PEDIATRIC OBESITY AND INSULIN RESISTANCE: Chronic Disease Risk and Implications for Treatment and Prevention Beyond Body Weight Modification

Cruz, Martha L.; Shaibi, Gabriel Q.; Weigensberg, Marc J.; Spruijt‐Metz, Donna; Ball, Geoff D.C.; Goran, Michael I.

doi:10.1146/annurev.nutr.25.050304.092625

Cited by 144 publications

(146 citation statements)

References 197 publications

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“…The North American adolescents were both older (14-18 years) and biologically more mature (Tanner stages 4-5) than the children involved in our study. Rapid and dynamic changes in various metabolic systems, including hormonal regulation, changes in body fat content and body fat distribution, as well as transient changes in insulin resistance, are known to occur during growth and puberty [1], which may partially explain the differences between studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies examining the interaction of markers of insulin resistance and fatness and fitness in a large sample of school-aged children are sparse and equivocal [9,10]. The purpose of the present study was to examine: (1) the association between markers of insulin resistance and body fat and waist circumference, taking into account cardiorespiratory fitness; and (2) to examine the association of markers of insulin resistance with cardiorespiratory fitness at differing levels of body fat and waist circumference in school-aged children.…”

Section: Introductionmentioning

confidence: 96%

“…One of the consequences of the paediatric obesity epidemic is thought to be an increased incidence of type 2 diabetes among children worldwide [1]. Longitudinal studies have shown that childhood obesity is closely related to markers of insulin resistance later in life [2].…”

Section: Introductionmentioning

confidence: 99%

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Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study

et al. 2007

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Aims/hypothesis Our aim was to examine the association between markers of insulin resistance and: (1) body fat and waist circumference, taking into account cardiorespiratory fitness in school-aged children; and (2) cardiorespiratory fitness at differing levels of body fat and waist circumference. Subjects and methods This was a cross-sectional study of 873 children aged 9.6±0.4 years from Estonia and Sweden. Weight, height and waist circumference were measured. Body fat was expressed as the sum of five skinfold thicknesses. Cardiorespiratory fitness was estimated by a maximal cycle-ergometer test. The studied markers of insulin resistance were fasting insulin and glucose, and homeostasis model assessment (HOMA). Results HOMA and fasting insulin were positively associated with body fat and waist circumference after adjusting for cardiorespiratory fitness, age, pubertal status and study location. HOMA and fasting insulin were negatively associated with cardiorespiratory fitness in children in the third (highest) tertile of body fat and waist circumference after controlling for sex, age, pubertal status and study location. Fasting glucose was negatively associated with cardiorespiratory fitness in children in the third (highest) tertile of waist circumference, but it was not associated when body fat was taken into account. Conclusions/interpretation In school-aged children, HOMA and fasting insulin are significantly associated with body fat and waist circumference. In addition, cardiorespiratory fitness explains a significant proportion of the HOMA and fasting insulin variance in those children with high levels of body fat and waist circumference. The findings suggest that the deleterious consequences ascribed to high fatness could be counteracted by having high levels of cardiorespiratory fitness.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study

et al. 2007

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“…44 However, few studies have examined associations between dietary factors and insulin sensitivity in children, and they have focused on carbohydrate and not fat intake. 46 …”

Section: Hypertension Insulin Resistance Resistin and Adiponectinmentioning

confidence: 99%

Dietary determinants of subclinical inflammation, dyslipidemia and components of the metabolic syndrome in overweight children: a review

Zimmermann

Aeberli

2008

Int J Obes

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Objective: To review and summarize the dietary determinants of the metabolic syndrome, subclinical inflammation and dyslipidemia in overweight children. Design: Review of the current literature, focusing on pediatric studies. Participants: Normal weight, overweight, or obese children and adolescents. Results: There is a growing literature on the metabolic effects of excess body fat during childhood. However, few pediatric studies have examined the dietary determinants of obesity-related metabolic disturbances. From the available data, it appears that dietary factors are not only important environmental determinants of adiposity, but also may affect components of the metabolic syndrome and modulate the actions of adipokines. Dietary total fat and saturated fat are associated with insulin resistance and high blood pressure, as well as obesity-related inflammation. In contrast to studies in adults, resistin and adiponectin do not appear to be closely linked to insulin resistance or dyslipidemia in childhood. However, circulating leptin and retinol-binding protein (RBP) 4 correlate well with obesity, central obesity and the metabolic syndrome in children. Intakes of antioxidant vitamins tend to be low in obese children and may be predictors of subclinical inflammation. Higher fructose intake from sweets and sweetened drinks in overweight children has been linked to decreased low-density lipoprotein (LDL) particle size. Conclusions: Dietary interventions aimed at reducing intakes of total fat, saturated fat and free fructose, whereas increasing antioxidant vitamin intake may be beneficial in overweight children. More research on the relationships between dietary factors and the metabolic changes of pediatric obesity may help to identify the dietary changes to reduce health risks. International Journal of Obesity (2008) 32, S11-S18; doi:10. 1038/ijo.2008.202 Keywords: child; metabolic syndrome; diet; inflammation; adipokine IntroductionIn both industrialized and non-industrialized countries, the prevalence of pediatric obesity is increasing. 1 Dietary factors are environmental determinants of adiposity, as well as components of the metabolic syndrome, and may modulate the actions of adipokines. Better understanding of the relationships between dietary factors and the metabolic changes of pediatric obesity may help to identify the dietary changes to reduce health risks. Hypertension, insulin resistance, resistin and adiponectinPediatric obesity is an important risk factor for adult hypertension and type 2 diabetes, and approximately one third of obese children are hypertensive and/or hyperinsulinemic. 2,3 The adipocyte-derived hormones resistin, adiponectin and leptin may play a role in the development of hypertension and/or insulin resistance. 4-7 Among children, inverse associations of adiponectin or resistin with body mass index (BMI) and insulin resistance have been reported, 8 but not all studies agree. 9 Studies on diet in childhood hypertension have mainly focused on sodium or calcium intake, rather than macr...

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“…In adults, dietary fat intake has been linked to insulin resistance independent of body weight [12], but pediatric studies have focused on carbohydrate and not fat intake [13]. Studies on diet in childhood hypertension have mainly focused on sodium or calcium intake [14], rather than on macronutrients.…”

Section: Introductionmentioning

confidence: 99%

Diet Determines Features of the Metabolic Syndrome in 6- to 14-Year-Old Children

Aeberli

Spinas²,

Lehmann³

et al. 2009

International Journal for Vitamin and Nutrition Research

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Background/Objectives: Insulin resistance (IR) and hypertension are common in overweight children, and the adipocyte-derived hormones resistin, adiponectin, and leptin may modulate IR and blood pressure (BP). Few data exist in children on dietary determinants of IR, BP, or leptin, and no data exist on dietary determinants of resistin and adiponectin. Therefore, the objective of this study was to investigate dietary determinants of IR, BP, resistin, adiponectin, and leptin concentrations, as well as the interrelationship among these variables, in normal and overweight children. Subjects/Methods: In 6- to 14-year-old Swiss children (n=79), nutritional intake was assessed using two 24-hour-recalls and a one-day dietary record. Body mass index (BMI), body fat percentage (BF%), waist/hip ratio (W/H ratio), BP, glucose, insulin, resistin, adiponectin, and leptin were determined. IR was calculated using the quantitative insulin sensitivity check index (QUICKI). Results: BMI, BF%, and W/H ratio were significant predictors of leptin and insulin, QUICKI, and systolic BP, but not resistin or adiponectin. Of the overweight and obese children, 40 % were diagnosed pre-hypertensive or hypertensive. Total energy, fat, saturated fat, and protein intakes were significant predictors of fasting insulin and QUICKI, and total fat, saturated fat, and monounsaturated fat intakes were significant predictors of systolic BP, independent of BMI standard deviation score (BMI-SDS) and age. There were no associations between these dietary factors and leptin, adiponectin, or resistin. Conclusion: In children, dietary macronutrient composition is a predictor of IR and systolic BP, but not resistin, adiponectin, or leptin concentrations. Resistin and adiponectin concentrations are not correlated with IR or BP in this age range.

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PEDIATRIC OBESITY AND INSULIN RESISTANCE: Chronic Disease Risk and Implications for Treatment and Prevention Beyond Body Weight Modification

Cited by 144 publications

References 197 publications

Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study

Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study

Dietary determinants of subclinical inflammation, dyslipidemia and components of the metabolic syndrome in overweight children: a review

Diet Determines Features of the Metabolic Syndrome in 6- to 14-Year-Old Children

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