Introduction: In the last years, the relationship between clinical markers and blood parameters has been evaluated closely as part of transversal studies, but a longitudinal approach might be more useful in explaining its complexity.
Aim: The study aims to evaluate the relationship between changes in the values of clinical markers and of the inflammatory, biochemical and hormonal profiles of obese and overweight children over a 4 to 12-month period.
Materials and Methods: An observational retrospective study was conducted on obese and overweighed children evaluated from January 2017 to March 2019 in the First Pediatric Clinic from Cluj-Napoca, Romania. Children without any comorbidity evaluated more than once in this period were included in the analysis. A minimum 4-month follow-up period was established. Clinical markers (body mass index, waist circumference, blood pressure) and inflammatory markers (leucocytes and neutrophils counts, C-reactive protein), biochemical serum markers (liver enzymes, uric acid, glycemic and fat profiles), insulin and cortisol levels were obtained from medical files.
Results: The study included twenty-two patients aged between 2 years and 17 years among which 20 were obese (≥95th percentile) and 2 overweight (≥85th percentile) at the initial evaluation. The follow-up body mass index (BMI) decreased in 12 cases without reaching statistical significance.
The fasting glucose levels significantly decreased at the follow-up as compared to baseline assessment (P-value = 0.010) within the normal range limits. There was a significant increase in fasting insulin levels (baseline median = 14.9 kg vs. follow-up median = 20.5 kg, P-value= 0.05, n=11). Moreover, there was a positive correlation between bodyweight and insulin levels in both baseline (ρ=0.60, P-value= 0.051, n=11) and follow-up (ρ=0.53, P-value= 0.028, n=17) assessments. One patient had hyperinsulinemia at baseline evaluation and 6 developed it at follow-up. Neither the change in glycemia, nor in the insulinemia correlated to changes in BMI or percentiles (P-value > 0.05). There was no significant difference or correlation between baseline and follow-up measurements regarding other parameters.
Conclusion: Fasting glucose and insulin levels changed significantly during the follow-up period independently of body mass index and HOMA-ir variations. Fasting hyperinsulinemia may precede the changes in body mass index as insulinemia is a sensitive indicator of lipid and carbohydrate metabolism. In addition to reflecting the effect of insulin, the glycemic profile may also reflect the mechanisms leading to insulin resistance onset. A longitudinal prospective study would explain the relation between clinical and laboratory markers in obesity more clearly.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology