Insulin Resistance in Obese Children <10 years.

Stout, J. (Janna) (2015) Insulin Resistance in Obese Children <10 years. thesis, Medicine.

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Abstract

Background. Childhood obesity is a worldwide increasing problem, being one of the most challenging issues healthcare is facing today. Obesity is highly associated with insulin resistance (IR), a known precursor of diabetes mellitus type 2 (T2DM) and part of the metabolic syndrome (MS). Research into risk factors for developing IR is mainly performed in adults and children aged ≥10 years. However, nowadays IR is also seen in children <10 years of age. Limited information is known on risk factors for IR in this young population. Aim. The aim of this study is to determine potential risk factors in obese children <10 years of age with IR. Study design. Retrospective observational study. Methods. Children who visited the pediatric obesity outpatient clinic of the St. Antonius hospital between 2006 and 2014 were screened for inclusion. We included children <10 years with obesity, defined as BMI-SDS >2.3. Children with diabetes mellitus type 1 or 2 were excluded. The following data were gathered: anthropometric measurements, blood samples for fasting plasma glucose (FPG), fasting plasma insulin (FPI) and lipid profile, ethnicity, family history of diabetes mellitus (T2DM and maternal gestational diabetes mellitus (GDM)) and dyslipidemia, gestational age, birth weight, infant feeding and dietary intake of high-fructose corn syrup (HFCS). Morbid obesity was defined as BMI-SDS ≥3.0. The American Diabetes Association criteria were used to interpret values of FPG and FPI. IR was defined as homeostatic model assessment (HOMA)-IR ≥3.4. Data were analyzed using means (standard deviation) and absolute and percentage values. Results. 190 patients were enrolled in this study; 38 patients with IR and 152 control patients. Regardless of gender, an increase in BMI-SDS increased the risk of IR with an OR of 2.7 (95% CI; 1.5-4.7); morbid obesity (BMI-SDS ≥3.0) increased the risk of IR with an OR of 5.3 (95% CI; 1.7-16.3). Patients with IR and control patients were similar in age and gender. The following parameters were significantly related to IR. IR was seen more often in children with maternal GDM (5 out of 7) and in children with parental T2DM (5 out of 20) compared to other children (p = 0.048). Children born preterm had a higher risk of developing IR (p = 0.042). Consumption of HFCS >350ml per day created a higher risk of IR (p = 0.043). IR was associated with the onset of impaired fasting glucose (IFG) in 5 patients (p = 0.029), with higher levels of triglycerides (p <0.001) and with lower levels of HDL-cholesterol (p = 0.025). Conclusion. Obese children <10 years are at risk of developing IR. We have observed that the risk of IR in our study population increases with increasing BMI-SDS. Morbid obese children are more likely to develop IR. The main risk factors for IR are a positive family history of parental T2DM or maternal GDM, preterm birth, and consumption of HFCS-containing beverages. In addition, children with IR are at risk of developing IFG.

Item Type:	Thesis (Thesis)
Supervisor name:	Bakker-van Waarde, Mw. Dr. W.M.
Supervisor name:	Vorst, Mw. Dr. M.M.J. van der and St. Antonius hospital, Nieuwegein
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:44
Last Modified:	25 Jun 2020 10:44
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/602

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