Morandi A, Maschio M, Marigliano M, Miraglia Del Giudice E, Moro B, Peverelli P, Maffeis C
Department of Life & Reproduction Sciences, Section of Pediatrics, Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, University of Verona, Verona, Italy.
Pediatr Obes. 2014 Feb;9(1):17-25. doi: 10.1111/j.2047-6310.2012.00136.x. Epub 2013 Jan 7.
What is already known about this subject Fasting triglycerides above 1.17 mmol/L have been shown to be useful to select obese children and adolescents who may present impaired glucose tolerance in a Canadian cohort. Fasting plasma glucose is associated with the risk to present impaired glucose tolerance in several cohorts of obese children and adolescents. What this study adds When applied to Italian cohorts of obese children and adolescents, the triglycerides cut-off of 1.17 mmol/L has similar validity as in the Canadian cohort to select patients who may present impaired glucose tolerance. Fasting plasma glucose and fasting triglycerides can be combined to obtain an accurate criterion to select obese children and adolescents who may present impaired glucose tolerance.
We aimed to validate fasting triglycerides > 1.17 mmol L(-1) , a criterion recently proposed for selecting obese children at risk of impaired glucose tolerance (IGT), and to assess whether the accuracy of triglycerides (TG) can be improved by the use of other variables.
We studied an Italian cohort of 817 obese children and adolescents (8-18.4 years) who underwent clinical examination, fasting blood analysis and the oral glucose tolerance test (OGTT). The discriminative properties of TG > 1.17 mmol L(-1) were assessed and compared with those observed in a Canadian cohort from which this criterion was derived: 71.4 [57.8-85.1]% sensitivity and 64.1 [57.7-70.4]% specificity. The possible contribution of other variables was evaluated by assessing the net reclassification improvement (NRI), i.e., the net increase in the percentage of subjects correctly classified.
Thirty-nine children (4.7%) had IGT. The 1.17 mmol L(-1) TG threshold showed 66.6 [51.8-81.4]% sensitivity and 68.2 [64.9-71.5]% specificity, thus successfully validated. Fasting plasma glucose (FPG) was independently associated with IGT (odds ratio = 3.86 [2.09-7.14], P < 0.001), besides TG. The bivariate criterion of TG ≥ 1.13 mmol L(-1) plus FPG ≥ 4.44 mmol L(-1) had a 69.2 [54.7-83.7]% sensitivity and a 78.2 [76.8-79.6]% specificity, thus displaying a 12.6% NRI (P < 0.001) compared with TG>1.17 mmol L(-1) .
TG > 1.17 mmol L(-1) is a useful criterion to detect roughly 66% of obese children with IGT through OGTT performed in about 33% of all obese children. However, the 'TG≥1.13 mmol L(-1) plus FPG≥4.44 mmol L(-1) ' criterion improved discrimination accuracy, leading to the possibility of detecting even more than 66% of obese children with IGT though limiting OGTT to just 25% of all obese children.
关于该主题的已知信息 在加拿大的一个队列中，空腹甘油三酯高于1.17 mmol/L已被证明有助于筛选可能存在糖耐量受损的肥胖儿童和青少年。空腹血糖与多个肥胖儿童和青少年队列中出现糖耐量受损的风险相关。本研究的新增内容 当应用于意大利肥胖儿童和青少年队列时，1.17 mmol/L的甘油三酯临界值在筛选可能存在糖耐量受损患者方面具有与加拿大队列相似的有效性。空腹血糖和空腹甘油三酯可以结合起来，以获得一个准确的标准来筛选可能存在糖耐量受损的肥胖儿童和青少年。
我们旨在验证空腹甘油三酯>1.17 mmol/L这一最近提出的用于筛选有糖耐量受损（IGT）风险的肥胖儿童的标准，并评估使用其他变量是否能提高甘油三酯（TG）的准确性。
我们研究了一个由817名肥胖儿童和青少年（8 - 18.4岁）组成的意大利队列，他们接受了临床检查、空腹血液分析和口服葡萄糖耐量试验（OGTT）。评估了TG>1.17 mmol/L的判别特性，并与得出该标准的加拿大队列中观察到的特性进行比较：敏感性为71.4 [57.8 - 85.1]%，特异性为64.1 [57.7 - 70.4]%。通过评估净重新分类改善（NRI）来评估其他变量的可能贡献，即正确分类的受试者百分比的净增加。
39名儿童（4.7%）患有IGT。1.17 mmol/L的TG阈值显示敏感性为66.6 [51.8 - 81.4]%，特异性为68.2 [64.9 - 71.5]%，从而成功得到验证。除了TG外，空腹血糖（FPG）与IGT独立相关（比值比 = 3.86 [2.09 - 7.14]，P < 0.001）。TG≥1.13 mmol/L加FPG≥4.44 mmol/L的二元标准敏感性为69.2 [54.7 - 83.7]%，特异性为78.2 [76.8 - 79.6]%，与TG>1.17 mmol/L相比，显示出12.6%的NRI（P < 0.001）。
TG>1.17 mmol/L是一个有用的标准，通过对约33%的肥胖儿童进行OGTT，可以检测出约66%患有IGT的肥胖儿童。然而，“TG≥1.13 mmol/L加FPG≥4.44 mmol/L”标准提高了判别准确性，使得即使将OGTT限制在仅25%的肥胖儿童中，也有可能检测出超过66%患有IGT的肥胖儿童。
