Endocrinology Service, KK Women's and Children's Hospital, Singapore
Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
BMJ Open Diabetes Res Care. 2023 Apr;11(2). doi: 10.1136/bmjdrc-2022-003228.
Our aim was to determine whether there are risk factors which increase the risk of developing dysglycemia in a child who has increased body mass index (BMI) (overweight/obese).
This was a retrospective cohort study of 715 children who had increased BMI (overweight/obese). They presented to tertiary care at KK Women's and Children's Hospital, Singapore, for metabolic risk assessment. Subjects who had more than one oral glucose tolerance test were included in order to track and analyze risk factors associated with worsening glycemic status from a previously normal glucose tolerance, impaired fasting glucose, or impaired glucose tolerance (IGT) state. Demographic characteristics, birth history, family history of metabolic syndrome, metabolic comorbidities, and interventions received were recorded. Statistical analysis was performed to determine odds ratio (OR) of worsening glycemic status progression in association with an analyzed variable, adjusted for intervention received.
Risk factors of developing dysglycemia can be present right from birth, as participants who were born preterm had increased odds of IGT (OR: 3.49 (1.10 to 11.03)), and a greater proportion of large-for-gestational-age (LGA)/small-for-gestational-age (SGA) babies had dysglycemia (SGA-IGT: 8.8%, SGA-diabetes mellitus (DM): 5.9%, LGA-IGT: 10.6%, LGA-DM: 11.8%) even at baseline. Being born preterm (OR: 3.49 (1.10 to 11.03)), with comorbidities of hypertension (OR: 1.61 (1.01 to 2.57)), hyperlipidemia (OR: 1.80 (1.19 to 2.72)), and fatty liver disease (OR: 2.08 (1.39 to 3.13)), was significantly associated with an increased OR of developing IGT. Risk factors for developing a worsening glycemic status, either to IGT or DM, included age >10 years (OR 4.94 (1.21 to 20.25)), BMI rise (OR 1.71 (1.17 to 2.49)), BMI increase >1.08 kg/m (OR 1.71 (1.16 to 2.51)), comorbidities of hyperlipidemia (OR 1.67 (1.12 to 2.50)), and fatty liver disease (OR 2.11 (1.43 to 3.12)).
A child who has increased BMI (overweight/obese) and possesses risk factors for worsening glycemic status, if intervened with routine lifestyle modification advice, may still have increased risk of developing dysglycemia and type 2 DM. Therefore, understanding their risk profile provides opportunities to have a tiered and individualized approach.
我们的目的是确定在 BMI（超重/肥胖）增加的儿童中，是否存在增加发生糖代谢异常风险的危险因素。
这是一项对 715 名 BMI 增加（超重/肥胖）的儿童进行的回顾性队列研究。他们在新加坡 KK 妇女儿童医院接受了代谢风险评估。为了追踪和分析从先前正常葡萄糖耐量、空腹血糖受损或糖耐量受损（IGT）状态恶化的与血糖相关的危险因素，纳入了有多次口服葡萄糖耐量试验的患者。记录了人口统计学特征、出生史、代谢综合征家族史、代谢合并症和接受的干预措施。为了确定与分析变量相关的血糖恶化进展的优势比（OR），对接受的干预措施进行了调整，并进行了统计分析。
发生糖代谢异常的危险因素可能从出生时就存在，因为早产儿发生 IGT 的几率更高（OR：3.49（1.10 至 11.03）），并且比例较大的大于胎龄儿（LGA）/小于胎龄儿（SGA）婴儿有糖代谢异常（SGA-IGT：8.8%，SGA-糖尿病：5.9%，LGA-IGT：10.6%，LGA-糖尿病：11.8%）即使在基线时也是如此。早产（OR：3.49（1.10 至 11.03））、合并高血压（OR：1.61（1.01 至 2.57））、血脂异常（OR：1.80（1.19 至 2.72））和脂肪肝疾病（OR：2.08（1.39 至 3.13））是发生 IGT 的 OR 显著增加的危险因素。发生血糖恶化（IGT 或糖尿病）的危险因素包括年龄>10 岁（OR 4.94（1.21 至 20.25））、BMI 升高（OR 1.71（1.17 至 2.49））、BMI 增加>1.08 kg/m（OR 1.71（1.16 至 2.51））、血脂异常（OR 1.67（1.12 至 2.50））和脂肪肝疾病（OR 2.11（1.43 至 3.12））。
BMI 增加（超重/肥胖）且存在血糖恶化风险因素的儿童，如果接受常规生活方式改变建议的干预，仍可能有发生糖代谢异常和 2 型糖尿病的风险增加。因此，了解他们的风险状况提供了分层和个体化的机会。
