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: 6.21). 12/2010; 95(12):5189-98. DOI: 10.1210/jc.2010-1047
Source: PubMed


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
    • "In adults, the syndrome is associated with an increased risk of type 2 diabetes (T2D) and cardiovascular complications, and it still continues to generate interest 25 y after it was first described by Reaven in 1988 [2]. The increasing prevalence of overweight in the paediatric population is associated with an increasing number of adolescents fulfilling the MetS criteria , but it is difficult to evaluate the prevalence of the MetS in the absence of a simple consensus definition of the syndrome in children and adolescents [3] [4]. The prevalence of the MetS varies between 2.0% and 9.4% in North American adolescents, depending on the definition, and is higher among obese adolescents (12.4% to 44.2%) [5]. "
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    ABSTRACT: Objectives This study aimed to estimate, in a large group of Algerian adolescents, the prevalence of the metabolic syndrome (MetS), using four definitions (by Cook, De Ferranti, Viner and the IDF), and to test the validity of unique thresholds of waist circumference, waist/height ratio and BMI in screening for the MetS regardless of the definition used. Subjects and methods A total of 1100 adolescent students, aged 12–18 y, were randomly selected from schools and classrooms in the city of Constantine; all had anthropometric measurements taken and 989 had blood tests. Results Prevalences of the MetS were: 2.6% for boys and 0.6% for girls by the Cook definition; 4.0% for boys and 2.0% for girls by the De Ferranti definition; 0.7% for boys and 0% for girls by the Viner definition; and 1.3% for boys and 0.5% for girls by the 2007 IDF definition. Prevalences ranged from 3.7% to 13.0% in obese adolescents. Unique thresholds, independent of gender, age and height, of 80 cm for waist circumference, 0.50 for waist/height ratio and 25 kg/m2 for BMI had sensitivities of 72–100%, 67–100% and 72–100%, respectively, and specificities of 74–78%, 74–86% and 74–78%, respectively, depending on the MetS definition used. Conclusion The MetS is present in Algerian adolescents and the prevalence is especially high in obese young people. Our thresholds for waist circumference, waist/height ratio and BMI for screening for the MetS should now be tested in other adolescent populations.
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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.
    Full-text · Article · Aug 2013 · Diabetes & metabolism journal
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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.
    Full-text · Article · Mar 2013 · International Journal of Endocrinology
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