University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.
University of Colorado School of Medicine, Department of Biostatistics, Aurora, Colorado.
J Clin Endocrinol Metab. 2020 May 1;105(5):e2061-8. doi: 10.1210/clinem/dgaa043.
Physiologic changes in glucose metabolism are well-described to occur during puberty. However, there are important gaps in understanding the interaction between obesity and the normal physiologic changes during puberty, as well as how these changes could contribute to the increased risk of comorbidities, such as type 2 diabetes and dyslipidemia, in youth with obesity.
The objective of this study was to compare longitudinal changes in insulin sensitivity (Si) and secretion during pubertal progression in youth with obesity versus those with normal weight.
Longitudinal observational study evaluating youth from early puberty (Tanner [T]2-T3) until puberty completion (T5).
Pediatric academic hospital Clinical Translational Research Center.
Pubertal youth with normal weight (n = 47; 22 female, 25 male) and obesity (n = 37; 23 female, 14 male).
Si, insulin response (acute insulin response to glucose, AIRg) and disposition index (DI) by intravenous glucose tolerance test at baseline (T2-T3), T4, and T5.
Youth with obesity had significantly lower Si and higher AIRg at each time point (P < 0.001), but DI was similar between the groups. There were no group differences in trajectory of Si, AIRg or DI over time. Leptin, insulin-like growth factor-1, and obesity were most strongly associated with Si and AIRg at all time points.
Obesity significantly impacts Si during puberty, even at the earliest stages. However, in general, obese youth have adequate β-cell compensation for the significantly reduced Si of puberty. Future studies are needed to better predict the subset of youth who fail to maintain β-cell compensation during puberty.
葡萄糖代谢的生理变化在青春期期间已有很好的描述。然而，对于肥胖症与青春期正常生理变化之间的相互作用，以及这些变化如何导致肥胖青少年患糖尿病和血脂异常等合并症的风险增加，我们的理解仍存在重要空白。
本研究旨在比较肥胖和正常体重青少年在青春期进展过程中胰岛素敏感性（Si）和分泌的纵向变化。
对从青春期早期（Tanner [T]2-T3）到青春期结束（T5）的青少年进行纵向观察性研究。
儿科学术医院临床转化研究中心。
正常体重（n = 47；22 名女性，25 名男性）和肥胖（n = 37；23 名女性，14 名男性）青春期青少年。
静脉葡萄糖耐量试验时的 Si、胰岛素反应（急性葡萄糖胰岛素反应，AIRg）和胰岛β细胞功能指数（DI），分别在基线（T2-T3）、T4 和 T5 时进行测量。
肥胖组在各个时间点的 Si 均显著降低，AIRg 显著升高（P < 0.001），但两组之间 DI 相似。两组间 Si、AIRg 和 DI 的随时间变化的轨迹无差异。瘦素、胰岛素样生长因子-1 和肥胖症与所有时间点的 Si 和 AIRg 相关性最强。
肥胖症显著影响青春期期间的 Si，即使在最早的阶段也是如此。然而，一般来说，肥胖青少年具有足够的β细胞代偿功能，以代偿青春期期间 Si 的显著降低。需要进一步研究以更好地预测青春期期间无法维持β细胞代偿的青少年亚组。
