ABSTRACT
El incremento de la adiposidad, conduce a un deterioro de la tolerancia a la glucosa y de la acción de la insulina. Se determinó la resistencia a la insulina (RI) por métodos indirectos y se correlacionó con variables clínicas, antropométricas y bioquímicas en escolares obesos normoglicémicos. Estudio descriptivo-correlacional, realizado en 72 escolares, que acudieron al ambulatorio El Concejo de la Universidad de Carabobo (UC) y al servicio de Gastroenterología y Nutrición Pediátrica de la Ciudad Hospitalaria Enrique Tejera (CHET), de Valencia, Venezuela, entre enero y abril de 2011. Criterio de Inclusión: obesidad exógena. Se evaluaron antecedentes personales y familiares, presencia de acantosis nigricans y valoración nutricional y bioquímica. Se encontró mayor porcentaje de RI, a través de la utilización del método QUICKI (66,7%), seguido del HOMA (55,6%) y la insulina basal (45,9%). Las medias de índice de masa corporal y circunferencia de cintura, fueron significativamente mayores (p<0,05), en pacientes con RI, estimadas por los métodos HOMA y QUICKI. El método QUICKI, detectó diferencias significativas (p<0,05), entre las glicemias e insulinas basales y entre las insulinas postprandiales, de los pacientes con sensibilidades insulínica disminuida y normal; mientras que el HOMA, detectó estas diferencias (p<0,05), en las glicemias e insulinas basales. Se observó una correlación estadísticamente significativa (p<0,05), entre la presencia de acantosis nigricans y la RI, estimada por los métodos HOMA, QUICKI e insulina basal. En conclusión, de los métodos evaluados, los índices QUICKI, HOMA y la insulina basal, fueron los más eficaces para detectar la RI.
Obesity leads to a deterioration of glucose tolerance and the action of insulin. The purpose of this study was to determine insulin resistance (IR) by indirect methods, and its correlation with clinical, anthropometric and biochemical variables in obese normoglycemic school children. This was a descriptive-correlational study of 72 school prepubescent children, who attended the ambulatory El Concejo of the University of Carabobo (UC) and at the Gastroenterology and Pediatric Nutrition service of the city hospital Enrique Tejera (CHET), in Valencia, Venezuela, between January-April 2011. Inclusion criteria: exogenous obesity. We assessed personal and family history, presence of Acanthosis Nigricans and nutritional and biochemical status. We found a higher percentage of IR, through the use of the QUICKI method (66.7%), followed by the HOMA (55.6%) and basal insulin (45.9%). The mean (c) indexes of body mass and waist circumference were significantly greater (p < 0.05) in patients with IR, by HOMA and QUICKI techniques. The QUICKI method detected significant differences (p < 0.05) in the values of glycemia, basal insulin and postprandial insulin, among patients with diminished and normal insulin sensitivities. While HOMA, detected these differences (p < 0.05) in the values of glycemia and basal insulin. A statistically significant relationship was observed (p < 0.05), between the presence of Acanthosis Nigricans and IR, by the HOMA, QUICKI and basal insulin methods. In conclusion, the evaluated techniques, QUICKI, HOMA and basal insulin indexes, were most effective for detecting the IR.
Subject(s)
Child , Female , Humans , Male , Insulin Resistance , Obesity/blood , Acanthosis Nigricans/blood , Acanthosis Nigricans/epidemiology , Body Composition , Body Mass Index , Blood Glucose/analysis , Checklist , /genetics , Fasting/blood , Homeostasis , Insulin/blood , Insulin , Lipids/blood , Models, Biological , Nutritional Status , Postprandial Period , Thigh/anatomy & histology , Venezuela/epidemiology , Waist CircumferenceABSTRACT
BACKGROUND: Studies have suggested an association between the presence of acanthosis nigricans (AN) and the development of diabetes. OBJECTIVE: To investigate the association between AN and insulin resistance (IR) in overweight children and adolescents receiving care at the Center for Childhood Obesity, Campina Grande, PB. METHODS: This cross-sectional study was conducted between April 2009 and April 2010 including 194 individuals of 2 to 18 years of age receiving care within the Brazilian national health network. The presence of acanthosis nigricans was verified and anthropometric measurements were taken. The following tests were performed: insulin, triglycerides, HDL-cholesterol, glucose and homeostasis model of assessment - insulin resistance (HOMA-IR). Statistical analyses were performed using the SPSS software program, version 17.0. RESULTS: There was a greater prevalence of females (66%), brown-skinned individuals (63.4%), adolescents (61.3%) and severely obese individuals (66.5%). Acanthosis nigricans was identified in 58.2% and IR in 42.7% of the participants. Acanthosis nigricans was associated with being non-white (p = 0.003), with being an adolescent (p = 0.003) and with IR (p = 0.001). Non-white individuals, adolescents and those with insulin resistance were 5.4, 2.47 and 2.66 times more likely to have acanthosis nigricans, respectively. CONCLUSION: The results of this study indicate a need to train healthcare professionals to identify acanthosis nigricans, since this condition is associated with IR. Identifying acanthosis nigricans in childhood permits the safe and timely treatment of cardiometabolic disorders through careful monitoring and appropriate treatment.
FUNDAMENTOS: Estudos sugerem haver associação entre a presença de Acantose Nigricans e o desenvolvimento do diabetes. OBJETIVO: Verificar a associação entre Acantose Nigricans e Resistência Insulínica (RI) em crianças e adolescentes com excesso de peso, atendidos no Centro de Obesidade Infantil, Campina Grande-PB. MÉTODOS: Estudo transversal realizado entre abril/2009 a abril/2010, com amostra de 194 pessoas entre 2 e 18 anos, usuários do Sistema Único de Saúde. Na avaliação, foi observada a presença de AN e verificadas as medidas antropométricas. Foram realizados os exames: insulina, triglicerídeos, HDL-colesterol, glicose e HOMA-IR. As análises estatísticas foram realizadas no SPSS, 17.0. RESULTADOS: Houve maior prevalência do sexo feminino (66%), pardos (63,4%), adolescentes (61,3%) e obesos graves (66,5%). Foi identificada AN em 58,2% e RI em 42,7%. A Acantose Nigricans esteve associada à cor não-branca (p=0,003), adolescentes (p=0,003) e RI (p=0,001). Os não-brancos apresentaram chance de 5,4 vezes maior de terem Acantose Nigricans, os adolescentes, de 2,47 e os com Resistência Insulínica, de 2,66. CONCLUSÃO: Os resultados na população em estudo indicam a necessidade de treinamento voltado à identificação da Acantose Nigricans para profissionais de saúde, pois este sinal esteve associado à Resistência Insulínica. Identificar a Acantose Nigricans desde a infância permite prevenir e tratar precocemente distúrbios cardiometabólicos, através de acompanhamento criterioso e tratamento adequado.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Young Adult , Acanthosis Nigricans/complications , Insulin Resistance/physiology , Metabolic Syndrome/etiology , Overweight/complications , Acanthosis Nigricans/blood , Acanthosis Nigricans/physiopathology , Body Mass Index , Blood Glucose/analysis , Cross-Sectional Studies , Cholesterol, HDL/blood , Homeostasis , Insulin/blood , Metabolic Syndrome/diagnosis , Metabolic Syndrome/physiopathology , Overweight/blood , Triglycerides/bloodABSTRACT
OBJETIVO: Verificar o impacto da obesidade sobre os componentes da síndrome metabólica e sobre os níveis de adipocitoquinas em crianças pré-púberes. MÉTODOS: Estudo transversal comparando 30 crianças obesas, 31 com sobrepeso e 33 eutróficas, oriundas do ambulatório de pediatria geral de um hospital universitário, quanto às médias de glicose, lipídios séricos, insulina, HOMA-IR (homeostasis model assessment-insulin resistance), relação glicose/insulina, adiponectina e leptina. Compararam-se as frequências de acantose nigricans e das alterações de cintura, pressão arterial, glicose, lipídios séricos e insulina. Avaliou-se a correlação entre escore z de índice de massa corporal (IMC) e adipocitoquinas. RESULTADOS: Houve diferença nas médias dos obesos, quanto a HDL-colesterol e adiponectina, e nas dos eutróficos, quanto a insulina, HOMA-IR, relação glicose/insulina e leptina (p < 0,001). O mesmo ocorreu em relação às frequências dos obesos quanto a acantose nigricans e alteração de cintura e HDL-colesterol (p < 0,005). O escore z de IMC se correlacionou positivamente com leptina (p < 0,001) e negativamente com adiponectina (p = 0,001). Na regressão linear múltipla, esta correlação se manteve apenas para leptina; o HDL-colesterol se correlacionou com adiponectina (p = 0,007) e o HOMA-IR com ambas (p < 0,05). CONCLUSÃO: Os achados comprovam a influência da obesidade sobre os componentes da síndrome metabólica e sobre os níveis de adipocitoquinas já nas crianças pré-púberes e apontam para a importância destas na gênese da doença cardiovascular.
OBJECTIVE: To verify the impact of obesity on metabolic syndrome components and adipokine levels in prepubertal children. METHODS: This cross-sectional study compared 30 obese, 31 overweight and 33 eutrophic children attending a university hospital-based outpatient pediatric clinic. Parameters assessed included glucose, serum lipids, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), glucose/insulin relation, adiponectin, and leptin. We compared the frequency of acanthosis nigricans and changes in waist, blood pressure, glucose, serum lipids, and insulin. The correlation between body mass index (BMI) z score and adipokines was evaluated. RESULTS: Among obese children, there was a difference in the mean values of HDL cholesterol and adiponectin, whereas among the eutrophic children, there was a difference in the mean values of insulin, HOMA-IR, glucose/insulin relation, and leptin (p < 0.001). A difference was also observed regarding the frequency of acanthosis nigricans and alteration in waist and HDL cholesterol (p < 0.005) in the obese group. The BMI z score showed a positive correlation with leptin (p < 0.001) and a negative correlation with adiponectin (p = 0.001). In multiple linear regression, this correlation was maintained only for leptin; HDL-cholesterol correlated with adiponectin (p = 0.007) and HOMA-IR correlated with both variables (p < 0.05). CONCLUSION: These findings provide evidence of the influence of obesity on metabolic syndrome components and on adipokine levels in prepubertal children, indicating that these components may contribute to the beginning of cardiovascular diseases.