Threshold for Improvement in Insulin Sensitivity with Adolescent Weight Loss
Threshold for Improvement in Insulin Sensitivity with Adolescent Weight Loss
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DOI：
10.1016/j.jpeds.2013.04.003
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发表时间：
2013-09-01
影响因子：
5.1
通讯作者：
Berkowitz, Robert I.
中科院分区：
文献类型：
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作者：
Abrams, Pamela;Katz, Lorraine E. Levitt;Berkowitz, Robert I.
目的评估肥胖青少年减肥治疗后体重减轻与胰岛素敏感性、糖耐量和代谢综合征(MS)的关系，并确定观察这些指标改善所需的减肥阈值。研究设计对113名肥胖青少年进行了随机对照行为减肥试验。结果4个月时空腹胰岛素、胰岛素抵抗稳态模型评价、全身胰岛素敏感指数(WBISI)、体重指数(BMI)、MS标准均有明显改善，平均空腹胰岛素由22.3降至16.6mU/mL(P<；0.0001)。稳态模型胰岛素抵抗评估从4.9降至3.7(P=.001)，WBISI从2.87升至3.98(P<；.0001)。BMI降低8%会显著改善WBISI(P=0.03)，这是最佳阈值。体重减轻后，符合MS标准的个体较少(P=.0038)，尽管综合征的个体特征没有显著变化。结论在本试验中，4个月体重减轻与肥胖青少年胰岛素敏感性的改善有关。体重指数大约下降8%是胰岛素敏感性改善的门槛水平。随着越来越多的减肥计划是为肥胖青少年设计的，制定合理的减肥目标将会改善代谢和心血管疾病的风险因素，这将是很重要的。
Objectives To assess the association of weight loss and insulin sensitivity, glucose tolerance, and metabolic syndrome (MS) in obese adolescents following weight loss treatment, and to determine the threshold amount of weight loss required to observe improvements in these measures.Study design A randomized, controlled behavioral weight loss trial was conducted with 113 obese adolescents. Changes in fasting insulin, homeostasis model assessment of insulin resistance, whole body insulin sensitivity index (WBISI), body mass index (BMI), and MS criteria were assessed at baseline and at month 4.Results There was significant improvement in all measures of insulin sensitivity at month 4. Mean fasting insulin dropped from 22.3 to 16.6 mu U/mL (P < .0001). Homeostasis model assessment of insulin resistance decreased significantly from 4.9 to 3.7 (P = .001) and WBISI increased significantly from 2.87 to 3.98 (P < .0001). An 8% reduction in BMI led to a significant improvement in WBISI (P = .03) and was the optimal threshold. Fewer individuals met criteria for MS after weight loss (P = .0038), although there were no significant changes in the individual features of the syndrome.Conclusions In this trial, weight loss at month 4 was associated with improved insulin sensitivity in obese adolescents. An approximate decrease in BMI of 8% was the threshold level at which insulin sensitivity improved. As more weight loss programs are designed for obese adolescents, it will be important to have reasonable weight loss goals that will yield improvements in metabolic and cardiovascular disease risk factors.