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Resistencia insulínica y otras expresiones del síndrome metabólico en niños obesos chilenos Translated title: Insulin resistance in obese Chilean children

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      Translated abstract

      Background: Infantile obesity is a probable risk factor for the early appearance of chronic illnesses like Type 2 Diabetes Mellitus, Dislipidemia and Hypertension. Insulin Resistance (IR) appears as the common etiological mechanism. Aim: To describe metabolic complications associated to obesity in a group of Chilean children and to correlate them with IR, estimated through the homeostasis model assessment index (HOMA). Subjects and methods: We studied 88 children, 12±2.4 years old. Fifty two had severe obesity, 19 were overweight, and 17 had a normal weight (body mass index z score (BMIz): 4.7±1.6, 1.7±0.5 and 0.2±0.6 respectively, p <0.001). In obese children, an oral glucose tolerance test, measuring basal and 30 min insulin levels, was performed and serum lipid levels were measured. Results: Eleven percent of the severely obese children were glucose intolerant, 67% had basal hyperinsulinemia (>20 uU/ml) and 79% had IR (HOMA >3.8). These children also had a higher prevalence of acantosis nigricans than the overweight and normal counterparts (63, 10.5 and 0% respectively, p <0.001), higher basal insulinemia: (24.4±10, 16.4±4 and 12.2±3 mU/ml respectively) and HOMA (5.3±2, 3.4±0.8 and 2.3±0.5 respectively, p <0.001). By multiple stepwise regression analysis, BMIz was the only significant predictor for basal hyperinsulinemia, HOMA and diastolic blood pressure. Age and BMIz were independent predictors for systolic blood pressure. The strongest predictor for plasma lipid levels was the family history of dislipidemia. Conclusions: Obese children have a high prevalence of metabolic complications, which are related to the severity of obesity. Most of the severely obese children have hyperinsulinism and IR. BMIz is the principal predictor for high blood pressure. Familiar history is the better predictor for dislipidemia (Rev Méd Chile 2003; 131: 259-68).

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      Most cited references 48

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        Obesity now affects one in five children in the United States. Discrimination against overweight children begins early in childhood and becomes progressively institutionalized. Because obese children tend to be taller than their nonoverweight peers, they are apt to be viewed as more mature. The inappropriate expectations that result may have an adverse effect on their socialization. Many of the cardiovascular consequences that characterize adult-onset obesity are preceded by abnormalities that begin in childhood. Hyperlipidemia, hypertension, and abnormal glucose tolerance occur with increased frequency in obese children and adolescents. The relationship of cardiovascular risk factors to visceral fat independent of total body fat remains unclear. Sleep apnea, pseudotumor cerebri, and Blount's disease represent major sources of morbidity for which rapid and sustained weight reduction is essential. Although several periods of increased risk appear in childhood, it is not clear whether obesity with onset early in childhood carries a greater risk of adult morbidity and mortality. Obesity is now the most prevalent nutritional disease of children and adolescents in the United States. Although obesity-associated morbidities occur more frequently in adults, significant consequences of obesity as well as the antecedents of adult disease occur in obese children and adolescents. In this review, I consider the adverse effects of obesity in children and adolescents and attempt to outline areas for future research. I refer to obesity as a body mass index greater than the 95th percentile for children of the same age and gender.
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            Author and article information

            Affiliations
            [1 ] Pontificia Universidad Católica de Chile Chile
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            rmc
            Revista médica de Chile
            Rev. méd. Chile
            Sociedad Médica de Santiago (Santiago )
            0034-9887
            March 2003
            : 131
            : 3
            : 259-268
            S0034-98872003000300003
            10.4067/S0034-98872003000300003

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Chile
            Categories
            MEDICINE, GENERAL & INTERNAL

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