Characterisation of morbidity in a UK, hospital based, obesity clinic.
OBJECTIVE
To identify clinical features which predict those most at risk of co-morbidities within an obesity clinic.


METHODS
Children attending an obesity clinic had fasting glucose, insulin, and lipids measured prior to a standard oral glucose tolerance test (OGTT). History and examination established birth weight, family history of type 2 diabetes/obesity, pubertal status, and presence of acanthosis nigricans. Central and total fat mass was estimated by bio-impedance.


RESULTS
Of the 126 children evaluated, 10.3% (n = 13) had impaired glucose tolerance (IGT); the majority (n = 11) of these would not have been identified on fasting glucose alone. Those with IGT were more likely to have a parental history of type 2 diabetes (relative risk 3.5). IGT was not associated with acanthosis nigricans. Twenty five per cent (n = 19) of those evaluated (n = 75) had evidence of the "metabolic syndrome" (MS). HDL cholesterol and triglyceride levels were related to insulin sensitivity (HOMA-R); HDL cholesterol was also related to birth weight SDS. We observed a trend for those with MS to have a lower birth weight SDS. The severity of obesity did not influence the likelihood of IGT or MS.


CONCLUSIONS
Significant numbers of obese children have associated co-morbidities. Analysis of fasting blood glucose samples alone is not satisfactory to adequately evaluate glucose homoeostasis. The overall level of obesity does not predict co-morbidities. Special attention should be given to those with parental diabetes and a history of low birth weight who are more likely to have IGT and abnormal lipid profiles respectively.
Sabin
M A
MA
University of Bristol, UK.
Ford
A L
AL
Holly
J M P
JM
Hunt
L P
LP
Crowne
E C
EC
Shield
J P H
JP
D000293:Adolescent; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000235:genetics; D005215:Fasting / Q000097:blood; D005260:Female; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology*; D009765:Obesity / Q000097:blood / Q000150:complications*; D010044:Outpatient Clinics, Hospital; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D008076:Cholesterol, HDL; D007328:Insulin; D014280:Triglycerides