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- September 3, 2010 |
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"The Metabolic Phenotype of Pre-diabetes in Obese Youth"Dr. Sonia Caprio (biography)
English - 2005-04-14 - 39 minutes
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Summary :
The unabated rise in the prevalence of childhood obesity has been accompanied by the appearance of a new pediatric disease: Type 2 diabetes. In adults, type 2 diabetes develops over a long period. Most, if not all, patients initially have impaired glucose tolerance (IGT), which is highly predictive of diabetes and cardiovascular disease. Little is known about IGT in pediatrics.
We determined the prevalence of IGT in a multiethnic clinic-based population of 167 obese children and adolescents. Irrespective of ethnicity, IGT was detected in ~20% obese children and adolescents.
Subsequently, we studied differences in insulin sensitivity and secretion in obese adolescents with NGT and IGT.
These studies revealed profound insulin resistance in the obese adolescents with IGT compared with those with NGT. Using 1H-NMR to measure intramyocellular fat (IMCL) in our obese children we demonstrated excessive accumulation of IMCL in the soleus muscle of obese adolescents with IGT compared to age and adiposity matched obese adolescents with NGT. Abdominal MRI showed that subcutaneous fat in IGT subjects was significantly lower compared with NGT subjects while visceral fat tended to be higher in the IGT group than in the NGT group.
These studies offer a novel insight into the pathogenesis of IGT in obese youth, namely that changes in glucose homeostasis are closely linked with altered partitioning of fat in both skeletal muscle and adipose tissues.
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The epidemiology of childhood obesity
• The emerging epidemic of type-2 diabetes in the world
• How the metabolic syndrome in adolescents was defined by Weiss et al (NEJM, 2004)
• Prevalence of impaired glucose tolerance and the metabolic syndrome in obese youth
• Mechanisms of insulin resistance in obese adolescents with impaired glucose tolerance
• The natural history of “pre-diabetes” in the young
Bibliographic references :
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002 Mar 14;346(11):802-10.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004 Jun 3;350(23):2362-74.
Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, Caprio S. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care. 2005 Apr;28(4):902-9.
Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, Boselli L, Barbetta G, Allen K, Rife F, Savoye M, Dziura J, Sherwin R, Shulman GI, Caprio S. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet. 2003 Sep 20;362(9388):951-7.
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