Cali Anna Mg, Caprio Sonia
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Curr Opin Endocrinol Diabetes Obes. 2008 Apr;15(2):123-7. doi: 10.1097/MED.0b013e3282f57251.
The prevalence of obesity in youth is increasing alarmingly among children and adolescents in the United States. The problem falls disproportionately on African-American and Hispanic children. Many of the metabolic and cardiovascular complications associated with obesity are already present during childhood and are closely linked to the concomitant insulin resistance/hyperinsulinemia and degree of obesity. Moreover, these co-morbidities persist into adulthood.
The progression from normal glucose tolerance to type 2 diabetes mellitus involves an intermediate stage known as prediabetes or impaired glucose regulation. Prediabetes is characterized by peripheral insulin-resistance and impaired glucose sensitivity of first-phase insulin secretion. On the other hand, in overt type 2 diabetes mellitus beta-cell failure becomes fully manifested. Progression from prediabetes to type 2 diabetes mellitus in youth is characterized by marked weight gain and further reduction in insulin secretion and insulin resistance.
Reverting obesity through lifestyle modification, that involves nutrition education, behavior modification and exercise, is an important step to prevent the progression to diabetes.
在美国儿童和青少年中，青少年肥胖患病率正以惊人的速度上升。这一问题在非裔美国人和西班牙裔儿童中尤为严重。许多与肥胖相关的代谢和心血管并发症在儿童期就已出现，并且与伴随的胰岛素抵抗/高胰岛素血症以及肥胖程度密切相关。此外，这些合并症会持续到成年期。
从正常糖耐量进展到2型糖尿病涉及一个称为糖尿病前期或糖调节受损的中间阶段。糖尿病前期的特征是外周胰岛素抵抗和第一相胰岛素分泌的葡萄糖敏感性受损。另一方面，在显性2型糖尿病中，β细胞功能衰竭完全显现出来。青少年从糖尿病前期进展到2型糖尿病的特征是体重显著增加，胰岛素分泌和胰岛素抵抗进一步降低。
通过生活方式改变来逆转肥胖，包括营养教育、行为改变和运动，是预防进展为糖尿病的重要一步。
