ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P590

Increased hyperinsulinism and insulin resistance, and decreased antioxidant defense, in children and adolescents with pre-metabolic versus metabolic syndromes

Vesna Dimitrijevic-Sreckovic1, Branko Sreckovic2, Emina Colak3, Predrag Djordjevic1, Fadil Canovic1, Dragana Vukosavljevic3 & Jecka Stojanovic3

1Institute of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia; 2Institute of Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia; 3Institute of Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.

Background and aims: The aim was to analyze insulin resistance (IR), glycoregulation disorders, lipid status, C-reactive protein (CRP), plasminogen activator inhibitor (PAI-1) and antioxidant defense in children and adolescents with pre-metabolic (Pre-MS) and metabolic (MS) syndromes.

Material and methods: The study included 30 obese individuals (age 10–20 years, body mass index (BMI) or waist circumference (WC) ≥90 percentile). Three of the following five criteria were used for MS diagnosis in children and adolescents: WC≥90 Pct. for age and sex; triglycerides (TG) >1.7 mmol/l; high density lipoprotein cholesterol (HDL-C) <1.0; hypertension ≥90 Pct. for height, age and sex; glycaemia >6.0. Patients with less than three afore mentioned criteria were indicated as patients with Pre-MS.

Insulin sensitivity was determined by HOMA IR. Serum CRP was measured by immunometric assay. Activities of markers of antioxidant defense, superoxide dismutase (SOD) and glutathion peroxidase (GSH-Px) were determined in erythrocytes.

Results: Metabolic syndrome was found in one third of patients (BMI 33.84±5.5 kg/m2; WC 103.9±15.6 cm; blood pressure 123.8±11.1/80.0±9.6 mmHg; increased HOMA IR (5.42±2.6); increased triglycerides (1.9±0.6 mmol/l); decreased HDL (0.88±0.23 mmol/l); increased LDL/HDL ratio (3.5±1.37); increased CRP (11.64±15.9 mg/l); increased PAI-1 (5.62±1.28 U/ml); low SOD and GSH-Px (1001.2+117.4 U/grHg and 35.3+17.9 U/grHg respectively). The other two thirds showed 1-2 metabolic syndrome criteria (mostly WC 91.6±16.0 cm; decreased HDL 1.07±0.16 mmol/l), increased HOMA IR (6.1±4.4, l), normal CRP (1.4±2.1 mg/l), increased PAI-1 (3.41±2.38 U/ml) and decreased antioxidative defense (SOD 932+0.81 U/grHg; GSH-Px 31.0+6.7 U/grHg).

Conclusion: PAI-1 and proinflammatory cytokines with CRP directly accelerate atherosclerosis and thrombosis. Positive correlations between PAI-1 and WC and BMI, and negative correlations between BMI and antioxidative defense in the pre-metabolic syndrome patients show that this early stage preceding MS is also characterized by evident hyperinsulinism and IR and atherosclerotic complication risks.

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