Background: Obesity is a rising problem in developed and developing countries. Currently little is known about prevalence and prognosis of type 2 diabetes and the metabolic syndrome in obese children and adolescents in Europe.
Patients and methods: About 491 obese children (mean-age 11.2 years; mean-BMI 30.3 kg/m2) were examined (lipid-profile; blood pressure, insulin-resistance1) and in 102 of them with risk factors for type 2 diabetes (type 2 DM) according to the ADA-criteria (positive family history, acanthosis, ethnic risk group) two oral glucose tolerance tests (OGTT) were performed with 912 months interval. The influence of puberty, BMI and therapy was verified by a multivariate analysis.
Results: Hypertension (2nd Task Force) was present in 18.3%, hyperlipidemia (total-cholesterol >200 mg/dl, triglycerides >150 mg/dl) in 27.7% and insulin-resistance (R-HOMA>3) in 46.3%. Overall in 64% of the patients at least one sign of a metabolic syndrome was present. In the diabetes-risk group the OGTT revealed impaired glucose tolerance (IGT) in 36% and type 2 DM in 8% of the patients (all white Caucasian). Longitudinally insulin-resistance was strongly influenced by progression of puberty (Odds-ratio 7.80; P=0.009) and increase of BMI (Odds-ratio 3.25; P=0.031). Participation on an obesity-training-programme improved insulin-resistance independent from BMI-change (Odds-ratio 4.4; P=0.008).
Conclusions: The metabolic syndrome is not only a feature of obesity in adults but also very frequent in children and adolescents mirroring the dimension of childhood obesity and related complications. Type 2 diabetes mellitus in obese children and adolescents is no longer restricted to minority groups. Dyslipidemia, reduced insulin sensitivity and impaired glucose tolerance are closely correlated. Longitudinal studies are needed to establish reliable screening criteria and non-pharmacological and pharmacological prevention strategies for obese children and adolescents.
Matthews DR et al. Diabetologia 1985 28 4129.
03 - 07 May 2008
European Society of Endocrinology