Determinants of High Fasting Insulin and Insulin Resistance Among Overweight/Obese Adolescents

Predicting Insulin Resistance in a Pediatric Population With Obesity

OBJECTIVES

Insulin resistance (IR) affects children and adolescents with obesity and early diagnosis is crucial to prevent long-term consequences. Our aim was to identify predictors of IR and develop a multivariate model to accurately predict IR.

METHODS

We conducted a cross-sectional analysis of demographical, clinical, and biochemical data from a cohort of patients attending a specialized Paediatric Nutrition Unit in Portugal over a 20-year period. We developed multivariate regression models to predict IR. The participants were randomly divided into 2 groups: a model group for developing the predictive models and a validation group for cross-validation of the study.

RESULTS

Our study included 1423 participants, aged 3-17 years old, randomly divided in the model (n = 879) and validation groups (n = 544). The predictive models, including uniquely demographic and clinical variables, demonstrated good discriminative ability [area under the curve (AUC): 0.834-0.868; sensitivity: 77.0%-83.7%; specificity: 77.0%-78.7%] and high negative predictive values (88.9%-91.6%). While the diagnostic ability of adding fasting glucose or triglycerides/high density lipoprotein cholesterol index to the models based on clinical parameters did not show significant improvement, fasting insulin appeared to enhance the discriminative power of the model (AUC: 0.996). During the validation, the model considering demographic and clinical variables along with insulin showed excellent IR discrimination (AUC: 0.978) and maintained high negative predictive values (90%-96.3%) for all models.

CONCLUSION

Models based on demographic and clinical variables can be advantageously used to identify children and adolescents at moderate/high risk of IR, who would benefit from fasting insulin evaluation.

Examining the associations between testosterone and biomarkers as men age

OBJECTIVES

Testosterone concentrations in men decline with advancing age. However, the cause of the decline is yet to be fully elucidated. Therefore, the aims of this study were to examine the associations between chronic diseases such as obesity and type 2 diabetes mellitus (T2DM) with total testosterone (TT) and sex hormone-binding globulin (SHBG), using a large nationally-representative data set (National Health and Nutrition Examination Survey; NHANES).

METHODS

NHANES is a cross-sectional survey, physical examination, and laboratory evaluation of a nationally-representative sample of a non-institutionalized United States population. Male participants aged ≥18 years during the NHANES 2013-2014 and NHANES 2015-2016 survey periods were selected for this analysis. The analysis included the following data: body mass index (BMI), oral glucose tolerance test (OGTT), homeostatic model assessment of insulin resistance (HOMA-IR), insulin, glucose, and age.

RESULTS

An overweight or obese condition was significantly inversely associated with TT and SHBG, even after adjusting for other variables. Several variables associated with T2DM (OGTT, HOMA-IR, insulin, and glucose) were also inversely associated with TT; however, only the associations between OGTT and insulin with TT remained significant after adjusting for the other variables. Insulin and HOMA-IR levels were significantly inversely associated with SHBG; however, only the association between SHBG and pre-diabetic HOMA-IR levels remained significant after adjusting for the other variables. OGTT became significantly associated with SHBG after adjusting for the other variables. Age was significantly inversely associated with TT, but positively associated with SHBG, even after adjusting for other variables.

CONCLUSION

The results of the present study, which is the largest to date, indicate that a marker of obesity, BMI, and some markers of T2DM are both independently and significantly inversely associated with TT and SHBG.

Beyond the Scale: Investigating Adiponectin, ICAM-1, and VCAM-1 as Metabolic Markers in Obese Adolescents with Metabolic Syndrome

Background

Adiponectin acts to prevent vascular dysfunction due to obesity by inhibiting ICAM-1 and VCAM-1 expressions.

Objective

We investigate adiponectin ICAM-1, VCAM-1, and metabolic syndrome (MetS) in obese adolescents.

Methods

A cross-sectional study with healthy obese adolescents aged 13 to 18 years was conducted from October 2019 to January 2020. Statistical analysis conducted was a test of normality and homogeneity tests, ANOVA/Kruskal-Wallis, independent sample T-test/Mann-Whitney U test, and Spearman correlation and determined as significant if p value <0.05.

Results

125 obese adolescents were recruited. 42 (33.6%) were obese with MetS (we grouped as MetS) and 83 (66.4%) subjects without MetS (non-MetS group). VCAM-1 was significantly higher on boys with MetS compared to girls with MetS, and even girls with MetS had lower levels of VCAM-1 than boys with non-MetS. ICAM-1 was significantly higher in boys with low-level HDL-c (p < 0.05) and correlated weakly with HDL-c, while adiponectin levels were significantly lower in girls with central obesity and hypertriglyceridemia. Path analysis showed that triglyceride had a direct effect on ICAM-1 but not VCAM-1 in both obese boys and girls. Adiponectin had a negative direct effect on ICAM-1 and VCAM-1 in girls. However, on boys, diastole blood pressure had a negative direct effect, which might be the role of sex hormones indirectly.

Conclusion

VCAM-1 was significantly higher in boys than girls, which showed that boys had a higher risk of atherosclerosis. ICAM-1 showed no significant difference in both gender and metabolic states. Adiponectin showed a protective effect by lowering ICAM-1 and VCAM-1 directly on girls.

Body Fat Distribution, Fasting Insulin Levels, and Insulin Secretion: A Bidirectional Mendelian Randomization Study

CONTEXT

Hyperinsulinemia and adiposity are associated with one another, but the directionality of this relation is debated.

OBJECTIVE

Here, we tested the direction of the causal effects of fasting insulin (FI) levels and body fat accumulation/distribution using 2-sample bidirectional Mendelian randomization (MR).

METHODS

We included summary statistics from large-scale genome-wide association studies for body mass index (BMI, n = 806 834), waist to hip ratio adjusted for BMI (WHRadjBMI, n = 694 649), abdominal subcutaneous, visceral and gluteofemoral adipose tissue (n = 38 965), FI levels (n = 98 210), pancreatic islets gene expression (n = 420), and hypothalamus gene expression (n = 155). We used inverse variance-weighted and robust MR methods that relied on statistically and biologically driven genetic instruments.

RESULTS

Both BMI and WHRadjBMI were positively associated with FI. Results were consistent across all robust MR methods and when variants mapped to the hypothalamus (presumably associated with food behavior) were included. In multivariable MR analyses, when waist circumference and BMI were mutually adjusted, the direct effect of waist circumference on FI was 2.43 times larger than the effect of BMI on FI. FI was not associated with adiposity. By contrast, using genetic instruments mapped to gene expression in pancreatic islets (presumably more specific to insulin secretion), insulin was positively associated with BMI and abdominal subcutaneous and gluteofemoral adipose tissue, but not with visceral adipose tissue.

CONCLUSION

Although these results will need to be supported by experimental investigations, results of this MR study suggest that abdominal adiposity may be a key determinant of circulating insulin levels. Alternatively, insulin secretion may promote peripheral adipose tissue accumulation.

Role of Appetite Hormone Dysregulation in Symptomology and Executive Function in Adolescents With Attention Deficit Hyperactivity Disorder

BACKGROUND

Evidence suggests an association of insulin and leptin with attention and executive function. The roles of dysregulated appetite hormones, including insulin and leptin, in the pathomechanisms of attention deficit hyperactivity disorder (ADHD) and associated cognitive function impairment remain unknown.

METHODS

In total, 50 adolescents with ADHD were enrolled and age and sex matched with 50 typically developing controls. The parent-reported Swanson, Nolan, and Pelham IV scale and self-reported Barratt Impulsiveness Scale were employed for symptom assessment. The fasting serum concentrations of appetite hormones-leptin, ghrelin, insulin, and adiponectin-were measured. The Wisconsin Card Sorting Test was used to examine executive function.

RESULTS

Generalized linear models with adjustment for age, sex, body mass index, and medications indicated that the adolescents with ADHD had higher levels of insulin (P = .039) and leptin (P = .006) than did those in the control group. Self-reported attention and self-control symptoms were negatively associated with insulin level (P = .025 and .018, respectively) and positively associated with leptin level (both P < .001). In addition, insulin level was positively associated with executive function (P = .031).

CONCLUSION

Appetite hormone dysregulation was associated with the symptomology and executive function among adolescents with ADHD. Our results may inspire researchers to further examine the role of appetite hormone dysregulation in ADHD pathogenesis.

The Relationship between Fat Mass Percentage and Glucose Metabolism in Children and Adolescents: A Systematic Review and Meta-Analysis

To assess the relationship between fat mass percentage (FMP) and glucose metabolism in children aged 0−18 years we performed a systematic review of the literature on Medline/PubMed, SinoMed, Embase and Cochrane Library using the PRISMA 2020 guidelines up to 12 October 2021 for observational studies that assessed the relationship of FMP and glucose metabolism. Twenty studies with 18,576 individuals were included in the meta-analysis. The results showed that FMP was significantly associated with fasting plasma glucose (FPG) (r = 0.08, 95% confidence interval (CI): 0.04−0.13, p < 0.001), fasting plasma insulin (INS) (r = 0.48, 95% CI: 0.37−0.57, p < 0.001), and homeostasis model assessment (HOMA)- insulin resistance (IR) (r = 0.44, 95% CI: 0.33−0.53, p < 0.001). The subgroup analysis according to country or overweight and obesity indicated that these associations remained significant between FMP and INS or HOMA-IR. Our results demonstrated that there is a positive relationship between FMP and FPG. Moreover, subgroup analysis according to country or overweight and obesity indicated that FMP is significantly associated with INS and HOMA-IR. This is the first known systematic review and meta-analysis to determine the associations of FMP with glucose metabolism in children and adolescents.

On the causal relationships between hyperinsulinaemia, insulin resistance, obesity and dysglycaemia in type 2 diabetes

Hundreds of millions of people are affected by hyperinsulinaemia, insulin resistance, obesity and the dysglycaemia that mark a common progression from metabolic health to type 2 diabetes. Although the relative contribution of these features and the order in which they appear may differ between individuals, the common clustering and seemingly progressive nature of type 2 diabetes aetiology has guided research and clinical practice in this area for decades. At the same time, lively debate around the causal relationships between these features has continued, as new data from human trials and highly controlled animal studies are presented. This 'For debate' article was prompted by the review in Diabetologia by Esser, Utzschneider and Kahn ( https://doi.org/10.1007/s00125-020-05245-x ), with the purpose of reviewing established and emerging data that provide insight into the relative contributions of hyperinsulinaemia and impaired glucose-stimulated insulin secretion in progressive stages between health, obesity and diabetes. It is concluded that these beta cell defects are not mutually exclusive and that they are both important, but at different stages.

Estimated Artificial Neural Network Modeling of Maximal Oxygen Uptake Based on Multistage 10-m Shuttle Run Test in Healthy Adults

We aimed to develop an artificial neural network (ANN) model to estimate the maximal oxygen uptake (VO₂max) based on a multistage 10 m shuttle run test (SRT) in healthy adults. For ANN-based VO₂max estimation, 118 healthy Korean adults (59 men and 59 women) in their twenties and fifties (38.3 ± 11.8 years, men aged 37.8 ± 12.1 years, and women aged 38.8 ± 11.6 years) participated in this study; data included age, sex, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), waist circumference, hip circumference, waist-to-hip ratio (WHR), body composition (weight, height, body mass index (BMI), percent skeletal muscle, and percent body), 10 m SRT parameters (number of round trips and final speed), and VO₂max by graded exercise test (GXT) using a treadmill. The best estimation results (R² = 0.8206, adjusted R² = 0.7010, root mean square error; RMSE = 3.1301) were obtained in case 3 (using age, sex, height, weight, BMI, waist circumference, hip circumference, WHR, SBP, DBP, number of round trips in 10 m SRT, and final speed in 10 m SRT), while the worst results (R² = 0.7765, adjusted R² = 0.7206, RMSE = 3.494) were obtained for case 1 (using age, sex, height, weight, BMI, number of round trips in 10 m SRT, and final speed in 10 m SRT). The estimation results of case 2 (using age, sex, height, weight, BMI, waist circumference, hip circumference, WHR, number of round trips in 10 m SRT, and final speed in 10 m SRT) were lower (R² = 0.7909, adjusted R² = 0.7072, RMSE = 3.3798) than those of case 3 and higher than those of case 1. However, all cases showed high performance (R²) in the estimation results. This brief report developed an ANN-based estimation model to predict the VO₂max of healthy adults, and the model’s performance was confirmed to be excellent.

Independent predictors of insulin resistance in Brazilian adolescents: Results of the study of cardiovascular risk in adolescents-Brazil

Considering the current changes in dietary patterns and the increasing prevalence of excess weight throughout the world, several studies have reported insulin resistance, which is a key driver of many chronic diseases, to be an important public health problem in all age groups. Therefore, the aim of the present study was to identify the prevalence and independent predictors of insulin resistance in Brazilian adolescents. A cross-sectional study was conducted with a probabilistic, representative sample of Brazilian adolescents (n = 37,023) who participated in the Study of Cardiovascular Risk in Adolescents. Data were collected on demographic, socioeconomic, lifestyle, anthropometric, and biochemical characteristics as well as antioxidant micronutrient intake (vitamins A, C, E, zinc, and selenium). Insulin resistance was determined using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and classified based on the 75th percentile of the sample distribution. Insulin resistance was detected in 27% of the adolescents and was more prevalent among those aged 12 to 14 years (PR: 1.26 [95%CI: 1.13;1.41]), those residing in the southern and south-eastern regions of the country (PR: 1.47 [95%CI: 1.27;1.70]), those who were physically inactive (PR: 1.12 [95%CI: 1.02;1.23]), and those did not consume alcohol (PR: 1.50 [95%CI: 1.13;1.99]). The prevalence of insulin resistance was 2.5-fold higher among individuals with severe obesity (PR: 2.49 [95%CI: 2.07;3.00]). Waist circumference indicative of cardiovascular risk and high serum triglyceride levels increased the likelihood of insulin resistance (PR: 1.37 [95%CI: 1.19;1.59] and 1.60 [95%CI: 1.45;1.78], respectively). The prevalence of the outcome was higher among adolescents in the lower quartiles of vitamin E intake (p<0.05). In the present study, the prevalence of insulin resistance was high among Brazilian adolescents and we identified sociodemographic, lifestyle, anthropometric, biochemical, and dietary predictors of this outcome.

Carbohydrate-Restricted Diet: A Successful Strategy for Short-Term Management in Youth with Severe Obesity-An Observational Study

Background: Obesity affects ∼20% of children in the United States and reports of successful dietary treatment are lacking. This study aimed to determine the change in body weight in severely obese youth after carbohydrate-restricted dietary intervention.

Methods: This single-center study of a carbohydrate-restricted diet (≤30 grams per day), with unlimited calories, fat, and protein for 3–4 months, examined two groups of severely obese youth of ages 5–18 years: Group A, retrospectively reviewed charts of severely obese youth referred to the Pediatric Obesity Clinic at Hoops Family Children's Hospital and the Ambulatory Division of Marshall Pediatrics, Marshall University School of Medicine, in Huntington, WV, between July 1, 2014 and June 30, 2017 (n = 130), and Group B, prospective participants, referred between July 1, 2018 and December 31, 2018, followed with laboratory studies pre- and postdietary intervention (n = 8).

Results: In Group A, 310 participants began the diet, 130 (42%) returned after 3–4 months. Group B had 14 enrollees who began the diet, and 8 followed up at 3–4 months (57%). Girls compared with boys were more likely to complete the diet (P = 0.02). Participants <12 years age were almost twice as likely to complete the diet compared with those 12–18 years (64% vs. 36%, P < 0.01); however, the older group subjects who completed the diet had the same percentage of weight loss compared with those <12 years (6.9% vs. 6.9%). Group A had reductions in weight of 5.1 kg (P < 0.001), body mass index (BMI) 2.5 kg/m² (P < 0.001), and percentage weight loss 6.9% (P < 0.001). Group B had reductions in weight 9.6 kg (P < 0.01), BMI 4 kg/m² (P < 0.01), and percentage weight loss 9% (P < 0.01). In addition, participants had significant reductions of fasting serum insulin (P < 0.01), triglycerides (P < 0.01), and 20-hydroxyeicosatetraenoic acid (P < 0.01).

Conclusions: This study demonstrated a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.

Plasma RBP4 Level in Association with Body Composition, Metabolic Profile, STRA6 and RBP4 Gene Polymorphisms in Obese Romanian Children

BACKGROUND

Pediatric obesity continues to remain a serious health concern which has significantly increased the morbidity risk in adulthood. Recent studies have analyzed the impact of the two adipokines, RBP4 (retinol binding protein 4) and STRA6 (stimulated by retinoic acid 6) in pediatric obese subjects with contradictory results.

METHODS

An observational study was conducted in the Pediatric and Endocrinology Departments, Targu-Mures, Romania, including 213 children between 5-17 years of age, divided into two groups according to body mass index (BMI) standard deviation score (SDS): case (overweight or obese) and control (normal SDS). Age, sex, basic anthropometric and biochemical measurements and genotype of rs3758539, and rs10882280 for RBP4 gene and rs974456 and rs351224 of STRA6 gene were analyzed. Statistical analysis used SPSS v. 25.0, with a level of significance α = 0.05.

RESULTS

There is no association between the two gene's polymorphisms and obesity in our pediatric population. In regression analysis, with HOMA IR (homeostatic model assessment of insulin resistance) as the outcome, the plasmatic level of RBP4 and fat mass percentage are significant predictors, with the model explaining 42% of the HOMA variability. Hypercholesterolemia was significantly associated with male sex, carrying variant allele and heterozygote status of rs10882280 RBP4 gene and wild-type allele rs351224 of STRA6 gene.

CONCLUSION

There is no significant association between obesity and SNPs of the RBP4 and STRA6 in our population, but they seem to play a role in insulin resistance and hypercholesterolemia.

Causal Pathways from Body Components and Regional Fat to Extensive Metabolic Phenotypes: A Mendelian Randomization Study

OBJECTIVE

The aim of this study was to explore the causal effects and pathways from body components to extensive metabolic phenotypes.

METHODS

Summarized data including 24 metabolic phenotypes from 10 consortiums were used to perform univariate, multivariable, and bidirectional Mendelian randomization analysis based on the network design.

RESULTS

For metabolically related biomarkers, a 1-SD increase in body fat mass (BFM) was robustly associated with increased fasting insulin, systolic blood pressure, diastolic blood pressure, and urate and decreased high-density lipoprotein cholesterol levels. For metabolically related diseases, the odds ratios and 95% CIs of a 1-SD increase in BFM were 1.76 (1.37 to 2.25) for type 2 diabetes mellitus (T2DM), 1.11 (1.09 to 1.13) for hypertension, 1.40 (1.25 to 1.57) for coronary artery disease, 1.41 (1.25 to 1.59) for myocardial infarction, 1.25 (1.12 to 1.40) for ischemic stroke, and 1.62 (1.02 to 2.57) for gout. The effects of body fat on diseases were mediated by extensive intermediate biomarkers, including blood pressure, lipids, glycemic traits, and urate. Regional fats had a similar effect with body fat in both absolute and relative scales, whereas fat-free components increased only the risk of T2DM 1.73 (1.11 to 2.68) and chronic kidney disease 1.51 (1.11 to 2.06).

CONCLUSIONS

Several potential pathways were found and confirmed the tremendous benefits of fat-lowering measures, including lowering of various regional fats. Future policies or interventions should focus more on the role of body fat.

Sex as a moderator of body composition following a randomized controlled lifestyle intervention among Latino youth with obesity

BACKGROUND

Body composition differences between males and females emerge during adolescence and continue throughout adulthood; however, whether sex moderates body composition changes in adolescents with obesity after an intervention is unknown.

OBJECTIVE

To examine sex as a moderator of changes in adiposity following lifestyle intervention.

METHODS

A total of 136 Latino youth with obesity (BMI% 98.2 ± 1.3) aged 14 to 16 years old were randomized to either a 12-week lifestyle intervention (27 males/40 females) or control (35 males/34 females) group. The intervention included nutrition education (1 h/wk) and moderate-to-vigorous physical activity (3 h/wk). Anthropometric data (body mass index [BMI], BMI%, waist circumference, total body fat, and fat-free mass) were obtained pre- and post-intervention. Sex differences were examined by general linear models with significance determined at P < .05 for the F-statistic.

RESULTS

Sex did not moderate changes in BMI (F1,115 = 0.01, P = .9), BMI% (F1,115 = 0.14, P = .7), or waist circumference (F1,117 = 1.1, P = .3). Sex significantly moderated changes in body fat percent (F1,117 = 5.3, P = .02), fat mass (F1,116 = 4.5, P = .04), and fat-free mass (F1,116 = 4.3, P = .04). Intervention males compared with females had greater relative reductions in fat percent (-4.1 ± 0.8% vs -1.2 ± 0.7%, P = .02) and fat mass (-5.0 ± 1.1 kg vs -1.5 ± 0.9 kg, P = .02) and gained more fat free mass (3.6 ± 0.9 kg vs 0.5 ± 0.8 kg, P = .02) when compared with same sex controls.

CONCLUSION

Males and females exhibited a differential response to lifestyle intervention for percent fat, fat mass, and fat-free mass indicating that sex-specific improvements in body composition favours males over females.

Genetic predisposition in type 2 diabetes: A promising approach toward a personalized management of diabetes

Diabetes mellitus, also known simply as diabetes, has been described as a chronic and complex endocrine metabolic disorder that is a leading cause of death across the globe. It is considered a key public health problem worldwide and one of four important non-communicable diseases prioritized for intervention through world health campaigns by various international foundations. Among its four categories, Type 2 diabetes (T2D) is the commonest form of diabetes accounting for over 90% of worldwide cases. Unlike monogenic inherited disorders that are passed on in a simple pattern, T2D is a multifactorial disease with a complex etiology, where a mixture of genetic and environmental factors are strong candidates for the development of the clinical condition and pathology. The genetic factors are believed to be key predisposing determinants in individual susceptibility to T2D. Therefore, identifying the predisposing genetic variants could be a crucial step in T2D management as it may ameliorate the clinical condition and preclude complications. Through an understanding the unique genetic and environmental factors that influence the development of this chronic disease individuals can benefit from personalized approaches to treatment. We searched the literature published in three electronic databases: PubMed, Scopus and ISI Web of Science for the current status of T2D and its associated genetic risk variants and discus promising approaches toward a personalized management of this chronic, non-communicable disorder.

Helminthostachys zeylanica alleviates hepatic steatosis and insulin resistance in diet-induced obese mice

Background

Obesity and its associated health conditions, type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD), are worldwide health problems. It has been shown that insulin resistance is associated with increased hepatic lipid and causes hepatic steatosis through a myriad of mechanisms, including inflammatory signaling.

Methods

Helminthostachys zeylanica (HZ) is used widely as a common herbal medicine to relieve fever symptoms and inflammatory diseases in Asia. In the present study, we evaluated whether HZ has therapeutic effects on obesity, NAFLD and insulin resistance. The protective effects of HZ extract were examined using free fatty acid-induced steatosis in human HuS-E/2 cells and a high-fat diet-induced NAFLD in mice.

Results

The major components of the HZ extract are ugonins J and K, confirmed by HPLC. Incubation of human hepatocytes, HuS-E/2 cells, with palmitate markedly increased lipid accumulation and treatment with the HZ extract significantly decreased lipid deposition and facilitated AMPK and ACC activation. After 12 weeks of a high-fat diet with HZ extract treatment, the HFD mice were protected from hyperlipidemia and hyperglycemia. HZ extract prevented body weight gain, adipose tissue expansion and adipocyte hypertrophy in the HFD mice. In addition, fat accumulation was reduced in mice livers. Moreover, the insulin sensitivity-associated index, which evaluates insulin function, was also significantly restored.

Conclusions

These results suggest that HZ has a promising pharmacological effect on high-fat diet-induced obesity, hepatic steatosis and insulin resistance, which may have the potential for clinical application.

Predictive Modeling of VO2max Based on 20 m Shuttle Run Test for Young Healthy People

This study presents mathematical models for predicting VO2max based on a 20 m shuttle run and anthropometric parameters. The research was conducted with data provided by 308 young healthy people (aged 20.6 ± 1.6). The research group includes 154 females (aged 20.3 ± 1.2) and 154 males (aged 20.8 ± 1.8). Twenty-four variables were used to build the models, including one dependent variable and 23 independent variables. The predictive methods of analysis include: the classical model of ordinary least squares (OLS) regression, regularized methods such as ridge regression and Lasso regression, artificial neural networks such as the multilayer perceptron (MLP) and radial basis function (RBF) network. All models were calculated in R software (version 3.5.0, R Foundation for Statistical Computing, Vienna, Austria). The study also involved variable selection methods (Lasso and stepwise regressions) to identify optimum predictors for the analysed study group. In order to compare and choose the best model, leave-one-out cross-validation (LOOCV) was used. The paper presents three types of models: for females, males and the whole group. An analysis has revealed that the models for females ( RMSE C V = 4.07 mL·kg−1·min−1) are characterised by a smaller degree of error as compared to male models ( RMSE C V = 5.30 mL·kg−1·min−1). The model accounting for sex generated an error level of RMSE C V = 4.78 mL·kg−1·min−1.

Ginseng-plus-Bai-Hu-Tang ameliorates diet-induced obesity, hepatic steatosis, and insulin resistance in mice

Background

Dietary fat has been suggested to be the cause of various health issues. Obesity, hypertension, cardiovascular disease, diabetes, dyslipidemia, and kidney disease are known to be associated with a high-fat diet (HFD). Obesity and associated conditions, such as type 2 diabetes mellitus and nonalcoholic fatty liver disease (NAFLD), are currently a worldwide health problem. Few prospective pharmaceutical therapies that directly target NAFLD are available at present. A Traditional Chinese Medicine, ginseng-plus-Bai-Hu-Tang (GBHT), is widely used by diabetic patients to control glucose level or thirst. However, whether it has therapeutic effects on fat-induced hepatic steatosis and metabolic syndrome remains unclear.

Methods

This study was conducted to examine the therapeutic effect of GBHT on fat-induced obesity, hepatic steatosis, and insulin resistance in mice.

Results

GBHT protected mice against HFD-induced body weight gain, hyperlipidemia, and hyperglycemia compared with mice that were not treated. GBHT inhibited the expansion of adipose tissue and adipocyte hypertrophy. No ectopic fat deposition was found in the livers of HFD mice treated with GBHT. In addition, glucose intolerance and insulin sensitivity in HFD mice was also improved by GBHT.

Conclusion

GBHT prevents changes in lipid and carbohydrate metabolism in a HFD mouse model. Our findings provide evidence for the traditional use of GBHT as therapy for the management of metabolic syndrome.

Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population

BACKGROUND

Elevation of serum ferritin levels is frequently observed in non-alcoholic fatty liver disease (NAFLD) patients. Our study aims to examine the association between serum ferritin levels and NAFLD in Korean population.

METHODS AND RESULTS

A total of 25,597 participants were selected from Korean National Health and Nutritional Examination Surveys 2007-2012. The NAFLD liver fat score (NLFS) was used to define NAFLD. Elevation of ALT levels was defined as ALT level > 40 IU/L for male and ALT level > 31 IU/L for female. Multiple logistic regression was used to examine the association of serum ferritin levels and NAFLD by sex. After adjusting for multiple covariates, the ORs (95% CI) of the elevated ALT levels were 1.56 (95% CI: 1.17-2.07), 1.84 (95% CI: 1.39-2.45), and 4.08 (95% CI: 3.08-5.40) for the second, third and fourth serum ferritin quartiles in male (p for trend < 0.01), 1.67 (95% CI: 1.24-2.23), 2.23 (95% CI: 1.68-2.96), and 5.72 (95% CI: 4.32-7.60) for the second, third and fourth serum ferritin quartiles in female (p for trend < 0.01). Serum ferritin levels were also significantly associated with NAFLD and liver fibrosis both in male and female.

CONCLUSIONS

Elevation of serum ferritin level is significantly associated with NAFLD and blood ALT elevation in Korean general population.

Parameters of Metabolic Syndrome in Obese Children and Adolescents

Background: Obesity is the most common chronic metabolic disease in children and adolescents. It has reached epidemic ranges and is a significant global problem.

Objective: This study aimed to investigate the possible metabolic disturbances in children and adolescents with obesity and severe obesity.

Subjects and methods: This cross-sectional study included 158 (82 boys, 76 girls) obese children and adolescents between ages of 0 and 17years (10.43 ± 3.11 years). The obesity was defined according to the sex- and age-specific growth charts proposed by the Centers for Disease Control and Prevention as BMI ≥ 95th percentile. Severe obesity was classified as 120% of the 95th percentile for age and sex. Study participants underwent medical assessment and analysis of: ALT, AST, fasting serum triglycerides, total serum cholesterol, fasting plasma glucose and plasma glucose from oral glucose tolerance test.

Results: The majority of study participants were severely obese (69.92%). The highest distribution of abnormal biochemical results was seen in elevated ALT (53.91%) followed by elevated triglycerides (34.75%). The prevalence of abnormal total cholesterol level was significantly higher (p=0.04) in the group of obese children compared to the severely obese children. The levels of total cholesterol were also statistically higher in the group of adolescents compared to preadolescents (p=0.02). An important number of obese patients (2.5%) and even higher number of severely obese patients (5.26%) had carbohydrate intolerance.

Conclusion: There was a significant elevation of ALT, total serum cholesterol and triglycerides in all study participants. High serum lipids and high hepatic enzymes (as introduction in non-alcoholic fatty liver disease) are alarming. Strikingly, there was carbohydrate intolerance in an important number of patients. Treatment and education of patients and parents is mandatory. Preventive measures in the society concerning childhood obesity are necessary.

Body Mass, Total Body Fat Percentage, and Visceral Fat Level Predict Insulin Resistance Better Than Waist Circumference and Body Mass Index in Healthy Young Male Adults in Indonesia

The incidence of obesity which leads to insulin resistance (IR) and metabolic disorder is increasing in developing countries, including Indonesia. Male adults have a higher risk of abdominal obesity than females. This is associated with cardiometabolic disorders. Several anthropometric measurements have been proposed to predict IR. The aim of this study was to investigate whether body mass, body mass index (BMI), waist circumference (WC), body fat percentage (BF) or visceral fat level (VF) could become a better predictor of IR in healthy young male adults. A total of 140 healthy young male adults ranging from 18⁻25 years were recruited in the study. Insulin resistance was measured by calculating their Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Subjects with a HOMA-IR value &ge;75th percentile, with cut off 3.75, were defined as IR. Anthropometric measurements including body weight, BMI, and WC were performed, whereas BF and VC were measured using bioelectrical impedance analysis (BIA). IR had a strong correlation with body weight, BMI, WC, BF, and VF. In the area under the curve of body mass, BF and VF were slightly greater than WC and BMI. Anthropometric measurements correlated strongly with IR but body weight, BF, VF had a stronger correlation than WC and BMI in healthy young male adults.

Metabolic Profiles in Obese Children and Adolescents with Insulin Resistance

BACKGROUND:

In the past several decades, the increasing frequency of overweight and obese children and adolescents in the world has become a public health problem. It has contributed significantly to the already high tide of diabetes, cardiovascular and cerebrovascular diseases.

AIM:

To investigate the frequency of insulin resistance and to evaluate the metabolic profile of insulin resistant and non-insulin resistant obese children and adolescents.

SUBJECTS AND METHODS:

The study included 96 (45 boys, 51 girls) obese children and adolescents aged 4-17 years old (10.50 ± 2.87 years). Only participants with Body Mass Index ≥ 95 percentile were included. We analysed sera for fasting insulin levels (FI), fasting serum triglycerides (TG), total serum cholesterol (TC), fasting plasma glucose (FPG) and plasma glucose 2 hours after the performance of the oral glucose tolerance test (2-h G). Homeostatic model assessment for insulin resistance (HOMA-IR) index was calculated as fasting insulin concentration (microunits per millilitre) x fasting glucose concentration (millimolar)/22.5. The value of HOMA-IR above 3.16 was used as a cut-off value for both genders.

RESULTS:

Insulin resistance was determined in 58.33% of study participants. Insulin resistant participants had significantly higher level of 2-h G (p = 0.02), FI level (p = 0.000) as well as TG levels (p = 0.01), compared to non-insulin resistant group. Strikingly, 70.73% of the pubertal adolescents were insulin resistant in comparison to 49.09% of the preadolescents (p = 0.03). Significantly higher percentage of insulin-resistant participants were girls (p = 0.009). Moreover, a higher percentage of the girls (70.59%) than boys (44.44%) had HOMA-IR above 3.16 and had elevated FI levels (70.59% vs 48.89%). The difference in the frequency of insulin resistance among obese versus severely obese children and adolescents was not significant (p = 0.73, p > 0.05). Our study results also showed positive, but weak, correlation of HOMA-IR with age, FPG, TG and BMI of the participants (p < 0.05).

CONCLUSION:

Higher percentage of insulin-resistant participants was of female gender and was adolescents. In general, insulin resistant obese children and adolescents tend to have a worse metabolic profile in comparison to individuals without insulin resistance. It is of note that the highest insulin resistance was also linked with the highest concentrations of triglycerides.

Evaluation of left ventricular function in obese children without hypertension by a tissue Doppler imaging study

Background:

The prevalence of obesity is increasing worldwide. Obese children without hypertension are becoming an important health challenge.

Aims:

Complications of obesity in adults are well established, but in obese children, cardiac dysfunction has not been reported clinically.

Settings and Design:

The present crosssectional study investigates subclinical systolic and diastolic dysfunction using echocardiographic modalities.

Materials and Methods:

Twentyfive youngsters with body mass index (BMI) >30 and 25 healthy children with BMI <25 were assigned into case and control group, respectively. In all participants, complete cardiovascular examination, electrocardiography, and echocardiography were fulfilled. Echocardiography surveys included standard, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI).

Statistical Analysis Used:

SPSS software, version 24.

Results:

The two groups were matched for age and sex. The resting heart rate and blood pressure were markedly higher in the obese group (P = 0.0001) though they were within the normal range in either category. Ejection fraction in the two groups was similar. Left ventricular (LV) mass (P = 0.0001), LV mass index (P = 0.029), left atrialtoaortic diameter ratio (P = 0.0001), and LV enddiastolic diameter (P = 0.008) were significantly greater in the case group, indicating cardiomegaly and subclinical systolic and diastolic dysfunction. Except for the aortic velocity, all PWD variables were considerably lower in the case group, suggesting subclinical diastolic dysfunction. All TDI parameters varied significantly between the two categories. There was a direct correlation between isovolumetric relaxation time and BMI.

Conclusions:

Obesity in children without hypertension is associated with subclinical systolic and diastolic cardiac dysfunction. We propose the evaluation of blood pressure as well as myocardial performance using PWD and TDI in all obese children without hypertension, regularly.

Predictors of Insulin Resistance in Children versus Adolescents with Obesity

INTRODUCTION

Obesity is a risk factor to develop metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM). Insulin resistance (IR) plays a major part in both. With increasing incidence of childhood obesity, this retrospective study aimed to identify predictors of IR in children/adolescents with obesity to optimize screening for IR.

METHOD

Patients aged ≥ 2-≤ 18 years with obesity (BMI-SDS > 2.3) were included. IR was defined as HOMA-IR ≥ 3.4, and MetS if ≥3 of the following criteria were present: waist circumference and blood pressure ≥ 95th age percentile, triglycerides ≥ 1.7 mmol/l, HDL < 1.03 mmol/l, and fasting plasma glucose ≥ 5.6 mmol/l.

RESULTS

In total, 777 patients were included. Of the 306 children, 51, 38, and 0 were diagnosed with IR, MetS, and T2DM, respectively. Of the 471 adolescents, 223, 95, and 0 were diagnosed with IR, MetS, and T2DM, respectively. In the multivariable regression model, BMI-SDS, preterm birth, and Tanner stage were associated with IR in children (6.3 (95% CI 1.3-31.1), 5.4 (95% CI 1.4-20.5), 2.2 (95% CI 1.0-4.8)), and BMI-SDS and waist circumference in adolescents (4.0 (95% CI 1.7-9.2), 3.7 (95% CI 1.5-9.4)).

CONCLUSION

Different IR predictors were observed in children/adolescents with obesity. These predictors can be used to optimize screening for IR in pediatric populations.