Best Practice & Research Clinical Endocrinology & Metabolism
6The metabolic consequences of childhood obesity
Section snippets
Prevalence of impaired glucose tolerance among children and adolescents with marked obesity
An unprecedented rise in the prevalence in T2DM is emerging in obese young people.5, 6 One dire prediction from the Centers for Disease Control (CDC) estimated that, if current obesity rates continue, one in three newborns born in 2000 will eventually develop diabetes.7 African American and Hispanic children are at greatest risk for both obesity and diabetes.8 In adults, T2DM develops over a long period. Most, if not all, patients initially have impaired glucose tolerance (IGT), which is an
The natural history of IGT in obese children
Transition from IGT to diabetes in adults is usually a gradual phenomenon, occurring over 5–10 years15, 16 depending on the population studied. The early presentation of T2DM in young people raises the possibility of an accelerated process in these youngsters, compared to adults, thus shortening the transition time between IGT and diabetes. We followed 102 obese children and adolescents from a pediatric weight management clinic (71 with normal and 31 with impaired glucose tolerance) by
Obesity and the metabolic syndrome in children and adolescents
The close association of T2DM with cardiovascular disease (CVD) led to the hypothesis that the two may arise from a common antecedent.20, 21 This concept has been codified by the World Health Organization (WHO) as the ‘metabolic syndrome’.22 According to the NCEP and ATPIII panel, persons meeting at least three of the following five criteria qualify as having the metabolic syndrome: (1) elevated blood pressure, (2) a high triglyceride level, (3) low HDL-cholesterol level, (4) high fasting
The relation between insulin resistance and tissue lipid partitioning
The studies described above in obese children and adolescents indicate that insulin resistance is the best predictor of IGT, a pre-diabetic condition.12, 32 Moreover, increasing levels of insulin resistance are strongly associated with higher prevalence rates of the metabolic syndrome in obese youngsters. The observation that not all obese young people demonstrate altered glucose metabolism or other components of the metabolic syndrome highlights the fact that obesity per se is not the single
Summary
Childhood obesity sets the stage for multiple target organ damage and related morbidity. Deposition of fat in insulin-sensitive tissues such as muscle and liver, as well as the levels of multiple fat-derived cytokines and adipocytokines, may act as mediators of the underlying pathophysiology of obesity. Impaired glucose tolerance, an early clinical manifestation of childhood obesity, is a prelude to diabetes, which is increasing in prevalence in children and adolescents with marked obesity.
Acknowledgements
This work was supported by grants RO1-HD40787, RO1-HD28016 and K24-HD01464 (to Dr Caprio), MO1-RR00125 and MO1-RR06022 from the National Institute of Health, and the Stephen I. Morse Pediatric Diabetes Research Fund (Dr Weiss).
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