The incidence of metabolic syndrome in obese Czech children: the importance of early detection of insulin resistance using homeostatic indexes HOMA-IR and QUICKI.

Common alimentary obesity frequently occurs on a polygenic basis as a typical lifestyle disorder in the developed countries. It is associated with characteristic complex metabolic changes, which are the cornerstones for future metabolic syndrome development. The aims of our study were 1) to determine the incidence of metabolic syndrome (based on the diagnostic criteria defined by the International Diabetes Federation for children and adolescents) in Czech obese children, 2) to evaluate the incidence of insulin resistance according to HOMA-IR and QUICKI homeostatic indexes in obese children with and without metabolic syndrome, and 3) to consider the diagnostic value of these indexes for the early detection of metabolic syndrome in obese children. We therefore performed anthropometric and laboratory examinations to determine the incidence of metabolic syndrome and insulin resistance in the group of 274 children with obesity (128 boys and 146 girls) aged 9-17 years. Metabolic syndrome was found in 102 subjects (37 %). On the other hand, the presence of insulin resistance according to QUICKI <0.357 was identified in 86 % and according to HOMA-IR >3.16 in 53 % of obese subjects. This HOMA-IR limit was exceeded by 70 % children in the MS(+) group, but only by 43 % children in the MS(-) group (p<0.0001). However, a relatively high incidence of insulin resistance in obese children without metabolic syndrome raises a question whether the existing diagnostic criteria do not falsely exclude some cases of metabolic syndrome. On the basis of our results we suggest to pay a preventive attention also to obese children with insulin resistance even if they do not fulfill the actual diagnostic criteria for metabolic syndrome.

[Epidemiology of the metabolic syndrome and possibility for its prevention by physical activities]. / Epidemiologie metabolického syndromu a moznosti prevence pohybovou aktivitou.

An epidemiological review of the metabolic syndrome is presented. Focus is on history of the discovery of the metabolic syndrome, its definition and changes made to it, etiopathogenesis, incidence and possibility for its prevention by physical activities.

[Exercise cardiorespiratory parameters in children motivated to physical activity after treatment for acute lymphoblastic leukemia]. / Zátezové kardiorespiracní parametry u detí motivovaných k pohybové aktivite po prelécené akutní lymfoblastické leukémii.

BACKGROUND: Children treated for acute lymphoblastic leukemia (ALL) with anthracycline antibiotic agents must be followed up for the danger of late cardiotoxic effects of the treatment. Another threat represents the consequence of the protective upbringing and inactive lifestyle. The aim of present study was to assess the exercise cardiorespiratory indexes and anthropometric variables in previously treated children without clinical, ECG and echocardiographic signs of cardiotoxicity, who had been motivated to physical activity. METHODS AND RESULTS: 29 children (12.3 +/- 2.7 years old) previously treated for ALL with anthracyclines were examined. The cumulative dosis of anthracyclines was 224 +/- 39.4 mg/m2. The treatment was finished before 4.8 +/- 2.1 years and after this period no signs of the late cardiotoxicity were detectable. Both children and their parents were encouraged to the regular physical activity of submaximal intensity. 29 age- and sex-matched control subjects were healthy children, never limited in their activities, but without special physical training. As soon as the basic anthropometric data had been verified, both groups completed a progressive exercise test with the assessment of submaximal and maximal spiroergometric indexes. In all parameters followed we failed to prove any significant differences between the two groups. The treated children exhibited only slightly lower body height, higher body weight and higher percentage of body fat. They reached lower respiratory exchange ratio (R), with higher oxygen uptake on both submaximal and maximal load levels. CONCLUSIONS: When sufficiently motivated, children surviving five years after the treatment with anthracycline for ALL, who have no signs of cardiotoxic effects, have their functional cardiorespiratory capacity approximately comparable to that of healthy children.

Serum leptin and leptin receptors in healthy prepubertal children: relations to insulin resistance and lipid parameters, body mass index (BMI), tumor necrosis factor alpha (TNF alpha), heart fatty acid binding protein (hFABP), and IgG anticardiolipin (ACL-IgG).

In a group of randomly selected 29 healthy prepubertal children (16 boys, mean age 9.56 +/- 0.7 years, 13 girls, mean age 9.96 +/- 0.9 years) fasting serum leptin and leptin receptor concentrations were measured by ELISA and compared with insulin parameters (homeostatic model of assessment insulin resistance = HOMA IR, insulin, intact proinsulin, C-peptide) and some metabolic parameters and factors that contribute to insulin resistance: triacylglycerols, high density lipoprotein cholesterol (HDL cholesterol), low density lipoprotein cholesterol, body mass index, tumor necrosis factor, heart fatty acid binding protein, and IgG fraction of anticardiolipin. Statistical analysis was performed using SAS/STAT software and included analysis of normality, analysis of variance, Spearman's correlations, linear and multiple regression analysis with insulin parameters as dependent variables. The subgroups of boys and girls did not differ significantly in any of parameters studied. Serum concentrations of insulin, intact proinsulin, HOMA IR, C-peptide and triacylglycerols appeared to be primarily influenced by serum leptin concentration. Serum leptin concentrations were tightly correlated with body mass indexes and negatively correlated with leptin receptor concentrations, probably as a manifestation of down regulation. The role of other factors studied appeared to be complementary or less significant (hFABP, ACL IgG), or absent (TNF alpha). We concluded that in healthy prepubertal children of both genders serum leptin concentration contributes to insulin resistance and to insulin resistance-related metabolic changes.