Metabolic Setup and Risks in Obese Children

Summary Background: In the past decades, the obesity epidemic in children of all ages has been an important research field for detecting the metabolic causes and consequences of obe- sity, the major focus being on insulin and adipocytokine lev- els. Metabolic work-up in obese children is recommended in the age group as young as 2-6 years. There is evidence that birth weight can be a factor causing obesity later in life accompanied by metabolic complications. Methods: Insulin, leptin, and adiponectin levels were ana- lyzed in 269 obese children and 60 controls, as well as 110 newborn children with different birth weight and different length of gestation, using standard methods. Results: In 53.6% of the obese children, complications of obesity such as diabetes mellitus, obesity, hyperlipidemia, heart attack or stroke were found in family members. The peak insulinemia on OGTT was significantly higher in the pubertal compared to the prepubertal group (110.5± 75.9 μU/mL versus 72.2±62.7 μU/mL) (p<0.005). Glucose intolerance was confirmed in 24%. The leptin level was significantly higher and the adiponectin level was lower in pubertal obese children compared to the prepubertal children and controls (p<0.05). In newborns the leptin and adiponectin levels were in correlation with anthropometric parameters: body weight (BW), body length (BL), BW/BL, BMI, and the pondered index (p<0.05). Conclusion: Obese children have high insulinemia in all ages, reaching its peak towards puberty. The leptin and adiponectin levels might be indicators of the metabolic syn- drome. Our findings in newborns might influence the nutritional approach in the future in order to prevent complications of obesity. Kratak sadržaj Uvod: Epidemija gojaznosti kod dece svih uzrasta u toku poslednjih decenija je plodno polje za istraživanje uzroka i posledica gojaznosti sa glavnim fokusom na uticaju insu- linemije i adipocitokina. Metabolička obrada se preporu- čuje čak i u najmla|oj grupi uzrasta 2-6 godina. Postoje podaci da te`ina na ro|enju može biti faktor pojave i kom- plikacija gojaznosti kasnije u životu. Metode: Standardnim testovima analizirani su nivoi insuli- na, leptina i adiponektina kod 269 gojazne i 60 zdrave dece kao i kod 110 novoro|enčadi različite te`ine na ro- |enju i različite dužine gestacije. Rezultati: Faktori rizika za komplikacije gojaznosti kao što su dijabetes melitus, gojaznost, hiperlipidemija, infarkt ili cerebralni insult su na|eni kod 53,6% ro|aka gojazne dece. Pik insulinemija na OGTT-u je bila značajno viša u pubertetskoj u pore|enju sa pretpubertetskom grupom, 110,5±75,9 μU/mL prema 72,2±62,7 μU/mL (p<0,005). Glikozna intolerancija je potvr|ena kod 24% ispitanika. Nivo leptina je signifikantno viši kod gojazne dece a adipo- nektin je ni`i u pore|enju sa pretpubertetskom decom i kontrolnom grupom (p<0,05). Kod novoro|enčadi nivoi leptina i adiponektina su u korelaciji sa antropometrijskim parametrima: te`inom, visinom, odnosom te`ina/visina, indeksom telesne mase i ponderalnim indeksom (p<0,05 i <0,01). Zaključak: Gojazna deca imaju visoku vrednost insulina u svim uzrastima i ona dostiže najviše vrednosti u pubertetu. Nivoi leptina i adiponektina mogu biti uključeni u indikatore metaboličkog sindroma. Naši nalazi kod novo ro|enčadi mogli bi uticati na nutritivni pristup ovoj grupi u budu}nosti sa ciljem prevencije komplikacija gojaznosti.