Background: Childhood critical period for onset/continuity of obesity with development of significant clinical and metabolic changes, impairing health in adulthood. Metabolic syndrome on rise both in adult and pediatric obese Indian population. Development of impaired glucose tolerance and progress to insulin resistance and other metabolic alterations like hypertension, dyslipidemia, Non alcoholic fatty liver disease are important.
Aim: Evaluate insulin resistance and associated comorbidities among children with Metabolic syndrome.
Materials and Methods: 50 overweight and obese 518years (BMI ≥90th centile WHO Charts) evaluated weight, height, waist circumference (WC), BMI, clinical and biochemical. Fasting plasma glucose and insulin, 2 h post glucose load plasma glucose and insulin and lipid profile measured. Metabolic syndrome (MS) defined in children >10 years International Diabetes Federation guidelines, central obesity WC >90th percentile (ethnicity-specific values) AND any two-Raised triglycerides ≥150 mg/dl (1.7 mmol/l), reduced HDL ≤40 mg/dl (1.03 mmol/l), hypertension, Elevated FPG ≥100 mg/dl. Homeostasis Model assessment index (HOMA) calculated >3.5 taken as cutoff for insulin resistance. Cutoffs of BMI, WC, HOMA-IR which best predicted occurrence of metabolic syndrome by plotting ROC were 24.1 kg/m2, 74.7 cm, and 3.48 respectively. Further, ROC analysis plotting HOMA is 3.48 predicting occurrence of MS with sensitivity and specificity of 77.8% and 78%.
Results: Metabolic syndrome in 9/50 (18%), mean age 11.46+1.59 years. Calories consumed and duration of physical activities did not differ among MS and non MS but with MS increased screen time 3.6+0.8 h vs 2.6+1.2 (P=0.02). Being in puberty higher rate of MS (71.4%). Mean WC 80.8+5.3 vs. 70.7+8.77 cm P=0.00 and systolic BP (118+7.2 vs 111.5+9.5 mmHg P=0.05), FPG (88.1+9.4 vs. 81.6+6.1 mg/dl P=0.01), PPPG (125.4+12.7 vs 109.4+9.2 mg/dl P=0.00), fasting insulin (19.2+5.6 vs 15.2+4.4 μU/ml P=0.02), HOMA index (4.17+1.35 vs 3.10+1.07 P=0.01) and TGL (164.6+29.8 vs 117.4+19.2 mg/dl P=0.00) significantly higher in MS. Abdominal obesity (100%), hypertension (44.4%), insulin resistance (77.7%), acanthosis nigricans (44.4%), dyslipidemia (77.7%) higher in MS.
Conclusions: Though MS established in (18%) of overweight/obese, comorbidities identified in significant number by simple clinical examinations and biochemical measurements, confirms disturbed glucose and lipid homeostasis starts early, increases likelihood of type 2 diabetes and cardiovascular disease at young age and need for early screening. HOMA-IR valuable tool (>3.5) useful for early evaluation identifying insulin resistance and metabolic syndrome have long-term benefit of preventive and diagnostic as well as therapeutic intervention.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology