Utility of the modified ATP III defined metabolic syndrome and severe obesity as predictors of insulin resistance in overweight children and adolescents: a cross-sectional study

Dhuper, Sarita; Cohen, Hillel W.; Daniel, Josephine; Gumidyala, Padmasree; Agarwalla, Vipin; St Victor, Rosemarie; Dhuper, Sunil
January 2007
Cardiovascular Diabetology;2007, Vol. 6, p4
Academic Journal
Background: The rising prevalence of obesity and metabolic syndrome (MetS) has received increased attention since both place individuals at risk for Type II diabetes and cardiovascular disease. Insulin resistance (IR) has been implicated in the pathogenesis of obesity and MetS in both children and adults and is a known independent cardiovascular risk factor. However measures of IR are not routinely performed in children while MetS or severe obesity when present, are considered as clinical markers for IR. Objective: The study was undertaken to assess the utility of ATPIII defined metabolic syndrome (MetS) and severe obesity as predictors of insulin resistance (IR) in a group of 576 overweight children and adolescents attending a pediatric obesity clinic in Brooklyn. Methods: Inclusion criteria were children ages 3-19, and body mass index > 95th percentile for age. MetS was defined using ATP III criteria, modified for age. IR was defined as upper tertile of homeostasis model assessment (HOMA) within 3 age groups (3-8, n = 122; 9-11, n = 164; 12-19, n = 290). Sensitivity, specificity, positive predictive values and odds ratios (OR) with 95% confidence intervals (CI) were calculated within age groups for predicting IR using MetS and severe obesity respectively. Results: MetS was present in 45%, 48% and 42% of the respective age groups and significantly predicted IR only in the oldest group (OR = 2.0, 95% CI 1.2, 3.4; p = .006). Sensitivities were <55%; specificities <63% and positive predictive values ≤ 42% in all groups. Severe obesity was significantly associated with IR in both the 9-11 (p = .002) and 12-18 (p = .01) groups but positive predictive values were nonetheless ≥ 51% for all groups. Conclusion: The expression of IR in overweight children and adolescents is heterogeneous and MetS or severe obesity may not be sufficiently sensitive and specific indicators of insulin resistance. In addition to screening for MetS in overweight children markers for IR should be routinely performed. Further research is needed to establish threshold values of insulin measures in overweight children who may be at greater associated risk of adverse outcomes whether or not MetS is present.


Related Articles

  • Red wine aid.  // Asian Pacific Post;10/11/2007, p23 

    The article reports on a study by Chinese researchers on the benefits of resveratrol, a chemical found in grape skin, in controlling type 2 diabetes, a life long disease marked by high level of sugar in the blood. According to the researchers, insulin resistance is the critical factor...

  • The association of dimethylarginine dimethylaminohydrolase 1 gene polymorphism with type 2 diabetes: a cohort study. Tse-Min Lu; Shing-Jong Lin; Ming-Wei Lin; Chiao-Po Hsu; Ming-Yi Chung // Cardiovascular Diabetology;2011, Vol. 10 Issue 1, p16 

    Background: Elevated plasma levels of asymmetric dimethylarginine (ADMA) has been reported to be associated with insulin resistance and micro/macrovascular diabetic complications, and may predict cardiovascular events in type 2 diabetic patients. Dimethylarginine dimethylaminohydrolase 1 (DDAH1)...

  • Exercise modulates myocardial protein kinase B/Akt in Zucker obese rats. Huisamen, B.; Lochner, A. // Heart;Feb2005, Vol. 91 Issue 2, p227 

    The article presents information on exercise that modulates myocardial protein kinase in obese rats. In type 2 diabetes, heart muscle is insulin resistant. Protein kinase B acts as a mediator of the metabolic effects of insulin, including translocation of the insulin sensitive glucose...

  • Inflammation, Insulin Resistance, and DiabetesMendelian Randomization Using CRP Haplotypes Points Upstream. Brunner, Eric J.; Kivimki, Mika; Witte, Daniel R.; Lawlor$2, Debbie A.; Smith, George Davey; Cooper, Jackie A.; Miller, Michelle; Lowe, Gordon D. O.; Rumley, Ann; Casas, Juan P.; Shah, Tina; Humphries, Steve E.; Hingorani, Aroon D.; Marmot, Michael G.; Timpson, Nicholas J.; Kumari, Meena // PLoS Medicine;Aug2008, Vol. 5 Issue 8, pe155 

    Using a Mendelian randomization approach, Eric Brunner and colleagues show that the associations between serum C-reactive protein and insulin resistance, glycemia, and diabetes are likely to be noncausal.

  • Sleep disturbance as a predictor of type 2 diabetes mellitus in men and women from the general population. Meisinger, C.; Heier, M.; Loewel, H. // Diabetologia;Feb2005, Vol. 48 Issue 2, p235 

    Aims/hypothesis: To examine gender specific associations between sleep disturbance and incident type 2 diabetes mellitus in a representative population sample in Germany. Methods: The study was based on 4,140 men and 4,129 women (aged 25-74 years) who participated in one of the three MONICA...

  • The emerging role of TRIB3 as a gene affecting human insulin resistance and related clinical outcomes. Prudente, Sabrina; Morini, Eleonora; Trischitta, Vincenzo // Acta Diabetologica;Jun2009, Vol. 46 Issue 2, p79 

    Type 2 diabetes is becoming epidemic. The personal and social burden imposed by diabetes will increase in the close future as its prevalence is expected to double in the next 15–20 years. Type 2 diabetes is caused by the combination of resistance to insulin action and inadequate insulin...

  • Insulin resistance and the metabolic syndrome. Landsberg, L. // Diabetologia;Jul2005, Vol. 48 Issue 7, p1244 

    This article focuses on the metabolic syndrome. Because the metabolic syndrome is associated with significant cardiovascular risk, and understanding the pathogenesis of this constellation of factors can help define therapeutic strategies to reverse or mitigate the risk. Additional risk factors...

  • The growth hormone-insulin like growth factor axis revisited: lessons from IGF-1 and IGF-1 receptor gene targeting. Yakar, Shoshana; Kim, Hyunsook; Zhao, Hong; Toyoshima, Yuka; Pennisi, Patricia; Gavrilova, Oksana; LeRoith, Derek // Pediatric Nephrology;Mar2005, Vol. 20 Issue 3, p251 

    We have created a liver-specificigf1gene-deletion mouse model (LID) with markedly reduced circulating IGF-I levels. They demonstrate that while they have normal growth and development they develop insulin resistance secondary to the elevation of circulating growth hormone. When mated with an...

  • Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women’s Heart and Health Study D.A. Lawlor et al.: Lung function and insulin resistance. Lawlor, D. A.; Ebrahim, S.; Davey Smith, G. // Diabetologia;Feb2004, Vol. 47 Issue 2, p195 

    Aims/hypothesis. The aim of this study was to assess the associations of lung function with insulin resistance and Type 2 diabetes. Methods. We did a cross-sectional study of 3911 women who were 60 to 79 years old from 23 British towns, assessing the association of measures of lung function with...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics