Differences in Cardiometabolic Risk between Insulin-Sensitive and Insulin-Resistant Overweight and Obese Children

Abstract

Background: It is known that 15-30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management.Methods: Baseline data from 7-to 12-year-old, overweight, and obese children enrolled in a weight management program at an urban hospital were analyzed. Homeostatic model assessment for insulin resistance (HOMA-IR) < 2.6 was used to define insulinsensitive and HOMA-IR ‡ 2.6 was used to defined insulin-resistant participants. Demographics, physical activity measures, and cardiometabolic risk factors were compared between the two phenotypes. Odds ratios (ORs) examining the association between intermediate endpoints (metabolic syndrome [MetS], nonalcoholic fatty liver disease [NAFLD], systemic inflammation, and microalbuminuria) and the two metabolic phenotypes were evaluated.Results: Of the 362 overweight/obese participants, 157 (43.5%) were insulin sensitive and 204 (56.5%) were insulin resistant. Compared to the insulin-sensitive group, the insulin-resistant group was older (8.6 -1.6 vs. 9.9 -1.7; p < 0.001) and had a higher BMI z-score (1.89 -0.42 vs. 2.04 -0.42; p = 0.001). After multivariable adjustment, compared to the insulin-sensitive group, the insulin-resistant group had higher odds of having MetS (OR, 5.47; 95% confidence interval [CI]: 1.72, 17.35; p = 0.004) and NAFLD (OR, 8.66; 95% CI, 2.48, 30.31; p = 0.001), but not systemic inflammation (OR, 1.06; 95% CI: 0.56, 2.03; p = 0.86) or microalbuminuria (OR, 1.71; 95% CI, 0.49, 6.04; p = 0.403).Conclusions: Using a HOMA-IR value of ‡ 2.6, clinical providers can identify prepubertal and early pubertal children most at risk. Focusing limited resources on aggressive weight interventions may lead to improvement in cardiometabolic health.

High-normal estimated glomerular filtration rate and hyperuricemia positively correlate with metabolic impairment in pediatric obese patients

“…Associations between microalbuminuria and other cardiometabolic markers in obese children and adolescents have been reported in some [ 16 , 18 , 20 , 21 , 22 , 25 ] but not all studies [ 17 , 19 , 26 ], including ours. Although this lack of correlation could be explained by the young mean age of our patients or the low prevalence of microalbuminuria registered in these latter, our findings do not support a routine assessment of microalbuminuria in all obese children and adolescents.…”

Defining metabolically healthy obesity in children: a scoping review

“…There were five MHO definition groups that were used in the studies included in the present review with variability in the number of risk factors included in MHO definitions. Half of the included studies (50%) underscored the lack of a universal definition , and highlighted the need for a universal definition of MHO in children. In response to these reports, we included a Delphi process with an international panel of experts to gain consensus on and establish a new, evidence‐based definition of MHO.…”

“…First, there is no fixed set of risk factors to define MHO in children. For instance, some studies used a combination of cardiometabolic risk factors plus a measure of insulin , while others used either insulin alone or cardiometabolic risk factors alone . Although there were several combinations of risk factors, most of the criteria used to define MHO were based on definitions that have been applied to define the metabolic syndrome .…”

“…To date, there is no complete and comprehensive synthesis of the definitions, risk factors, and cut‐off values that are currently being applied in the MHO literature in children. Moreover, several papers highlighted the lack of a universal definition , and many papers emphasized the need for a universal definition of MHO in children . For these reasons, our purpose was to conduct a scoping review to address two fundamental questions: (i) What definitions have been used for MHO in children?…”

Contribution of insulin resistance to decreased baroreceptor sensitivity & cardiometabolic risks in pre-obesity & obesity

“…The sample size was calculated using OpenEpi, version 3 ( www.OpenEpi.com ), open source calculator. Based on the previous report 18 , the sample size was calculated with 90 per cent power to detect the difference (2.44) between means and standard deviation (SD) of 2.23 in group 1 and 1.81 in group 2 of homeostatic model for IR (HOMA-IR) with a significance level of (alpha) 0.05. The minimum sample size was calculated to be 15 in each group.…”