Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
Clinical Epidemiology Unit, Liver Research Center, Area Science Park, Trieste, Italy.
JAMA Pediatr. 2014 Oct;168(10):917-24. doi: 10.1001/jamapediatrics.2014.900.
To date, the relationship among adiposity, insulin resistance, and cardiovascular risk factors at the onset of overweight or obesity has been unexplored.
To assess whether insulin resistance and metabolic abnormalities are detectable at the onset of obesity and to unravel the interplay among adiposity, insulin resistance, and other such abnormalities.
DESIGN, SETTING, AND PARTICIPANTS: The Origin of Cardiovascular Risk in Overweight Preschool Children cohort study aimed to evaluate at the onset of obesity in preschool children the prevalence of metabolic abnormalities, including hypertension, dyslipidemia, impaired carbohydrate metabolism, and nonalcoholic fatty liver disease. Between July 1, 2011, and July 30, 2012, in the Rome municipality, 13 family pediatricians enrolled healthy children (age range, 2.0-5.8 years) in the study during their routine practice of growth monitoring. Clinical medical records of 5729 children were reviewed; 597 children manifested new-onset overweight or obesity as their body mass index changed from normal weight to overweight or obesity in the previous 12 months according to the International Obesity Task Force classification. Of them, 219 were studied.
Patients with new-onset overweight or obesity underwent clinical laboratory testing, including oral glucose tolerance test, and ultrasonographic investigations of fatty liver and intimal medial thickness of the common carotid arteries, subcutaneous adipose tissue, and visceral adipose tissue. The homeostatic assessment model algorithm-insulin resistance was calculated.
Among the entire population (n = 5729), overweight increased from 7.0% at 2.0 years to 16.9% at 5.8 years, with corresponding figures of 1.1% to 2.9% for obesity. In total, 597 overweight or obese children (10.4%) were identified, and 219 of them (36.7%) were studied. Among the latter, 86 patients (39.3%) had at least 1 metabolic abnormality. Hypertension was diagnosed in 29 patients (13.2%), dyslipidemia in 55 patients (25.1%), impaired fasting glucose level in 7 patients (3.2%), and glucose intolerance in 6 patients (2.7%). Nonalcoholic fatty liver disease was diagnosed in 68 patients (31.1%).
Cardiometabolic risk factors, including fatty liver, are detectable in preschoolers at the onset of overweight or obesity, despite short-term exposure to excess weight and reduced insulin sensitivity. Our findings suggest the need to screen for cardiometabolic abnormalities at an earlier age than is now recommended.
迄今为止，超重或肥胖发生时的肥胖、胰岛素抵抗与心血管风险因素之间的关系尚未得到研究。
评估肥胖发生时是否可检测到胰岛素抵抗和代谢异常，并阐明肥胖、胰岛素抵抗和其他异常之间的相互作用。
设计、地点和参与者：超重学龄前儿童心血管风险起源研究（Origin of Cardiovascular Risk in Overweight Preschool Children）旨在评估学龄前儿童肥胖发生时代谢异常（包括高血压、血脂异常、糖代谢受损和非酒精性脂肪肝疾病）的患病率。2011 年 7 月 1 日至 2012 年 7 月 30 日，在罗马市，13 名家庭儿科医生在儿童生长监测的常规实践中招募了新出现超重或肥胖的健康儿童（年龄 2.0-5.8 岁）。共查阅了 5729 名儿童的临床病历记录，597 名儿童表现为新出现的超重或肥胖，他们的体重指数在过去 12 个月内从正常体重转变为超重或肥胖（根据国际肥胖工作组的分类）。其中，219 名儿童接受了研究。
新出现超重或肥胖的患者接受了临床实验室检查，包括口服葡萄糖耐量试验、肝脂肪变和颈总动脉内膜中层厚度、皮下脂肪组织和内脏脂肪组织的超声检查。计算了稳态评估模型算法胰岛素抵抗。
在整个人群（n = 5729）中，超重比例从 2.0 岁时的 7.0%增加到 5.8 岁时的 16.9%，肥胖比例从 1.1%增加到 2.9%。共发现 597 名超重或肥胖儿童（10.4%），其中 219 名（36.7%）接受了研究。在这些患者中，86 名患者（39.3%）存在至少 1 种代谢异常。29 名患者（13.2%）诊断为高血压，55 名患者（25.1%）诊断为血脂异常，7 名患者（3.2%）诊断为空腹血糖受损，6 名患者（2.7%）诊断为葡萄糖耐量受损。68 名患者（31.1%）诊断为非酒精性脂肪性肝病。
尽管超重时间较短且胰岛素敏感性降低，但在学龄前儿童超重或肥胖发生时，可检测到心血管代谢风险因素，包括脂肪肝。我们的研究结果表明，需要比目前推荐的更早的年龄筛查心血管代谢异常。
