Effects of metformin administration on endocrine-metabolic parameters, visceral adiposity and cardiovascular risk factors in children with obesity and risk markers for metabolic syndrome: A pilot study

Abstract

BackgroundMetformin treatment (1000–2000 mg/day) over 6 months in pubertal children and/or adolescents with obesity and hyperinsulinism is associated with a reduction in body mass index (BMI) and the insulin resistance index (HOMA-IR). We aimed to ascertain if long-term treatment (24 months) with lower doses of metformin (850 mg/day) normalizes the endocrine-metabolic abnormalities, improves body composition, and reduces the carotid intima-media thickness (cIMT) in pre-puberal and early pubertal children with obesity.MethodsA pilot double-blind, placebo-controlled trial was conducted on 18 pre-puberal and early pubertal (Tanner stage I-II) children with obesity and risk markers for metabolic syndrome. Patients were randomly assigned (1:1) to receive metformin (850 mg/day) or placebo for 24 months. Clinical, biochemical (insulin, lipids, leptin, and high-sensitivity C-reactive protein [hsCRP]), and imaging (body composition [dual-energy X-ray absorptiometry and magnetic resonance imaging]) parameters as well as cIMT (ultrasonography) were assessed at baseline and at 6, 12, and 24 months.ResultsThe 12-month treatment tend to cause a reduction in weight standard deviation scores (SDS), BMI-SDS, leptin, leptin–to–high-molecular-weight (HMW) adiponectin ratio, hsCRP, cIMT, fat mass, and liver fat in metformin-treated children compared with placebo. The effect of metformin on the reduction of BMI-SDS, leptin, leptin-to-HMW adiponectin ratio, hsCRP, and liver fat seemed to be maintained after completing the 24 months of treatment. No changes in insulin sensitivity (HOMA-IR) or adverse effects were detected.ConclusionIn this pilot study, metformin treatment in pre-puberal and early pubertal children with obesity seemed to improve body composition and inflammation markers. Our data encourage the development of future fully powered trials using 850 mg/day metformin in young children, highlighting its excellent tolerance and potential long-term benefits.

Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

“…The medical community has recognized overweight and obesity as an epidemic negatively affecting a large proportion of the pediatric population across the nation, introducing new physiological and social problems. Although most of the associated health concerns involve endocrine abnormalities and an increased risk of cardiovascular disease later in life [ 19 , 20 ], clinicians should also be aware of the orthopedic issues associated with childhood overweight, including an increased risk of fracture and greater fracture severity [ 21 – 23 ]. Growing numbers of reports are detailing higher rates of complications associated with surgical and conservative treatments in overweight children [ 24 , 25 ].…”

Proof on Concept on the Consumption of a Beverage with Ancestral Mexican Corn and Bean Flour and its Cardiometabolic Effects on Adolescents with Obesity

“…shows that 6 patients in the metformin group refused to continue, and 2 in the placebo group abandoned the study due to low attachment [50].…”

The Current and Potential Therapeutic Use of Metformin—The Good Old Drug

“…Most, although not all, clinical studies have shown that metformin, lowering IR, may reduce the risk of chronic vascular complications of diabetes and significantly decrease modifiable cardiovascular risk factors, including hyperglycemia and hyperglycemia -related inflammation and oxidative stress, increased platelet aggregation PAI, HbA1c, dyslipidemia, IR, visceral obesity, and blood pressure [ 192 , 193 , 194 ]. The effect of metformin on cardiovascular risk factors is depicted in Figure 2 .…”