Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece.
Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece.
Clin Endocrinol (Oxf). 2018 Dec;89(6):757-764. doi: 10.1111/cen.13859. Epub 2018 Oct 11.
Adults with plasma glucose levels at one hour (1h-GL) ≥8.6 mmol/L during an oral glucose tolerance test (OGTT) are at increased risk for type 2 diabetes mellitus and present an unfavourable cardiometabolic and inflammatory profile, but relevant data on children are scarce.
To investigate if elevated 1h-GL during OGTT in obese children and adolescents is associated with insulin resistance and specific pro-inflammatory biomarkers.
The study group comprised 88 obese children who attended the Outpatient Pediatric Clinic of our Hospital between January and December 2016. Children were divided into two groups according to 1h-GL during an OGTT: group 1 (n = 57) consisted of those with 1h-GL <8.6 mmol/L and group 2 (n = 31) of those with 1h-GL ≥8.6 mmol/L. Arterial blood pressure, body mass index (BMI) and waist circumference (WC) z-scores were measured in all participants. Specific insulin resistance (IR) indices, that is HOMA-IR, Matsuda index and Cederholm insulin sensitivity index (ISI) were calculated. Further, pro-inflammatory biomarkers that have been correlated with obesity complications, namely adiponectin, leptin, visfatin and interleukin (IL)-6 together with lipid levels were measured in all participants. Logistic regression analysis was used.
Children in group 2 had higher insulin (15.5 ± 6.4 vs 10.9 ± 4.8 μU/mL), HOMA-IR (3.41 ± 1.4 vs 2.34 ± 1.05) and lower Matsuda index [4.7 (3.1) vs 18.4 (17) median plus IQR] and Cederholm ISI (38 ± 6 vs 56 ± 11), than children in group 1 (all P < 0.001). They also had higher visfatin (15.4 ± 5.2 vs 10.1 ± 7 ng/mL), and IL-6 [12.5 (6.7) vs 4.8 (4.4) pg/mL], and lower adiponectin (5.9 ± 3.4 vs 11.8 ± 4.7 μg/mL) than children in group 1 (all P < 0.001). Logistic regression showed that these differences between the two groups were independent of age, sex, Tanner stage, BMI and WC z-scores.
In obese children, 1h-GL ≥8.6 mmol/L during an OGTT is correlated with worsened IR, and an unfavourable metabolic and inflammatory profile. Thus, 1h-GL could be used as an additional marker to identify obese children and adolescents at increased risk of developing obesity complications.
口服葡萄糖耐量试验（OGTT）1 小时血糖（1h-GL）≥8.6mmol/L 的成年人患 2 型糖尿病的风险增加，且存在不良的心血管代谢和炎症特征，但儿童的相关数据很少。
研究肥胖儿童和青少年 OGTT 中升高的 1h-GL 是否与胰岛素抵抗和特定的促炎生物标志物相关。
该研究组包括 2016 年 1 月至 12 月期间在我院儿科门诊就诊的 88 名肥胖儿童。根据 OGTT 中 1h-GL 将儿童分为两组：第 1 组（n=57）的 1h-GL＜8.6mmol/L，第 2 组（n=31）的 1h-GL≥8.6mmol/L。所有参与者均测量了动脉血压、体重指数（BMI）和腰围（WC）z 评分。计算了特定的胰岛素抵抗（IR）指数，即 HOMA-IR、Matsuda 指数和 Cederholm 胰岛素敏感指数（ISI）。此外，在所有参与者中测量了与肥胖并发症相关的促炎生物标志物，即脂联素、瘦素、内脏脂肪素和白细胞介素（IL）-6 以及血脂水平。采用 logistic 回归分析。
第 2 组的胰岛素（15.5±6.4 vs 10.9±4.8μU/mL）、HOMA-IR（3.41±1.4 vs 2.34±1.05）更高，Matsuda 指数[4.7（3.1）vs 18.4（17）中位数加 IQR]和 Cederholm ISI（38±6 vs 56±11）更低，而第 1 组的儿童则更低（均 P＜0.001）。第 2 组的内脏脂肪素（15.4±5.2 vs 10.1±7ng/mL）和白细胞介素（IL）-6[12.5（6.7）vs 4.8（4.4）pg/mL]更高，脂联素（5.9±3.4 vs 11.8±4.7μg/mL）更低，而第 1 组的儿童则更低（均 P＜0.001）。logistic 回归显示，两组之间的这些差异独立于年龄、性别、Tanner 分期、BMI 和 WC z 评分。
在肥胖儿童中，OGTT 中 1h-GL≥8.6mmol/L 与 IR 恶化和代谢及炎症特征不良有关。因此，1h-GL 可作为识别肥胖儿童和青少年发生肥胖并发症风险增加的额外标志物。
