title: Insulin resistance in children: consensus, perspective, and future directions.
abstract: 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.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Levy-Marchal
authors.forename: Silva
authors.initials: S
authors.lastname: Arslanian
authors.forename: Wayne
authors.initials: W
authors.lastname: Cutfield
authors.forename: Alan
authors.initials: A
authors.lastname: Sinaiko
authors.forename: Celine
authors.initials: C
authors.lastname: Druet
authors.forename: M Loredana
authors.initials: ML
authors.lastname: Marcovecchio
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarelli
mesh_terms: 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
chemical_list: D004041:Dietary Fats; D004043:Dietary Fiber