Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany.
Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711 Datteln, Germany.
Clin Nutr. 2014 Aug;33(4):620-5. doi: 10.1016/j.clnu.2013.09.007. Epub 2013 Sep 18.
Insulin resistance has been proposed to be associated with weight gain in obesity. Therefore, we analyzed the impact of insulin resistance and its associated cardiovascular risk factors (CRFs) summarized in the Metabolic Syndrome (MetS) on change of weight status in obese children.
We analyzed 484 obese children who had participated in a lifestyle intervention and 533 obese children without lifestyle intervention. The changes of BMI-SDS in the time period of 1-year were related to baseline fasting insulin resistance index HOMA, blood pressure, waist circumference, waist-to-height ratio, lipids, uric acid, and HbA1c.
In contrast to obese children without lifestyle intervention, BMI-SDS decreased and the majority of CRFs improved significantly in obese children with lifestyle intervention. Age, BMI, waist circumference, waist-to-height ratio, blood pressure, uric acid, triglycerides, and HOMA were negatively significantly related to reduction of BMI-SDS in children with lifestyle intervention. In multiple linear regression analysis adjusted for gender, pubertal stage, and treatment center (R² = 0.26), waist circumference (r = -0.016 [confidence interval -0.019 up to -0.013], p < 0.001) was the strongest negative predictor of weight loss in children with lifestyle intervention. In children without lifestyle intervention, we did not find significant relationships between change of BMI-SDS and CRFs including insulin resistance in multiple regression analysis.
Insulin resistance and components of the MetS were associated negatively with weight loss in lifestyle intervention. Waist circumference at baseline was the strongest negative predictor of weight loss suggesting that obese children with abdominal fat distribution need more intensive interventions. This study is registered at clinicaltrials.gov (NCT00435734).
胰岛素抵抗与肥胖患者的体重增加有关。因此，我们分析了肥胖儿童中胰岛素抵抗及其相关心血管危险因素（CRFs）在代谢综合征（MetS）中对体重变化的影响。
我们分析了 484 名接受生活方式干预的肥胖儿童和 533 名未接受生活方式干预的肥胖儿童。1 年内 BMI-SDS 的变化与基线空腹胰岛素抵抗指数 HOMA、血压、腰围、腰高比、血脂、尿酸和 HbA1c 相关。
与未接受生活方式干预的肥胖儿童相比，接受生活方式干预的肥胖儿童 BMI-SDS 降低，大多数 CRFs 显著改善。年龄、BMI、腰围、腰高比、血压、尿酸、甘油三酯和 HOMA 与生活方式干预儿童 BMI-SDS 的降低呈负相关。在调整性别、青春期阶段和治疗中心的多元线性回归分析中（R²=0.26），腰围（r=-0.016[置信区间-0.019 至-0.013]，p<0.001）是生活方式干预儿童体重减轻的最强负预测因子。在未接受生活方式干预的儿童中，我们在多元回归分析中未发现 BMI-SDS 变化与包括胰岛素抵抗在内的 CRFs 之间存在显著关系。
胰岛素抵抗和代谢综合征的成分与生活方式干预中体重减轻呈负相关。基线时的腰围是体重减轻的最强负预测因子，这表明腹部脂肪分布的肥胖儿童需要更强化的干预措施。本研究在 clinicaltrials.gov 注册（NCT00435734）。
