Department of Pediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Eur J Pediatr. 2012 Sep;171(9):1331-7. doi: 10.1007/s00431-012-1724-6. Epub 2012 Mar 28.
This study explores in a group of obese children and adolescents aged 10 to 16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.
本研究旨在探讨国际糖尿病联合会（IDF）标准下，10 至 16 岁肥胖儿童和青少年代谢综合征（MS）的患病率。此外，还研究了胰岛素抵抗（IR）的患病率，以寻找 MS 与 IR 之间的相关性。IDF 定义与改良的世界卫生组织（WHO）定义进行了比较。共有 159 名肥胖患者（74 名男性，85 名女性；中位年龄 12.7 岁）纳入研究。评估了人体测量学测量、血压和血清空腹血脂。进行了口服葡萄糖耐量试验（OGTT），并在 0、30、60、90 和 120 分钟时测量血清葡萄糖和胰岛素水平。计算了稳态模型评估的胰岛素抵抗（HOMA-IR）、定量胰岛素敏感性检查指数（QUICKI）、空腹血糖/胰岛素比值（FGIR）、Matsuda 指数和 OGTT 期间的总胰岛素水平。对于 IR 诊断，我们使用了先前文献中描述的临界值（HOMA-IR＞3.16、QUICKI＜0.357、FGIR＜7 以及/或 OGTT 期间胰岛素水平总和＞300mIU/mL）。根据 IDF 标准，MS 的患病率为 34.6%。使用 IDF 定义，MS 患者和非 MS 患者之间的替代 IR 指数没有统计学差异（QUICKI，94.5 与 83.7%；FGIR，81.1 与 78.8%；HOMA-IR，70.9 与 63.5%；以及 OGTT 期间的总胰岛素水平，61.8 与 51.9%）。Matsuda 指数值、空腹高胰岛素血症和糖耐量受损的患病率在这两组中也相似。总之，肥胖患者无论是否存在 MS，IR 都很明显。除非专门进行调查，否则 IDF 定义的 MS 无法发现存在 IR 的个体。
