimize complications. Metformin is currently first-line treatment for type 2 DM in children and adolescents older than age 10 years who present nonacutely. (18) (19) Strong research evidence and consensus demonstrate that because type 2 DM has an insidious onset, microvascular and macrovascular complications can be present at the time of diagnosis. Patients should be screened for the presence of complications when the diagnosis of type 2 DM is made and in follow-up. (6) (10).
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Affiliation(s)
- Kavitha Dileepan
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Children's Mercy Hospital Kansas City, MO. Dr Dileepan was a pediatric endocrinology fellow at Children's Mercy Hospital, Kansas City, MO, at the time this article was authored
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Garnett SP, Gow M, Ho M, Baur LA, Noakes M, Woodhead HJ, Broderick CR, Burrell S, Chisholm K, Halim J, De S, Steinbeck K, Srinivasan S, Ambler GR, Kohn MR, Cowell CT. Optimal macronutrient content of the diet for adolescents with prediabetes; RESIST a randomised control trial. J Clin Endocrinol Metab 2013; 98:2116-25. [PMID: 23533232 DOI: 10.1210/jc.2012-4251] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Prediabetes and clinical insulin resistance in adolescents are rapidly emerging clinical problems with serious health outcomes. OBJECTIVE The objective of this study was to determine the efficacy of 2 structured lifestyle interventions, both differing in diet macronutrient composition, on insulin sensitivity. DESIGN This study was a randomized controlled trial, known as Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers, in 2 hospitals in Sydney, Australia. PARTICIPANTS Participants included overweight or obese 10- to 17-year-olds with either prediabetes and/or clinical features of insulin resistance. INTERVENTION At baseline adolescents were prescribed metformin and randomized to a structured diet, which was either high carbohydrate or moderate carbohydrate with increased protein. The program commenced with a 3-month dietary intervention, with the addition of an exercise intervention in the next 3 months. OUTCOMES The outcomes included an insulin sensitivity, anthropometry, and cardiometabolic profile at 6 months. RESULTS One hundred eleven subjects (66 girls) were recruited and 98 subjects (58 girls) completed the 6-month intervention. After 3 months the mean insulin sensitivity index increased by 0.3 [95% confidence interval (CI) 0.2-0.4]. After 6 months the mean insulin (picomoles per liter) to glucose ratio (millimoles per liter) decreased by 7.2 [95%CI -12.0 to -2.3], body mass index, expressed as a percentage of the 95th centile, decreased by 9% (95% CI -3 to -15), but there was no significant change in the lipids. There were no significant differences in outcomes between the diet groups at any time point. CONCLUSIONS These results are in contrast with our hypothesis that adolescents randomized to the increased protein diet would have better outcomes. Further strategies are required to better address prediabetes and clinical features of insulin resistance in adolescents.
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Affiliation(s)
- Sarah P Garnett
- The Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia.
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Abstract
Type 2 diabetes (T2DM), historically an adult disease, is now increasingly prevalent in obese youth. Poor diet and increased sedentary behavior contribute to the increasing rates of obesity in youth, yet not all obese children develop T2DM. In general, T2DM is characterized by both insulin resistance (IR) and pancreatic beta-cell insufficiency. In children, IR is related to elevated body mass index (BMI) and pubertal hormones, along with abnormal fat partitioning, elevated free fatty acids, inflammation, and/or mitochondrial dysfunction. Hyperglycemia and T2DM develop when the pancreas cannot match the increased insulin demands resulting from IR. Unique to youth, IR varies with stage of pubertal development, and some children may have resolution of hyperglycemia post-puberty once the IR of puberty resolves. Further understanding of IR, the progression to T2DM in youth, and later outcomes as adults will help direct future therapies and interventions for youth at risk.
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Affiliation(s)
- Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver and the Children's Hospital Colorado, Box # 265, 13123 E. Colfax Avenue, Aurora, CO 80045, USA.
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Siklar Z, Berberoglu M. Pediatric hormonal disturbances after hematopoietic stem cell transplantation. Expert Rev Endocrinol Metab 2013; 8:81-90. [PMID: 30731655 DOI: 10.1586/eem.12.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for various malignant and nonmalignant diseases. Improvement of HSCT in children has resulted in many long-term survivors with substantial long-term morbidities. Endocrine complications are most frequently observed as late effects in HSCT recipients. Growth failure, pubertal disorders, thyroid dysfunctions, obesity, metabolic syndrome and bone loss are usually encountered after HSCT in children, while infertility is an important problem in adulthood. Patient age at HSCT, characteristics of primary diseases, intervention duration, preparative conditioning regimens, dose of irradiation and specificity of chemotherapeutic agents affect the prevalence of endocrine late effects. Awareness of endocrine late effects of HSCT and close follow-up of patients would help to increase the quality of health of patients.
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Affiliation(s)
- Zeynep Siklar
- b Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey.
| | - Merih Berberoglu
- a Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
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Faigenbaum AD, Chu DA, Paterno MV, Myer GD. Responding to exercise-deficit disorder in youth: integrating wellness care into pediatric physical therapy. Pediatr Phys Ther 2013; 25:2-6. [PMID: 23288000 PMCID: PMC3538023 DOI: 10.1097/pep.0b013e31827a33f6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
THE PROBLEM The decline and disinterest in regular physical activity among contemporary youth have created an immediate need to identify and treat these youngsters before they become resistant to our interventions. KEY POINTS Exercise-deficit disorder is a term used to describe a condition characterized by reduced levels of physical activity that are inconsistent with current public health recommendations. Pediatric physical therapists are in an enviable position to identify and treat exercise-deficit disorder in youth, regardless of body size or physical ability. RECOMMENDATION If pediatric physical therapists want to become advocates for children's health and wellness, there is a need to address limitations in the physical therapist professional curriculum, educate families on the benefits of wellness programming, and initiate preventive strategies that identify youth who are inactive, promote daily physical activity, and encourage healthy lifestyle choices.
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Affiliation(s)
- Avery D Faigenbaum
- Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey 08628, USA.
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The absence of insulin resistance in metabolic syndrome definition leads to underdiagnosing of metabolic risk in obese patients. Eur J Pediatr 2012; 171:1331-7. [PMID: 22450765 DOI: 10.1007/s00431-012-1724-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 03/15/2012] [Indexed: 02/06/2023]
Abstract
This study explores in a group of obese children and adolescents aged 10 to 16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.
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Abstract
PURPOSE OF REVIEW This review focuses on recent literature on insulin resistance in youth with type 2 diabetes mellitus (T2DM). Insulin resistance is associated with a variety of cardiometabolic problems leading to increased morbidity and mortality across the lifespan. RECENT FINDINGS Functional pancreatic β-cell changes play a role in the transition from obesity to impaired glucose tolerance (IGT). Insulin resistance drives islet cell upregulation, manifested by elevated glucagon and c-peptide levels, early in the transition to IGT. Surrogate measurements of insulin resistance and insulin secretion exist but their accuracy compared to clamp data is imperfect. Recent large longitudinal studies provide detailed information on the progression from normoglycemia to T2DM and on the phenotype of T2DM youth. Defining prediabetes and T2DM remains a challenge in youth. Lifestyle interventions do not appear as effective in children as in adults. Metformin remains the only oral hypoglycemic agent approved for T2DM in youth. SUMMARY New insights exist regarding the conversion from insulin resistance to T2DM, measurement of insulin resistance and phenotypes of insulin resistance youth, but more information is needed. Surrogate measurements of insulin resistance, additional treatment options for insulin resistance and individualization of treatment options for T2DM adolescents in particular require further investigation.
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Affiliation(s)
- Kara Mizokami-Stout
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver and the Children's Hospital Colorado, Denver, Colorado, USA
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Abstract
Childhood obesity represents a significant challenge for paediatric healthcare delivery. As obesity rates increase, obese children and adolescents are at significant risk for the development of a myriad of medical and surgical problems as well as mental health problems. Moreover, children with mental health problems are increasingly presenting to their psychiatrists with obesity. Treatment of paediatric obesity requires a multidisciplinary approach with incorporation of the family into the treatment plan although still typically only offering suboptimal results. Paediatric providers from all disciplines should focus efforts primarily on obesity prevention and encouragement of healthy lifestyles, while incorporating treatment for obesity when such efforts fail. The goals of this article are to provide an overview of the epidemiology, pathophysiology, genetics, clinical features and treatment strategies for paediatric obesity.
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Affiliation(s)
- Ann O Scheimann
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD 21287-2631, USA.
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