[Prevalence of carbohydrate metabolism disturbances in a population of children and adolescents with severe obesity].
BACKGROUND
There is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism.


OBJECTIVE
To establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes.


METHODS
A cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA(1c)), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure.


RESULTS
A total of 133 patients were included: 67 boys (50.4%) and 66 girls (49.6%), with a mean age of 12.17±3.27 years. Fourteen patients (10.52%) had prediabetes (10 IFG, 3 IGT, 1 IFG+IGT): 7 girls and 8 boys, with a mean age of 13.2±3.3 years. One patient had DM2 (0.75%). Patients with prediabetes had significantly higher concentrations of fasting glucose (98±10.76 vs 88.53±6.3mg/d; p=0.001), insulinemia (35.38±14.22 vs 22.95±14.30μU/ml; p=0.009) and HOMA index (8.10±3.24 vs 4.89±3.27; p=0.004) than patients without impaired carbohydrate metabolism. These patients also had higher values of HbA(1c), triglycerides, blood pressure and HDL concentrations, although differences were not statistically significant.


CONCLUSIONS
The prevalence of prediabetes (IFG/IGT) in children with severe obesity was high (10.52%). These patients should therefore be investigated to establish early diagnosis and appropriate treatment. Obese patients with prediabetes have significantly higher levels of insulin and insulin resistance than individuals without impaired carbohydrate metabolism.
Servicio de Endocrinología y Nutrición, Hospital Universitario de Getafe, Madrid, Spain. docguada@hotmail.com
María Guadalupe
MG
Guijarro De Armas
Susana
S
Monereo Megias
Soralla
S
Civantos Modino
July Maribel
JM
Montaño Martínez
Paloma
P
Iglesias Bolaños
María
M
Durán Martínez
D000293:Adolescent; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism; D042241:Early Diagnosis; D005260:Female; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000453:epidemiology*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D009765:Obesity / Q000097:blood / Q000453:epidemiology*; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology; D015995:Prevalence; D013030:Spain / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
D001786:Blood Glucose; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D007328:Insulin; D014280:Triglycerides