Prevalence of impaired glucose tolerance among children and adolescents with marked obesity
Prevalence of impaired glucose tolerance among children and adolescents with marked obesity
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DOI：
10.1056/nejmoa012578
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发表时间：
2002-03-14
影响因子：
158.5
通讯作者：
Caprio, S
中科院分区：
文献类型：
--
作者：
Sinha, R;Fisch, G;Caprio, S
背景资料：儿童肥胖症在美国流行，伴随着儿童和青少年2型糖尿病患病率的增加。我们确定了糖耐量受损的患病率在一个多种族队列的167名肥胖儿童和青少年。方法：所有受试者进行了两个小时的口服葡萄糖耐量试验（每公斤体重1.75毫克的葡萄糖），葡萄糖，胰岛素和C-肽水平进行了测量。获得空腹胰岛素原水平，并计算胰岛素原与胰岛素的比值。通过稳态模型评估来估计胰岛素抵抗，通过计算摄入葡萄糖后前30分钟内胰岛素水平和葡萄糖水平变化之间的比率来估计β细胞功能。55名肥胖儿童中有25%的人发现葡萄糖耐量受损（4至10岁）和112名肥胖青少年（11至18岁）中的21%;在4%的肥胖青少年中发现了无症状的2型糖尿病。在糖耐量受损受试者中，胰岛素和C肽水平在糖耐量试验后显著升高，但在患有糖尿病的青少年中没有，他们的胰岛素水平30分钟变化与葡萄糖水平30分钟变化的比率降低。后的体重指数已被控制，胰岛素抵抗是更大的受影响的队列，是最好的预测葡萄糖耐量受损。结论：葡萄糖耐量受损是非常普遍的儿童和青少年严重肥胖，无论种族。口服葡萄糖耐量受损与胰岛素抵抗相关，而β细胞功能仍然相对保留。显性2型糖尿病与β细胞衰竭有关。（N Engl J Med 2002;346：802-10.）版权所有（C）2002马萨诸塞州医学会。
Background: Childhood obesity, epidemic in the United States, has been accompanied by an increase in the prevalence of type 2 diabetes among children and adolescents. We determined the prevalence of impaired glucose tolerance in a multiethnic cohort of 167 obese children and adolescents.Methods: All subjects underwent a two-hour oral glucose-tolerance test (1.75 mg of glucose per kilogram of body weight), and glucose, insulin, and C-peptide levels were measured. Fasting levels of proinsulin were obtained, and the ratio of proinsulin to insulin was calculated. Insulin resistance was estimated by homeostatic model assessment, and beta-cell function was estimated by calculating the ratio between the changes in the insulin level and the glucose level during the first 30 minutes after the ingestion of glucose.Results: Impaired glucose tolerance was detected in 25 percent of the 55 obese children (4 to 10 years of age) and 21 percent of the 112 obese adolescents (11 to 18 years of age); silent type 2 diabetes was identified in 4 percent of the obese adolescents. Insulin and C-peptide levels were markedly elevated after the glucose-tolerance test in subjects with impaired glucose tolerance but not in adolescents with diabetes, who had a reduced ratio of the 30-minute change in the insulin level to the 30-minute change in the glucose level. After the body-mass index had been controlled for, insulin resistance was greater in the affected cohort and was the best predictor of impaired glucose tolerance.Conclusions: Impaired glucose tolerance is highly prevalent among children and adolescents with severe obesity, irrespective of ethnic group. Impaired oral glucose tolerance was associated with insulin resistance while beta-cell function was still relatively preserved. Overt type 2 diabetes was linked to beta-cell failure. (N Engl J Med 2002;346:802-10.) Copyright (C) 2002 Massachusetts Medical Society.