Presence of the Metabolic Syndrome in Obese Adolescents Predicts Impaired Glucose Tolerance and Nonalcoholic Fatty Liver Disease

Abstract

Purpose-To evaluate whether the presence of MS in obese adolescents is associated with other co-morbidities of obesity Methods-85 obese teens with fasting insulin > 25 uU/ml and family history of type 2 diabetes mellitus and/or acanthosis nigricans. Mean age 15.8 ± 1.7 years; body mass index 39.3 ± 6.6 kg/m2; 70% female; 54% Hispanic, 35% black. Laboratory analysis included fasting lipids, glucose, gamma gluteryl transferase (GGT), and oral glucose tolerance testing. Additional liver transaminases and liver ultrasound (US) were performed to evaluate presence and severity of fatty liver.Results-All subjects met MS criteria for children for waist circumference; 49% for blood pressure; 54% for high density lipoprotein (HDL); 54% for triglycerides; 20% for impaired fasting glucose or impaired glucose tolerance (IGT). 47 subjects had 3 or more MS criteria. BMI was no different between groups with and without MS. Subjects with 3 or more MS criteria were more likely to have IGT (p = .004), elevated ALT (p = .039), elevated GGT (p = .036), fatty liver on US (p < .001), and more severe fatty liver (p = .001).Reprint requests: kathryn.love-osborne@dhha.org, University of Colorado at Denver and Health Sciences Center, Denver Health and Hospitals Authority Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Abnormal glucose regulation and evidence of non-alcoholic fatty liver disease (NAFLD) were more common in subjects meeting 3 criteria for MS than in those meeting fewer criteria. The identification of MS provides value to the primary care provider. Those patients meeting criteria for MS should be evaluated for glucose intolerance and NAFLD. NIH Public Access

Etiology of Insulin Resistance in Youth with Type 2 Diabetes

“…Abnormal fat partitioning, with increased visceral, hepatic, and intramyocellular lipids and elevated BMI are related to IR in adults [1, 2, 23]. Similarly this relationship between IR and increased visceral, hepatic and intramyocellular lipids are seen in youth with prediabetes and T2DM [13, 24–26]. In obese youth with normal glucose tolerance, increased muscle, hepatic, and visceral fat are also related to the degree of IR [27].…”

Metabolic syndrome in a sample of the 6- to 16-year-old overweight or obese pediatric population: a comparison of two definitions

“…Few studies have estimated the prevalence of MS in children and adolescents,14 and diagnostic criteria have not been standardized 15–17. Definitions agree on the essential components of the syndrome but there are differences in some diagnostic criteria 13,18.…”

Paediatric non-alcoholic fatty liver disease

“…Children with NAFLD are insulin resistant (96%); the presence of clinical features of the MetS is diagnosed in almost 60% of patients and diabetes in 8% 8 12 34 35. The vast majority of subjects are dyslipidaemic with abnormal levels of circulating triglicerydes and/or low high-density lipoprotein (HDL)-cholesterol, and up to 40% are hypertensive.…”