Insulin Resistance and the Metabolic Syndrome in Obese French Children

Abstract

In many parts of the world, overweight and obesity have become increasingly prevalent in children in the past 2 decades. These states are associated with cardiovascular risk factors, and the risk increases with the development of complications such as impaired glucose tolerance, insulin resistance (IR), dyslipidemia, and hypertension. This study was planed to estimate the frequency of the IR syndrome (IRS) and metabolic syndrome (MS) in 65 overweight and 243 obese children and adolescents 7 to 17 years of age. MS was diagnosed using the National Cholesterol Education Program Adult Treatment Panel III criteria and IRS using the World Health Organization criteria. MS was diagnosed in 15.9% of the study group and IRS in 42.5%. More than half the children studied, 54.2%, did not have either IRS or MS. All but 3.6% of children with MS also presented with IRS. Body mass index (BMI) was a significant factor in MS after adjusting for age and gender. Other risk factors for MS included the homeostatic model assessment (HOMA) index and acanthosis nigricans. Children with IRS had significantly higher BMI values, and IRS became more frequent as the waist-to-hip ratio increased. Pubertal children were approximately 1.7-fold more likely than those who were prepubertal to develop IRS. The mother’s BMI, but not the father’s, significantly influenced the frequency of IRS. On multiple regression analysis, both the HOMA index and waist-to-hip ratio were significant and independent risk factors for MS. Both adiposity (personal and maternal) and puberty correlated positively and significantly with IRS. These findings show that metabolic abnormalities and insulin resistance are frequent in overweight and obese children and adolescents. In this study of obese European children, IRS appeared to be a relevant marker for cardiovascular complications.