Abstract
PurposeTo investigate the relationship between the single-point insulin sensitivity estimator (SPISE) index, an insulin sensitivity indicator validated in adolescents and adults, and metabolic profile in overweight/obese children, and to evaluate whether basal SPISE is predictive of impaired glucose regulation (IGR) development later in life.MethodsThe SPISE index (= 600 × HDL0.185/Triglycerides0.2 × BMI1.338) was calculated in 909 overweight/obese children undergoing metabolic evaluations at University of Cagliari, Italy, and in 99 normal-weight, age-, sex-comparable children, selected as a reference group, together with other insulin-derived indicators of insulin sensitivity/resistance. 200 overweight/obese children were followed-up for 6.5 [3.5–10] years, data were used for longitudinal retrospective investigations.ResultsAt baseline, 96/909 (11%) overweight/obese children had IGR; in this subgroup, SPISE was significantly lower than in normo-glycaemic youths (6.3 ± 1.7 vs. 7 ± 1.6, p < 0.001). The SPISE index correlated positively with the insulin sensitivity index (ISI) and the disposition index (DI), negatively with age, blood pressure, HOMA-IR, basal and 120 min blood glucose and insulin (all p values < 0.001). A correlation between SPISE, HOMA-IR and ISI was also reported in normal-weight children. At the 6.5-year follow-up, lower basal SPISE—but not ISI or HOMA-IR—was an independent predictor of IGR development (OR = 3.89(1.65–9.13), p = 0.002; AUROC: 0.82(0.72–0.92), p < 0.001).ConclusionIn children, low SPISE index is significantly associated with metabolic abnormalities and predicts the development of IGR in life.
Highlights
Overweight and obesity in childhood are conditions epidemically spread worldwide, and the dramatic increase of their incidence in the last decades has become a relevant public health issue around the world [1]
The single-point insulin sensitivity estimator (SPISE) index positively correlated with the insulin sensitivity index (ISI) and disposition index (DI) whereas an inverse association was found between SPISE and age, blood pressure, HOMAIR, basal and 120 min blood glucose and insulin (Table 2)
The main finding of this study is that the SPISE index correlates with insulin-derived indicators of insulin resistance and sensitivity in children, and significantly predicts the development of glucose metabolism abnormalities later in life in this population
Summary
Overweight and obesity in childhood are conditions epidemically spread worldwide, and the dramatic increase of their incidence in the last decades has become a relevant public health issue around the world [1]. For the cross-sectional phase of this study, we analysed the SPISE index from data obtained in 909 overweight or obese children (median age [interquartile range]: 10 [8,9,10,11,12,13] years) consecutively recruited at the Paediatric Endocrine outpatient clinics of the Paediatric Hospital for Microcitaemia, Cagliari, Italy. To provide a reference range in children with normal metabolic status, the SPISE index was calculated in 99 normal-weight healthy children (median age [interquartile range]: 11 [9–12.9] years) with age and sex distribution comparable to the first cohort These normal-weight children, without any endocrine, cardiovascular, gastrointestinal or renal disorder, were recruited in the same clinical setting and selected among those referring to the Paediatric outpatients’ clinic for undergoing routine clinical assessment. Study participants were classified as pre-pubertal or pubertal according to the Tanner stage for pubertal development (pre-puberal, for Tanner’s stage I: boys with pubic hair and gonadal stage I, girls with pubic hair stage and breast stage I; puberal for Tanner’s stages ≥ II–V: boys with pubic hair and gonadal stage ≥ II and girls with pubic hair stage and breast stage ≥ II) [29]
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