Threshold for Improvement in Insulin Sensitivity with Adolescent Weight Loss

Abstract

Objectives To assess the association of weight loss and insulin sensitivity, glucose tolerance, and metabolic syndrome (MS) in obese adolescents following weight loss treatment, and to determine the threshold amount of weight loss required to observe improvements in these measures. Study design A randomized, controlled behavioral weight loss trial was conducted with 113 obese adolescents. Changes in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), whole body insulin sensitivity index (WBISI), body-mass index (BMI), and MS criteria were assessed at baseline and at month 4. Results There was significant improvement in all measures of insulin sensitivity at month 4. Mean fasting insulin dropped to 16.6 from 22.3 μU/mL (p<0.0001). HOMA-IR decreased significantly from 4.9 to 3.7 (p=0.001) and WBISI increased significantly from 2.87 to 3.98 (p<0.0001). An 8% reduction in BMI led to a significant improvement in WBISI (p=0.03) and was the optimal threshold. Fewer individuals met criteria for MS after weight loss (p=0.0038), although there were no significant changes in the individual features of the syndrome. Conclusions In this trial, weight loss at month 4 was associated with improved insulin sensitivity in obese adolescents. An approximate decrease in BMI of 8% was the threshold level at which insulin sensitivity improved. As more weight loss programs are designed for obese adolescents, it will be important to have reasonable weight loss goals that will yield improvements in metabolic and cardiovascular disease risk factors.

Exercise reduces body fat and improves insulin sensitivity and pancreatic β-cell function in overweight and obese male Taiwanese adolescents

“…In the present study, most of the participants in the overweight/obese group showed significant reductions in body mass and fat mass, and their FSI and HOMA-IR were reduced by about 38, and 39%, respectively. In contrast, Abrams et al [ 30 ] reported that a decrease in BMI of 8% was required for improvements in insulin sensitivity in adolescents participating in a 4-month behavioral weight loss trial.…”

The effects of probiotic administration on patients with prediabetes: a meta-analysis and systematic review

“…In turn, weight loss can improve insulin sensitivity in pediatric T2DM. In a randomized controlled trial, an 8% reduction in BMI was associated with improved insulin sensitivity in obese adolescents [ 84 ]. In addition, pediatric T2DM exhibited faster islet β-cell decline and higher rates of treatment failure compared to adult T2DM [ 85 ], and supplementation with Lactobacillus casei strain Shirota fermented milk was found to enhance islet β-cell function in the present study.…”

CHECK: A randomized trial evaluating the efficacy and cost-effectiveness of home visitation in pediatric weight loss treatment

“…A two-sample ttest (or the Mann-Whitney test if the primary outcome is not normally distributed) will compare the two arms on mean ΔzBMI. As a secondary analysis, the proportions of children in each arm that achieve a decrease in ΔzBMI of at least 0.25, which is considered to be a threshold for clinically significant weight loss [albeit based on limited data [56][57][58][59];], will be compared. Linear mixed models will be used to investigate the pattern of change in zBMI over time.…”