Background: It is debated whether oral glucose tolerance test (OGTT) should be routine in child obesity units to identify high risk individuals for impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).
Aims: To investigate the prevalence of some signs of metabolic syndrome in child obesity.
Methods: All consecutive newly referred obese children (BMI>30) at a Swedish university unit were evaluated with fasting glucose, insulin, apolipoprotein A1 and B, HbA1c, cholesterol and triglyceride (TG). An OGTT was performed and glucose was measured before and 120 minutes after intake of 75 gram oral glucose. Fasting glucose > 6.0 mmol/L was defined IFG and >7.0 mmol/L diabetes. IGT was defined as glucose >8.8 mmol/L at 120 minutes. Correlations were performed with Spearman test.
Results: 134 children (60% females), mean±SD age 12.5±2.9 years, BMI 30±5.6 (BMI SDS range 2.85.0) were examined at referral and after one year working in a life-change program. Four of these were found to have diabetes and ten IFG. Only five had IGT despite the majority (75%) having insulin levels >20 mU/L. Fasting insulin correlated strongly to TG (r=0.6, P<0.01), and to less degree to low HLD and high LDL cholesterol (both r=0.3, P<0.05), maybe due to some outliers with low HDL but normal insulin levels. Interestingly, heredity for type 2-diabetes was the strongest risk factor correlating to pathological OGTT, followed by low HDL cholesterol levels below 1.0 mmol/L. Despite decreased BMI, HDL cholesterol stayed almost unchanged over the years and correlated with high TG as well as apolipoprotein B/A1>0.7 as a marker of cardiovascular risk in 30 children.
Conclusion: Despite OGTT being a routine examination yearly at our university unit, it is the complex combination of high fasting glucose, low HDL and high TG that will discriminate for those with increased risk of developing diabetes, IGT or IFG.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology