ESPE Abstracts

Background: Rising trend of both type 2 diabetes and obesity observed in adult and pediatric Indian population. Imperative to evaluate insulin resistance among overweight and obese children.

Objective and hypotheses: To examine insulin resistance and associated co-morbidities in overweight and obese children.

Method: Hospital based Cross sectional study 50 overweight and obese 5–18 years (BMI ≥90th centile WHO Charts). Weight, height, waist circumference, BMI, clinical and biochemical evaluation of fasting plasma glucose (FPG) and insulin, 2 hour post glucose load plasma glucose (FPPG) and insulin and lipid profile measured. Homeostasis Model assessment index (HOMA-IR) calculated and uniform HOMA value >3.5 defining Insulin Resistance (IR) taken as cutoff. In view of wide variability in cut offs of HOMA used, a Receiver Operating coefficient (ROC) curve in study population, predicting occurrence of metabolic abnormalities and value of 2.91 obtained.

Results: Of 50, 22(44%) prepubertal, 28 (56%) pubertal mean age, BMI and WC were 10.76±2.48 years, 24.18±3.12 kg/m² and 72.55±9.12 cm. Fasting plasma glucose (FPG-82.7+7.2 mg/dl), post prandial plasma glucose (PPPG112.3+11.6 mg/dl), fasting insulin (15.95+4.83 uU/ml), normal limits and mean HOMA 3.29+1.19. Abdominal obesity, hypertension, dyslipidemia, insulin resistance, metabolic syndrome, fatty liver in 33(66%), 15(30%), 15(30%), 18(36%), 9(18%), 9(18%) respectively. Pubertal children had higher hypertension (39.3% vs 18.2% P=0.03) and metabolic syndrome (28.6% vs 4.5% P=0.03). 18/50 children of IR (HOMA>3.5) had higherWC (76.02+8.07 vs 70.6+9.21 P=0.04), FPG (86.6+7.1 vs 80.6+6.4 P=0.00), PPPG (117.3+13.4 vs 109.5+9.6 P=0.02), fastinginsulin (21.45+2.32 vs 12.86+2.57 P=0.00), postprandialinsulin (25.69+4.02 vs 17.30+3.76), HOMA (4.58+0.82 vs 2.56+0.59 P=0.00). Abdominal obesity, hypertension, dyslipidemia, metabolic syndrome, acanthosis nigricans, fatty liver found in 16(88.8%), 8(44.4%), 9(50%), 7(38.8%), 3(16.6%), 9(50%). HOMA values correlated with total cholesterol (r=0.28), postprandial insulin (r=0.79), PPPG (r=0.46). At HOMA 2.91, 30(60%) Insulin resistant vs 20 non insulin resistant weight, BMI and systolic blood pressure of the insulin resistant subjects were significantly higher and 21(70%) were pubertal (P=0.02) with hypertension (12/30, 40%), dyslipidemia (12/30, 40%), and fatty liver (9/30, 30%) significantly higher. WC higher (74.52±9.44 vs 69.5±7.94 cm), FBS (85.1±6.2 vs 79.2±7.3), fasting insulin (19.11±3.44 vs 11.2±1.65 P=0.00), postprandialinsulin (23.58±4.56 vs 15.4±2.52), HOMA (4.03±0.05 vs 2.19±0.37 P=0.00) significant.

Conclusion: Obese children showed metabolic derangements as early as 10years, Insulin resistance (HOMA>3.5) observed 18(36%), significantly more at pubertal mean age 12.54±1.65 and with associated comorbidities hypertension, dyslipidemia, fatty liver. In this cohort ROC of 2.91 predicted metabolic abnormalities with 30/50 (70%) being insulin resistant. Early evaluation of insulin resistance and metabolic derangements mandatory for sensitization and interventions.