Antoniotti Valentina, Amore Martina, Caputo Marina, Fania Chiara, Mancioppi Valentina, Casoli Gloria, Tini Sabrina, Antonioli Alessandro, Aimaretti Gianluca, Rabbone Ivana, Bellone Simonetta, Prodam Flavia
SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy.
Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy.
J Endocr Soc. 2023 Jun 26;7(8):bvad088. doi: 10.1210/jendso/bvad088. eCollection 2023 Jul 3.
Insulin resistance, glucose alterations, arterial hypertension (HTN), and the renin-angiotensin-aldosterone system (RAAS) are related in adult obesity. This crosstalk is still unexplored in childhood.
Characterize the relationships of fasting and postload glucose and insulin levels with new American Academy of Pediatrics classification of HTN and RAAS in pediatric obesity.
This was a retrospective observational study; 799 pediatric outpatients (11.4 ± 3.1 years) at a tertiary center who were overweight or obese and not yet on diet were included. The main outcome measures were mean and correlations among parameters of a complete clinical and metabolic screening (body mass index, blood pressure, and glucose and insulin levels during an oral glucose tolerance test, and renin and aldosterone levels and their ratio).
774 subjects had all the parameters, of whom 87.6% had HTN (5% elevated blood pressure, 29.2% stage I HTN, and 53.4% stage II HTN). Eighty subjects had 1 or more glucose alterations, and more frequently presented HTN. Blood pressure levels were higher in subjects with glucose alterations than in those with normal glucose levels. Fasting and stimulated glucose and insulin levels were directly related to the HTN stages, and insulin sensitivity was lower in HTN than in normal blood pressure. Aldosterone, renin, and aldosterone-renin ratio (ARR) were similar in sexes, whereas aldosterone was higher in prepubertal individuals. Subjects with impaired glucose tolerance (IGT) had higher renin and lower ARR. Renin was positively correlated with postload glucose, and ARR was negatively correlated with the Homeostatic Model Assessment for Insulin Resistance index.
A close relationship exists among insulin resistance, glucose alterations, HTN, and renin in childhood obesity. Specific categories of risk could provide indicators for strict clinical surveillance.
胰岛素抵抗、血糖改变、动脉高血压（HTN）以及肾素 - 血管紧张素 - 醛固酮系统（RAAS）在成人肥胖中相互关联。这种相互作用在儿童期仍未得到充分研究。
明确儿童肥胖患者空腹及负荷后血糖和胰岛素水平与美国儿科学会新的高血压和RAAS分类之间的关系。
这是一项回顾性观察研究；纳入了一家三级中心的799名儿科门诊患者（11.4±3.1岁），这些患者超重或肥胖且尚未接受饮食治疗。主要观察指标为完整临床和代谢筛查参数（体重指数、血压、口服葡萄糖耐量试验期间的血糖和胰岛素水平，以及肾素和醛固酮水平及其比值）的均值和相关性。
774名受试者具备所有参数，其中87.6%患有HTN（5%血压升高，29.2%为I期HTN，53.4%为II期HTN）。80名受试者有1种或更多血糖改变，且更常出现HTN。血糖改变患者的血压水平高于血糖正常者。空腹及刺激后的血糖和胰岛素水平与HTN分期直接相关，HTN患者的胰岛素敏感性低于血压正常者。醛固酮、肾素以及醛固酮 - 肾素比值（ARR）在性别上相似，而醛固酮在青春期前个体中较高。糖耐量受损（IGT）患者的肾素较高，ARR较低。肾素与负荷后血糖呈正相关，ARR与胰岛素抵抗稳态模型评估指数呈负相关。
儿童肥胖中胰岛素抵抗、血糖改变、HTN和肾素之间存在密切关系。特定风险类别可为严格的临床监测提供指标。
