Hirschler Valeria, Calcagno Maria L, Aranda Claudio, Maccallini Gustavo, Jadzinsky Mauricio
Nutrition Department, Durand Hospital, Buenos Aires, Argentina.
Pediatr Diabetes. 2007 Oct;8(5):272-7. doi: 10.1111/j.1399-5448.2007.00282.x.
The metabolic syndrome is associated with insulin resistance in adults. We defined pediatric metabolic syndrome using criteria analogous to Adult Treatment Panel III. The purpose of this study was to determine whether these criteria are reliable for insulin resistance in children.
Out of 167 children (6.7 +/- 3 yr), 73 overweight [body mass index (BMI) > 95 percentile], 41 at risk of overweight (BMI > 85 < 95 percentile), and 53 normal-weight (BMI < 85 percentile) children matched for sex and age were examined. The results for waist circumference, blood pressure, oral glucose tolerance test, C-reactive protein, adiponectin, insulin, and lipids were obtained.
There was a comparable prevalence of the metabolic syndrome in both sexes. The prevalence of the metabolic syndrome was 11.3% [95% confidence interval (CI) 6.56-16.19%] among the whole group and 21.9% (95% CI 12.24-31.0%) among overweight children. Waist circumference >75 percentile 53.2% (95% CI 45.73-60.86%) and low high-density lipoprotein 27.5% (95% CI 20.77-34.32%) were common in this sample. Compared with patients without any component of the metabolic syndrome, homeostasis model assessment insulin resistance (HOMA-IR) for patients with one through four components was higher (beta = 0.6, 95% CI 0.4-0.7, p < 0.0001, R(2) = 0.185). A logistic regression analysis using the metabolic syndrome as the dependent variable showed that HOMA-IR (odds ratio 1.52, 95% CI 1.2-2.0, p = 0.007) was the only independent risk factor for the metabolic syndrome, adjusted for age and sex.
The importance of insulin resistance in the metabolic syndrome is supported by the results of logistic regression analysis. Early identification of children may be useful to predict future cardiovascular disease and type 2 diabetes.
代谢综合征与成年人的胰岛素抵抗相关。我们使用类似于成人治疗小组第三次报告的标准来定义儿童代谢综合征。本研究的目的是确定这些标准对儿童胰岛素抵抗是否可靠。
在167名儿童（6.7±3岁）中，检查了73名超重儿童（体重指数[BMI]>第95百分位数）、41名超重风险儿童（BMI>第85百分位数<第95百分位数）以及53名年龄和性别匹配的正常体重儿童（BMI<第85百分位数）。获得了腰围、血压、口服葡萄糖耐量试验、C反应蛋白、脂联素、胰岛素和血脂的结果。
代谢综合征在两性中的患病率相当。整个组中代谢综合征的患病率为11.3%[95%置信区间（CI）6.56 - 16.19%]，超重儿童中为21.9%（95%CI 12.24 - 31.0%）。腰围>第75百分位数在该样本中占53.2%（95%CI 45.73 - 60.86%），高密度脂蛋白低占27.5%（95%CI 20.77 - 34.32%）。与无代谢综合征任何组分的患者相比，有一至四个组分的患者的稳态模型评估胰岛素抵抗（HOMA - IR）更高（β = 0.6，95%CI 0.4 - 0.7，p < 0.0001，R(2)=0.185）。以代谢综合征为因变量的逻辑回归分析表明，调整年龄和性别后，HOMA - IR（优势比1.52，95%CI 1.2 - 2.0，p = 0.007）是代谢综合征的唯一独立危险因素。
逻辑回归分析结果支持胰岛素抵抗在代谢综合征中的重要性。早期识别儿童可能有助于预测未来的心血管疾病和2型糖尿病。
