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Insulin Resistance and Other Mechanisms of Obesity Hypertension

Pediatric Hypertension

Abstract

Insulin has important biological effects on the metabolic regulation of carbohydrates, lipids, and proteins. In addition, it has important influences on the vasculature, kidneys, and the sympathetic nervous system. Insulin resistance (or loss of insulin sensitivity) is typically defined as decreased insulin-mediated glucose disposal in the body in response to physiological (endogenous) or exogenous insulin. Insulin resistance is most commonly associated with obesity, although not all obese individuals are insulin resistant, and insulin resistance may be present in nonobese individuals. It can have important adverse consequences on the vasculature and blood pressure, thought to be mediated via vascular inflammation, nitric oxide action, sympathetic nervous system, and renal sodium retention. The “gold standard” for measurement of insulin sensitivity is glucose clamp studies; and the most widely used index for insulin resistance, is the homeostasis model for insulin resistance (HOMA-IR). The prevalence of insulin resistance and its adverse effects has been found to be higher in children and adolescents with obesity, diabetes, chronic kidney disease, and associated with low-birth weight. Modifications in diet, especially use of DASH diet, physical activity, and drugs such as metformin have been found to be effective in improving insulin resistance. Genetic and epigenetic mechanisms likely influence insulin resistance and are an active area of research.

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Authors and Affiliations

  1. Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, Russ Berrie Medical Sciences Pavilion, 1150 St Nicholas Ave, 10032, New York, NY, USA

    Vidhu V. Thaker

  2. Division of Endocrinology, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA

    Vidhu V. Thaker

  3. Departments of Medicine and Pediatrics, Thomas Jefferson University, 833 Chestnut Street, Suite 700, 19107, Philadelphia, PA, USA

    Bonita Falkner

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  1. Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA

    Joseph Flynn

  2. Massachusetts General Hospital, Boston, Massachusetts, USA

    Julie R. Ingelfinger

  3. Arkansas Children's Hospital, University of Arkansas Medical Science, Little Rock, Arkansas, USA

    Karen Redwine

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  1. Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Harvard Medical School, Fruit St. 55, 02114, Boston, MA, USA

    Julie R. Ingelfinger M.D.

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Thaker, V.V., Falkner, B. (2017). Insulin Resistance and Other Mechanisms of Obesity Hypertension. In: Flynn, J., Ingelfinger, J., Redwine, K. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31420-4_39-1

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  1. Latest

    Insulin Resistance and Other Mechanisms of Obesity Hypertension
    Published:
    16 July 2022

    DOI: https://doi.org/10.1007/978-3-319-31420-4_39-2

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    Insulin Resistance and Other Mechanisms of Obesity Hypertension
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    DOI: https://doi.org/10.1007/978-3-319-31420-4_39-1

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