Insulin resistance in children: consensus, perspective, and future directions.
OBJECTIVE
Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points.


METHODS
The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants.


METHODS
An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children.


METHODS
The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement.


CONCLUSIONS
Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.
Levy-Marchal
Claire
C
Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France.
Arslanian
Silva
S
Cutfield
Wayne
W
Sinaiko
Alan
A
Druet
Celine
C
Marcovecchio
M Loredana
ML
Chiarelli
Francesco
F
D000293:Adolescent; D000328:Adult; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D018752:Diet, Fat-Restricted; D004041:Dietary Fats; D004043:Dietary Fiber; D002149:Energy Intake; D015444:Exercise; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008019:Life Style; D008403:Mass Screening / Q000379:methods; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors
D004041:Dietary Fats; D004043:Dietary Fiber