P0053 PP INSULINE RESISTANCE SYNDROME IN OBESE CHILDREN

Abstract

Introduction: Obesity in children is associated to risk factors for the development of cardiovascular disorders and type 2 diabetes. Methods: To characterize the insulin sensitivity of obese children and to identify the association of insulin resistance with obesity, hyperleptinaemia, hyperlipaemia and hypertension and to investigate the prevalence of cardiovascular risk factors, we studied 104 (52 boys/52 girls) obese, 10.8±2.50 year-old children and 99 (51 boys/48 girls), control, 10.20±2.52 year-old children (Tanner stage 1–4). We considered obesity when BMIP95 and skinfoldsP95. Measures of insulin resistance were determined by homeostasis model assessment (HOMA), and insulin sensitivity was determined by basal insulinemia, and Glycaemia/insulin index.Measures of blood pressure, BMI, subcutaneous fat lipids and leptin were obtained under informed consent.The obese group underwent an oral glucose tolerance test (SOGT) and it was studied the presence of acanthosis nigricans. Results: Following a glucose challenge, obese children produced significantly more insulin (p<0.001), specially in puberal children (p<0.001).There was only one case of glucose intolerance in response to SOGT.Hyperinsulinemia in correlation with skinfolds was very significant (r: 0.683). As BMI increased, there was a statistically significant decrease in insuline sensitivity (p<0.001) and a proportional increase in the HOMA value (p<0.001).Insuline resistance was directly correlated to increases in blood pressure (p<0.001) and in triglycerides (p<0.001).HOMA was inversely correlated to decreases in C-HDL (p<0.001). However,it was not correlated with CLDL (p:0.693).74% of obese children with hyperinsulinemia presented acanthosis nigricans (p:0.001).After correlating leptin with adiposity, body fat content did significantly differ between obese and control children (p<0.001)and a direct relation with insulinemia was observed (p= 0.007).Clustering of cardiovascular risk factors in obese and control children demonstrated that only a few (15.96%) of the obese children were free of any risk factor; 84.04% of them had one, two, three or four risk factors. Conclusion: The decrease in insulin sensitivity and the clustering of risks factors (insulin resistance syndrome) are already apparent in obese children, showing evidence of hyperinsulinemia following a glucose load. This suggests that the early stages of metabolic decompensation leading to type 2 diabetes are already occurring.Monitoring these risk factors (known to be part of IRS) should become part of habitual medical care for obese children.The cardiovascular risk factors are more common in obese children than in controls and tend to be clustered in these group.