Insulin resistance in prepubertal children

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Presentation transcript:

Insulin resistance in prepubertal children Vera Zdravkovic 1,2, Jovana Vuković2, Maja Jesic1,2, Vladislav Bojic1, Silvija Sajic1, 2. University Children’s Hospital, Belgrade, Serbia1, University of Belgrade, School of medicine2 Results Discussion Introduction Methods The case-control study included 73 obese patients with BMI>2 SDS for age and gender Study duration 2014 - 2017 Children were classified into prepubertal and pubertal group according to the Tanner staging criteria BW and BL, breastfeeding duration, eating patterns and family history of T2D Height, weight, BP and fasting glucose, lipid profile, liver enyymes and oGTT Our study showed a statistically significant difference in relation to age, gender,weight, height nd BMI between groups Study revealed significantly higher cholesterol, LDL and HDL cholesterol, CRP, AST and phosphorus levels in prepubertal children Indices of insulin sensitivity and secretion between groups didn’t show a statistically significant difference Insulin resistance was present in almost 80% of the patients according to the HOMA index. However, lower values of HOMA, WBISI and higher IGI, were found in prepubertal subjects Obesity in childhood is a risk factors for cardiovascular disease and type 2 diabetes (T2D) later in life IR increase in puberty Obese children in puberty are more insulin resistant than their peers, but are they IR before puberty onset? (mmHg) Prepubertal Pubertal p Systolic blood pressure 114.9±16.8 116.1±13.5 0.742 Diastolic blood pressure 72.6±10.5 74.7±9.5 0.386 mmol /L Prepubertal 23 Pubertal 25 p Glucose 0 min 5.2 (4.9-5.5) 5.0 (4.7-5.4) 0.327 Glucose 30 min 8.7 (7.7-9.9) 8.4 (6.4-9.3) 0.443 Glucose 60 min 6.8 (6.1-8.2) 7.9 (6.6-8.9) 0.164 Glucose 90 min 7.2 (6.5-7.6) 7.1 (6-7.8) 0.821 Glucose 120 min 6.3 (5.7-7.3) 6.4 (5.5-7.6) 0.585 IDF criteria for the definition of metabolic syndrome in children and adolescents Biochemistry Prepubertal Pubertal p HDL-c (mmol/l) 1.4±0.3 1.2±0.02 0.019* LDL-c (mmol/l) 3.0±0.8 2.6±0.7 0.025* Total cholesterol (mmol/l) 4.6±0.9 4.1±0.7 0.006* Triglycerides (mmol/l) 1.2±0.8 1.2±0.6 0.984 ALT (u/l) 51.2±33.4 41.3±13.5 0.154 AST (u/l) 25.0±11.4 18.7±7 0.016* HbA1c (%) 5.5±0.2 5.6±0.9 0.599 serum calcium (mmol/l) 2.4±0.1 0.121 serum phosphorus (mmol/l) 1.6±0.2 1.5±0.2 0.042* CRP (mg/l) 3.9 (2.5-7.4) 2.2 (1.5-3.7) 0.009* Indices of insulin sensitivity Limit values HOMA-IR (insulin (μU/L) x glucose(mmol/L))/22,5 ≥2.6 QUICKI 1/[log(insulin(μU/L))+log glucose ((mmol/L))] ≤0.33 WBISI 10 000/√ (fasting glucose × fasting insulin) x(glucose average ×insulin average) ≤ 2.5 IGI Δinsulin (0-30 min)/ Δglucose (0-30 min) <0.4 McA exp ( 2.63-0.28 ln ( insulin μU/L )- 0.31 ln ( triglycerides mmol /L )) ≤5.8 μU/ml Prepubertal 23 Pubertal 25 p Insulin 0 min 16.0 (13.3-26.9) 19.1 (13.2-24.2) 0.831 Insulin 30 min 148.1 (80.8-266.6) 128.1 (85-208.6) 0.655 Insulin 60 min 93.5 (59.9-179.8) 136.0 (81.7-164.7) 0.404 Insulin 90 min 89.4 (58.1-235.1) 112.3 (65-176.7) 0.660 Insulin 120 min 79.7 (42.8-117.7) 98.0 (64.6-152.9) 0.271 AGE CRITERIA 6-10 years Obesity ≥90. percentile (WC) 10-16 years Triglycerides ≥1,7 mmol/l (150 mg/dl) HDL cholesterol <1,03 mmol/l (40 mg/dl) Systolic pressure ≥130 mmHg or diastolic ≥85 mmHg FPG ≥5.6 mmol / l (100 mg / dl) or known T2D Conclusions In our study we have found a high prevalence of insulin resistance and lipid disorders in a group of obese children before puberty onset. This demand’s for early intervention to prevent the obesity at earlier stage. Baseline characteristics 73 HOMA 58 (80%) 38 Prepubertal 30 (79%) 35 Pubertal 28 (80%) 48 WBISI 32 (67%) 23 13 (57%) 25 19 (76%) 69 McAuley 22 (32%) 36 10 (38%) 33 12 (36%) Objectives Characteristics Prepubertal (38) Pubertal (35) p Age (y) 10.1±2.1 13.6±1.3 0.000* Gender (M/F) 26 / 12 10 /25 0.001* Height (cm) 153.1±13.6 166.4±7 Height SDS 2.1±1.5 1.2±1.4 0.006* Weight (kg) 73.9±20.2 96.7±18.6 Weight SDS 3.3±0.9 3.5±0.9 0.353 BMI (kg/m2) 31.0±5.5 35.0±7 0.007* BMI SDS 3.2±0.7 3.1±0.6 0.558 Indices of insulin sensitivity Prepubertal Pubertal p Fasting glucose 5.3 (4.8-5.6) 5.0 0.964 Fasting insulin 14.5 (12.2-22.9) 19.2 (11.8-26.3) 0.251 HOMA 3.5 (2.8-5.5) 4.7 (2.6-6) 0.284 QUICKI 0.5 (0.5-0.6) WBISI 2.1 (1.5-3.2) 2.2 (1.6-2.5) 0.951 IGI 2.9 (1.4-4.6) (1.3-3.9) 0.573 McA 6.5 (5.8-7) 6.1 (5.4-7) 0.313 to estimate the insulin resistance in obese children before puberty onset to compare the indices of insulin resistance in prepubertal and pubertal children References 1. Zimmet P, Alberti K, George MM et al. IDF Consensus Group. The metabolic syndrome in children and adolescents-an IDF consensus report. Pediatric Diabetes 2007;8:299-306. 2. Weiss R, Taksali SE, Tamborlane WV et al. Predictors of Changes in Glucose Tolerance Status in Obese Youth. Diabetes Care. 2005;28:902-9. 3.Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab 2004;89:2526-2539. 4. Pacini G and M. A. Methods for clinical assessment of insulin sensitivity and beta-cell function. Best Pract Res Clin Endocrinol Metab. 2003;17(3):305-22. 5. Pedrosa C, Oliveira BM, Albuquerque i et al. Obesity and metabolic syndrome in 7-9 years-old Portuguese schoolchildren. Diabetol Metab Syndr. 2010;2(1):40.