Department of Pediatrics, Ruth Children's Hospital, Rambam Medical Center, Haifa, Israel.
Department of Woman and Child's Health, University of Padova, Padova, Italy.
Diabetes Care. 2022 Jun 2;45(6):1400-1407. doi: 10.2337/dc21-2210.
The carbohydrate-insulin model (CIM) claims that chronic exposure to hyperinsulinemia induced by dietary carbohydrates explains development of obesity via direct effects of insulin and/or low postprandial metabolic fuel levels. We aimed at testing whether indices of hyperinsulinemia and postprandial glucose levels can predict increases in the degree of obesity over time.
Children and adolescents with obesity attending a pediatric obesity clinic performed oral glucose tolerance tests (OGTTs) and received standard obesity management. Indices of hyperinsulinemia and insulin secretion were derived from the OGTT and evaluated in the face of changes in the degree of obesity over time.
A total of 591 children (217 males and 374 females) participated, and the mean follow-up was 1.86 ± 1.29 years. OGTT-derived area under the curve of insulin, peak insulin, fasting insulin, the insulinogenic index, or insulin at 30 min were not associated with greater changes in the degree of obesity in univariate or multivariate analyses (adjusted for baseline age, BMI z score, sex, and ethnicity). Low postprandial glucose <75 mg/dL was not associated with greater changes in the degree of obesity in univariate or multivariate analyses. In a subsample of 104 participants with a follow-up >4 years, none of these parameters was associated with greater increases in the degree of obesity.
In children and adolescents with obesity, exposure to hyperinsulinemia, greater insulin secretion, or low postprandial glucose is not associated with greater increases in the degree of obesity over 2-4 years. The CIM should be evaluated in children with lower BMI and for longer follow-up periods.
碳水化合物-胰岛素模型（CIM）声称，饮食碳水化合物引起的慢性高胰岛素血症会通过胰岛素的直接作用和/或餐后低代谢燃料水平来解释肥胖的发展。我们旨在测试高胰岛素血症和餐后血糖水平的指标是否可以预测肥胖程度随时间的增加。
参加儿科肥胖诊所的肥胖儿童和青少年进行口服葡萄糖耐量试验（OGTT）并接受标准肥胖管理。从 OGTT 中得出高胰岛素血症和胰岛素分泌的指数，并在随时间变化的肥胖程度方面进行评估。
共有 591 名儿童（217 名男性和 374 名女性）参与，平均随访时间为 1.86±1.29 年。在单变量或多变量分析中（调整基线年龄、BMI z 评分、性别和种族），OGTT 衍生的胰岛素曲线下面积、峰值胰岛素、空腹胰岛素、胰岛素生成指数或 30 分钟胰岛素与肥胖程度的更大变化无关。餐后血糖<75mg/dL 与肥胖程度的更大变化无关，无论是在单变量还是多变量分析中。在随访时间>4 年的 104 名参与者的亚组中，这些参数均与肥胖程度的更大增加无关。
在肥胖的儿童和青少年中，暴露于高胰岛素血症、更大的胰岛素分泌或餐后低血糖与 2-4 年内肥胖程度的更大增加无关。CIM 应在 BMI 较低的儿童中进行评估，并进行更长时间的随访。
