Insulin Resistance in Children: Consensus, Perspective, and Future Directions

Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.31). 12/2010; 95(12):5189-98. DOI: 10.1210/jc.2010-1047
Source: PubMed

ABSTRACT Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points.
The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants.
An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children.
The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement.
Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.

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Available from: M. Loredana Marcovecchio, Dec 21, 2013
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    • "As with the increasing epidemic of childhood obesity in recent years, the prevalence of type 2 diabetes has increased among obese youth, particularly in a racial/ethnic minority group [4]. Although transient insulin resistance can occur during puberty [5], obesity is the most prevalent pathophysiological cause of insulin resistance in children and adolescents [1]. Sinha et al. [6] reported that impaired glucose tolerance is present in 25% of prepubertal obese children and 21% of obese adolescents based on a 2-hour oral glucose tolerance test (OGTT). "
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    ABSTRACT: As with the dramatic increases in childhood obesity over the past decades, the incidence of type 2 diabetes has increased among children and adolescents in the United States. Insulin resistance is a common feature of childhood obesity and increases the risk of type 2 diabetes, metabolic syndrome, and atherogenic lipoprotein profile in obese youth. Although cross-sectional studies report beneficial effects of physical activity or cardiorespiratory fitness on insulin sensitivity, the role of regular exercise alone (e.g., no calorie restriction) as a strategy to reduce the risk of type 2 diabetes is unclear in obese children and adolescents. In this mini review, we examined the independent effects of various exercise on glucose tolerance and insulin sensitivity in obese youth.
    Diabetes & metabolism journal 08/2013; 37(4):225-32. DOI:10.4093/dmj.2013.37.4.225
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    • "Pubertal development is known to affect insulin status in children, but it was not significant in our obese children [2, 24]. It seems that obesity effect on IR is stronger than pubertal stage in obese Korean children. "
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    ABSTRACT: Elevated levels of serum gamma-glutamyltransferase (GGT) levels have been found to predict the development of type 2 diabetes in adults. The role of GGT in insulin resistance (IR) among children is largely unknown. We investigated whether GGT among hepatic enzymes is independently associated with IR in obese Korean children. A total of 1308 overweight (above the 85th BMI percentile of Korean reference) boys (n = 822) and girls (n = 486), aged 9-15 years, were studied. Measures acquired included weight, height, percent body fat (BF%), waist circumference, blood pressure, blood glucose and insulin, C-reactive protein, total cholesterol, triglycerides, HDL-Cholesterol, GGT, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). IR was calculated using the homeostasis model assessment (HOMA-IR). Serum GGT and ALT, but not AST, were positively correlated with HOMA-IR in boys (r = 0.222 for GGT; P < 0.05, r = 0.188 for ALT; P < 0.05) and girls (r = 0.292 for GGT; P < 0.05, r = 0.258 for ALT; P < 0.05). In multiple regression analysis for HOMA-IR as dependent variable, GGT (β = 0.068; P = 0.053 in boys, β = 0.145; P = 0.002 in girls) and ALT (β = 0.074; P = 0.034 in boys, β = 0.130; P = 0.005 in girls) emerged as determinants of HOMA-IR after adjusting age, BMI, tanner stage, and triglycerides. Serum GGT level is a strong marker of IR in obese Korean children.
    International Journal of Endocrinology 03/2013; 2013:578693. DOI:10.1155/2013/578693 · 1.52 Impact Factor
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    • "Although we found that girls with PA had lower IS and higher MSI concentrations during OTT, they were not found to be more IR than controls unlike the findings in Catalonian girls, in which the presence of dyslipidemia, IR, and atherogenesis was linked to reduced fetal growth (30, 31, 32, 33). The presence of IR in girls with PA may require reassessment as a recent consensus on evaluation of IR in children declared that none of the currently used parameters be considered as reliable and that new studies be carried out to define IR in children (45). "
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    ABSTRACT: An association between low birth weight, insulin resistance (IR), dyslipidemia, and atherogenesis has been shown in girls with precocious adrenarche (PA). To evaluate whether girls with PA born appropriate for gestational age (AGA) have increased risk for metabolic complications at initial evaluation. We conducted a cross-sectional study on 69 AGA born girls with PA (mean (±s.d.) age 7.1±1 years) and 45 body mass index (BMI)- and waist circumference (WC)-matched prepubertal peers born AGA (mean (±s.d.) 7.5±1.9 years). A standard 2-h oral glucose tolerance test with insulin sampling was performed. Fasting plasma lipids and high-sensitivity C-reactive protein were analyzed, and blood pressure was recorded. Insulin sensitivity (IS) index (ISIcomp), homeostasis model assessment of IR, and atherogenic index (AI) (triglycerides/high-density lipoprotein cholesterol) were calculated. The study was performed at University Hospital. AI was significantly lower in girls with PA than in controls (P<0.001), and it was correlated with BMI SDS (r=0.44, P=0.001) and WC (r=0.39, P=0.001). The significant correlation of AI with ISIcomp (r=-0.38, P=0.001) disappeared after correcting for BMI (r=-0.185, P=0.16). Multivariate regression analysis revealed that DHEAS was the only significant parameter influencing AI in girls with born AGA (R (2)=0.475 β=-0.018, P=0.0001). Metabolic screening in prepubertal AGA born girls with PA may yield favorable lipid profiles. AI in girls with PA is increased in relation to decreasing IS and increasing BMI and WC. DHEAS seems to have the most significant effect on AI.
    03/2013; 2(1):1-10. DOI:10.1530/EC-12-0059
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