Insulin resistance in a cohort of 5-15 year old children in urban Sri Lanka.

BACKGROUND: South Asian populations develop insulin resistance from a young age. Poor intrauterine growth and increased rates of post natal growth predisposes to develop insulin resistance later in life. This study identifies insulin resistance and relation to birth weight among a group of 5-15 year old children of urban Sri Lanka. METHODS: A cross sectional descriptive study, using two-stage probability proportionate cluster sampling technique. After a 12 h overnight fast, blood was drawn for fasting blood glucose and insulin. OGTT was performed with 2 h random blood glucose. Basic anthropometry was assessed and insulin resistance measured by HOMA-IR. RESULTS: Of 309 children (boys 133) 13 (4.2%) were obese and 35 (11.3%) were overweight. Eight had impaired glucose homeostasis but no diabetes mellitus. The mean (SD) fasting insulin was 37.8 (37.9) and 32.5 (40.4) pmol/L in girls and boys respectively. 2 h post glucose insulin in girls and boys were 258 (324) and 152 (168) pmol/L respectively. The mean HOMA-IR was 1.1 (1.1) and 0.94 (1.2) for girls and boys respectively. The 4th quartile value of HOMA-IR for the whole population was 1.2 (95% CI 1.1, 1.3) and in obese children 2.26 (95% CI 2.0, 3.1). Fasting and 2 h insulin and HOMA-IR was not affected by birth weight but showed significant difference when compared across present BMI tertile with significantly high values in the highest tertile. CONCLUSION: Although many children were able to control glucose within normal limits, evidence of early development of insulin resistance was seen. Children born small but became obese, had the highest risk of developing insulin resistance.

Psychological impact on parents of children with congenital adrenal hyperplasia: a study from Sri Lanka.

INTRODUCTION: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessively inherited disorders with significant morbidity. The long-term implications result in immense psychological stress to the parents. This study assessing the psychological impact on the parents is a first in Sri Lanka and one of the few worldwide. OBJECTIVE: Document the presence of depressive symptoms in parents of children with CAH. DESIGN: Study participants were 37 parents of children diagnosed with CAH who were attending an endocrinology clinic of the largest children's hospital in Sri Lanka. Centre for Epidemiological Studies-Depression scale (CES-D), a psychometrically sound scale for assessing depressive symptomatology, was used. RESULTS: The study classified 59% of the parents as being affected, and the psychological impact on them did not reduce with time. CONCLUSION: Parents of children with CAH demonstrated symptoms of depression that did not abate with the passage of time.

Validity of newly-developed BMI and waist cut-off values for Sri Lankan children.

BACKGROUND: Excess body fat leads to obesity-related morbidity and population/ethnicity-specific cut-off values of anthropometric measures are useful for better diagnosis. This study assesses the suitability of newly-developed Sri Lankan anthropometric cut-off values in the diagnosis of obesity in Sri Lankan children. METHODS: A cross-sectional study was conducted at University of Colombo, Sri Lanka involving 5-15 year old children. Height, weight, waist (WC), and hip (HC) circumferences were measured. Total body fat (FM) was measured using whole body BIA. WHR and WHtR were calculated. Validity of anthropometric measures in detecting childhood obesity (Sri Lankan BMI/WC; IOTF, WHO, British and CDC BMI and British WC cut-off values) were evaluated. RESULTS: Nine hundred and twenty children were assessed. FM showed significant associations with BMI (r = 0.92, p < 0.001), WC (r = 0.90, p < 0.001) and HC (r = 0.85, p < 0.001), but poor association with WHR (r = 0.17, p < 0.001). However, WHtR had a high association with FM (r = 0.75, p < 0.001) and %FM (r = 0.78, p < 0.001). Based on %FM cut-offs, 85 (22.8%) girls and 101 (18.5%) boys were obese. All international anthropometric cut-off values under-estimated obesity. Sri Lankan WC and BMI cut-off values over-estimated obesity. International BMI based cut-off values had high specificity (>99%) but a low sensitivity (∼12-33%), while Sri Lankan BMI cut-off values had high sensitivity (>93.1) but low specificity (>79.7). CONCLUSIONS: Internationally available BMI cut-off values are poor in diagnosing obesity in Sri Lankan children. Newly developed Sri Lankan BMI cut-off values for children improved the diagnosis. WC can be used successfully as an alternative diagnostic tool of obesity.

Distribution of obesity-related metabolic markers among 5-15 year old children from an urban area of Sri Lanka.

BACKGROUND: Obesity-associated metabolic consequences are commonly seen among young South Asians. OBJECTIVE: To assess the nutritional status, prevalence of metabolic derangements and to identify the validity of different obesity diagnostic criteria in the detection of metabolic derangements among 5-15 year old school children in the Colombo district of Sri Lanka. MATERIALS AND PROCEDURES: After a 12-hour overnight fast, blood was drawn for glucose, lipid profile and alanine amino transferase (ALT) enzyme. Oral glucose tolerance test (OGTT) was done with blood taken for random blood sugar 2 hours after glucose load. Height, weight, waist circumference (WC) and blood pressure were measured. RESULTS: Nine hundred and twenty children were studied (boys, n = 547). Thirty-two (3.5%) were obese according to IOTF classification. Five (0.5%) and 57 (6.2%) children had systolic and diastolic hypertension. Twelve (1.3%) and three (0.3%) had impaired fasting glucose and 2-hour OGTT, respectively. One hundred and thirty-nine (15.1%) had hypercholesterolemia and 36 (3.9%) hypertriglyceridaemia. Two hundred and fifteen (23.3%) had low HDL. Fifteen (1.6%) had metabolic syndrome according to IDF definition. Two hundred and eighty-three (30.7%) had one metabolic derangement; 95 (10.3%) had two metabolic derangements; and 16 (1.7%) had three or more metabolic derangements. Sri Lankan BMI and WC obesity cut-offs had a higher sensitivity in detecting metabolic abnormalities than international cut-offs. CONCLUSION: Metabolic derangements are prevalent in children who were detected to be non-obese by anthropometric measures, and clinicians should actively look and correct them. New research is needed to study the long-term effects on health.