Insulin resistance and cardiometabolic risk factors in obese children and adolescents: a hierarchical approach

Abstract

This study aims to globally assess the network of insulin resistance (IR)-related factors in a sample of overweight and obese Greek youths.A total of 185 subjects were examined, and IR was quantified by homeostasis model assessment (HOMA-IR). Multivariate hierarchical approach was performed, and five distinct levels were recognized, namely, immutable demographic features and early life parameters, current anthropometric measures, IR, unfavorable clinical conditions, and social parameters. Two analyses were performed based on HOMA-IR cut-off values (3.16 and, as an alternative, 3.99).Obesity was associated with IR (adjusted OR=3.19, 95% CI: 1.12–9.09). IR steadily predicted low HDL (adjusted OR=5.75, 95% CI: 1.58–20.87), hypertriglyceridemia (adjusted OR=10.28, 95% CI: 1.18–89.55), and systolic hypertension. At the alternative analysis, IR was also associated with older age, older age at menarche, hyperuricemia, and low school grades.Emerging on the grounds of obesity, IR confers risks for dyslipidemia and hypertension at a relatively early age. Along with weight loss, interventions targeted at IR are required to prevent cardiometabolic risk in adolescence.

Decreased Cardiovascular Risk after Roux-en-Y Gastric Bypass Surgery in Chinese Diabetic Patients with Obesity

“…Haffner et al [22] reported that hyperinsulinemia or insulin resistance kept the central role in pathogenesis of metabolic syndrome, T2DM, and CVD. A higher HOMA-IR (≥2.6) confers higher cardiovascular risk, reported by the studies on 667 adolescents (16-17 years old) [23] and 185 Greek children [24]. Consistently, mean HOMA-IR in our patients changed from 12.19 to 2.48 with significant reduction after RYGB surgery.…”

Effects of insulin resistance on the association between the circulating retinol-binding protein 4 level and clustering of pediatric cardiometabolic risk factors

“…In a large‐scale survey conducted in India, high HOMA1‐IR was linked to elevated TG, FPG, and blood pressure . Based on 5 levels of hierarchical investigation, IR (HOMA‐IR > 3.16) was observed to steadily predict low HDL‐C, hypertriglyceridemia, and systolic hypertension among obese children . One puberty‐associated study conducted in children with obesity revealed that MetS was correlated with increased oral glucose tolerance test (OGTT)‐based IR values in prepuberty, while it was associated with increased HOMA1‐IR postpuberty .…”

“…Higher levels of postprandial IR have been reported in obese children with MetS, even before the onset of puberty . In a 5‐level hierarchical study among children and adolescents with obesity, IR was observed to confer a high risk for dyslipidemia and hypertension at a relatively early age . In southern India, IR was linked to individual cardiometabolic risk factors, and plasma insulin exhibited an association with the clustering of certain risk components .…”

Childhood obesity at the crossroads

“…In this issue of our journal we have compiled comprehensive data on several aspects of childhood obesity to highlight the importance of obesity research for society, individuals at risk and the affected patients (2,4,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). It is clear that we have to strengthen our efforts in respect to investigate prevention and interventions that will work both on an individual and a societal level.…”

“…Hence, the importance of physical activity on metabolic health is again documented (10). Insulin resistance and cardiometabolic risk are also studied in the work by Sakou et al (11). A putative link between thyroid function, obesity and insulin resistance is the topic of the study by Santos et al It looks as if children with higher TSH levels had higher degrees of insulin resistance as, for example, expressed by HOMA-IR (12).…”