OBJECTIVE -To investigate in a population of Hispanic children if 1) the presence of acanthosis nigricans (AN) is related to insulin sensitivity (S i ) independent of adiposity and 2) scale scoring AN severity adds to the clinical estimation of insulin sensitivity, above and beyond the presence or absence AN alone. RESEARCH DESIGN AND METHODS-The study population, 131 Hispanic overweight children (mean BMI percentile 97.0 Ϯ 3.1, 72 boys, 59 girls, ages 8 -13 years, mean Tanner stage 2.4 Ϯ 1.5) with a family history of type 2 diabetes, underwent a physical examination of the neck to determine AN absence or presence (0 -1), AN extent score (0 -4 scale), AN texture score (0 -3 scale), and an AN combined score (extent ϩ texture; 0 -7 scale). S i was measured by the frequently sampled intravenous glucose tolerance test and minimal modeling. Multivariate linear regression analysis was used to determine the role of BMI and AN in predicting S i .RESULTS -BMI was the main predictor of S i , explaining ϳ41% of the variance. The presence of AN explained an additional 4% of the variability in S i ; scale scoring of AN extent or texture did not significantly improve the prediction.CONCLUSIONS -Although AN is an independent risk factor for insulin resistance in overweight Hispanic children at risk for type 2 diabetes, body adiposity is the primary determinant of insulin sensitivity. In addition, scale scoring AN seems of minimal usefulness in clinically estimating the severity of insulin resistance over and above assessing the presence or absence of AN and calculating BMI. Diabetes Care 27:1412-1416, 2004W ith the rise of overweight (1) and type 2 diabetes (2,3) in the pediatric population, especially in young Hispanics and other minority groups, early identification of those at elevated health risk is important so that appropriate interventions can be established. Insulin resistance is thought to be a major factor in the pathophysiology of type 2 diabetes in both adults and children (4 -6). Acanthosis nigricans (AN), a skin disorder characterized by hyperpigmentation, hyperkeratosis, and papillomatosis, is a clinical marker that has been linked to surrogate markers of insulin resistance in adults (7,8) and adolescents (9), but only a few studies have explored the relation between directly measured insulin sensitivity (S i ) and AN in children (10 -12). Studies in adults have suggested that those with AN have elevated fasting insulin levels (13,14). However, these studies were limited in that they did not measure S i directly, neither did they evaluate the severity of AN. Burke et al. (8) proposed a classification system to grade the severity of AN and found that the severity of AN was associated with elevated fasting insulin and increased BMI. Previous studies that have examined the relation between S i and the severity of AN in adults and children have found mixed results (10 -12). Thus, the interrelation between obesity, insulin resistance, and severity of AN still needs to be clarified, particularly in children at risk fo...
OBJECTIVE:To examine cross-sectional differences in insulin sensitivity, insulin secretion and b-cell function during puberty in overweight Hispanic boys and girls with a family history of type 2 diabetes. STUDY DESIGN AND PARTICIPANTS: This cross-sectional, observational study included 214 8-13-y-old Hispanic children with a BMI percentile Z85th percentile and family history of type 2 diabetes. METHODS AND ANALYSES: Participants underwent a physical examination, body composition measures, oral glucose tolerance test (OGTT), and frequently-sampled intravenous glucose tolerance test. Unadjusted and adjusted general linear models (GLM) tested whether insulin/glucose dynamics differed by Tanner stage and gender. RESULTS: Unadjusted group comparisons showed that fasting insulin increased whereas insulin sensitivity (SI) and the disposition index (DI) (a measure of pancreatic b-cell function) decreased across Tanner stage groups (all Po0.05). No differences in the acute insulin response to glucose (AIRg), fasting glucose or 2-h glucose were found. After adjusting for covariates, there was no independent effect of Tanner stage on SI (P ¼ 0.9) or AIRg (P ¼ 0.2), but DI was slightly lower in later Tanner stages suggesting decreased b-cell function in the more mature groups (P ¼ 0.10). CONCLUSIONS: Overweight Hispanic children with a family history of type 2 diabetes may represent a unique population given that pubertal insulin resistance was not evident once analyses controlled for body composition. Longitudinal analyses are required to determine whether the slightly diminished b-cell function in later Tanner stages plays a role in the development of type 2 diabetes.
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