Department of Clinical Sciences, Sapienza University of Rome, Polo Pontino, Viale del Policlinico 155, Rome, Italy.
Circulation. 2011 Apr 26;123(16):1757-62. doi: 10.1161/CIRCULATIONAHA.110.012898. Epub 2011 Apr 11.
Excess fat is one of the main determinants of insulin resistance, representing the metabolic basis for developing future cardiovascular disease. The aim of the current study was to find an easy-to-detect clinical marker of insulin resistance which can be used to identify young subjects at increased risk of cardiovascular disease.
Four-hundred and seventy-seven overweight/obese children and adolescents (mean age 10.31±2.80 years) were consecutively enrolled. Standard deviation score body mass index, fasting biochemical parameters, and homeostasis model assessment of insulin resistance were evaluated. Statistical differences were investigated using multiple linear regression analysis. Manual measure of wrist circumference was evaluated in all children and adolescents. Fifty-one subjects, randomly selected, underwent nuclear magnetic resonance imaging of the wrist to evaluate transversal wrist area at the Lister tubercle level. A statistically significant association was found between manual measure of wrist circumference and insulin levels or homeostasis model assessment of insulin resistance (β=0.34 and 0.35, respectively; P<10(-5) for both comparisons). These associations were more significant than those between SD score body mass index and insulin levels or homeostasis model assessment of insulin resistance (β=0.12 and 0.10, respectively; P≤0.02 for both comparisons). Nuclear magnetic resonance imaging acquisition clarified that the association between wrist circumference and insulin levels or homeostasis model assessment of insulin resistance reflected the association with bone tissue-related areas (P≤0.01 for both) but not with the adipose tissue ones (P>0.05), explaining 20% and 17% of the variances of the 2 parameters.
Our findings suggest a close relationship among wrist circumference, its bone component, and insulin resistance in overweight/obese children and adolescents, opening new perspectives in the prediction of cardiovascular disease.
过多的脂肪是导致胰岛素抵抗的主要决定因素之一，它是未来发生心血管疾病的代谢基础。本研究旨在寻找一种易于检测的胰岛素抵抗临床标志物，以便识别发生心血管疾病风险增加的年轻人群。
连续纳入 477 名超重/肥胖的儿童和青少年（平均年龄 10.31±2.80 岁）。评估了标准差评分体重指数、空腹生化参数和稳态模型评估的胰岛素抵抗。使用多元线性回归分析研究了统计学差异。对所有儿童和青少年进行了手腕周长的手动测量。随机选择 51 名受试者进行手腕的磁共振成像，以评估 Lister 结节水平的腕部横截面积。手动测量的手腕周长与胰岛素水平或稳态模型评估的胰岛素抵抗之间存在统计学显著相关性（β=0.34 和 0.35，均 P<10(-5)）。这些相关性比身体质量指数标准差评分与胰岛素水平或稳态模型评估的胰岛素抵抗之间的相关性更显著（β=0.12 和 0.10，均 P≤0.02）。磁共振成像采集结果表明，手腕周长与胰岛素水平或稳态模型评估的胰岛素抵抗之间的相关性反映了与骨组织相关区域的相关性（均 P≤0.01），而与脂肪组织的相关性不显著（P>0.05），可以解释这两个参数变异的 20%和 17%。
我们的研究结果表明，超重/肥胖的儿童和青少年中手腕周长、其骨骼成分与胰岛素抵抗之间存在密切关系，为心血管疾病的预测开辟了新的视角。
