Journal of Endocrinological Investigation

, Volume 32, Issue 5, pp 401–405 | Cite as

The effect of puberty on insulin resistance in obese children

  • S. Pilia
  • M. R. Casini
  • M. L. Foschini
  • L. Minerba
  • M. C. Musiu
  • V. Marras
  • P. Civolani
  • S. LocheEmail author
Original Articles


Objective: Insulin resistance (IR) increases during puberty in normal children. IR is the first adverse metabolic event of obesity, and the marker of the metabolic syndrome. We aimed to study the effect of puberty on IR in obese and normal-weight children. Design: Cross-sectional evaluation of fasting glucose, insulin concentrations, and homeostasis model assessment of IR (HOMA-IR) in obese and control children throughout puberty. Patients and methods: We recruited 424 obese children (207 pre-pubertal and 217 pubertal divided in Tanner stages 2–3, 4, and 5) and estimated IR using the HOMA-IR index. Data were compared to those obtained in 123 healthy normal-weight children (40 pre-pubertal and 83 pubertal divided in Tanner stages 2–3, 4, and 5). Results: In the obese children mean HOMA-IR increased progressively across Tanner stages, and was significantly higher in all groups (pre-pubertal and Tanner stages 2–3, 4, and 5) of obese than in control children. HOMA-IR was significantly correlated with BMI. Conclusions: HOMA-IR in obese children increases at puberty more than in normal-weight children and does not return to pre-pubertal values at the end of puberty.


BMI HOMA insulin obesity puberty 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lobstein T, Baur L, Uauy R; IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev 2004, 5 (Suppl): 4–85.PubMedCrossRefGoogle Scholar
  2. 2.
    Miller J, Rosenbloom A, Silverstein J. Childhood obesity. J Clin Endocrinol Metab 2004, 89: 4211–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Troiano RP, Flegal KM. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics 1998, 10: 497–504.Google Scholar
  4. 4.
    Marras V, Macchis R, Foschini ML, et al. Prevalence of overweight and obesity in primary school children in Southern Sardinia, Italy. Ital J Pediatr 2006,32: 251–5.Google Scholar
  5. 5.
    American Diabetes Association. Type II Diabetes in children and adolescents. Pediatrics 2000, 105: 671–80.CrossRefGoogle Scholar
  6. 6.
    Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002, 346: 802–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Beard JC, Ward WK, Halter JB, Wallum BJ, Porte D Jr. Relationship of islet function to insulin action in human obesity. J Clin Endocrinol Metab 1987, 65: 59–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Caprio S, Bronson M, Sherwin RS, Rife F, Tamborlane WV. Co-existence of severe insulin resistance and hyperinsulinaemia in preadolescent obese children. Diabetologia 1996, 39: 1489–97.PubMedCrossRefGoogle Scholar
  9. 9.
    Krotkiewski M, Björntorp P, Sjöström L, Smith U. Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest 1983, 72: 1150–62.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Larsson B, Svärdsudd K, Welin L, Wilhelmsen L, Björntorp P, Tibblin G. Abdominal adipose tissue distribution, obesity and risk of cardiovascular disease and death: a 13 years follow-up of partecipants in the study of men born in 1913. Brit Med J 1984, 288: 1401–4.CrossRefGoogle Scholar
  11. 11.
    Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjöström L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow-up of partecipants in the population study of women in Gothenburg, Sweden. Brit Med J (Clin Res Ed) 1984, 289: 1257–61.CrossRefGoogle Scholar
  12. 12.
    Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998, 101: 518–25.PubMedGoogle Scholar
  13. 13.
    Kissebah AH, Vydelingum N, Murray R, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982, 54: 254–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa heart study. Pediatrics 2001, 108: 712–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Bloch CA, Clemons P, Sperling MA. Puberty decreases insulin sensitivity. J Pediatr 1987, 110: 481–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Caprio S, Plewe G, Diamond MP, et al. Increased insulin secretion in puberty: a compensatory response to reductions in insulin sensitivity. J Pediatr 1989, 114: 963–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Cook JS, Hoffman RP, Stene MA, Hansen JR. Effects of maturational stage on insulin sensitivity during puberty. J Clin Endocrinol Metab 1993, 77: 725–30.PubMedGoogle Scholar
  18. 18.
    Moran A, Jacobs DR Jr, Steinberger J, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes 1999, 48: 2039–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Hoffman RP, Vicini P, Sivitz WI, Cobelli C. Pubertal adolescent male-female differences in insulin sensitivity and glucose effectiveness determined by the one compartment minimal model. Pediatr Res 2000, 48: 384–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Klein DJ, Aronson Friedman L, Harlan WR, et al. Obesity and the development of insulin resistance and impaired fasting glucose in black and white adolescent girls: a longitudinal study. Diabetes Care 2004, 27: 378–83.PubMedCrossRefGoogle Scholar
  21. 21.
    Cacciari E, Milani S, Balsamo A, et al. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 2006, 29: 581–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969, 44: 291–303.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970, 45: 13–23.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Luciano A, Bressan F, Zoppi G. Body mass index reference curves for children aged 3–19 years from Verona, Italy. Eur J Clin Nutr 1997, 51: 6–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Arslanian S, Suprasongsin C, Janosky JE. Insulin secretion and sensitivity in black versus white prepubertal healthy children. J Clin Endocrinol Metab 1997, 82: 1923–7.PubMedGoogle Scholar
  26. 26.
    Travers SH, Jeffers BW, Bloch CA, Hill JO, Eckel RH. Gender and Tanner stage differences in body composition and insulin sensitivity in early pubertal children. J Clin Endocrinol Metab 1995, 80: 172–8.PubMedGoogle Scholar
  27. 27.
    McCartney CR, Blank SK, Prendergast KA, et al. Obesity and sex steroid changes across puberty: evidence for marked hyperandrogenemia in pre- and early pubertal obese girls. J Clin Endocrinol Metab 2007, 92: 430–6.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Ferrannini E, Mari A. How to measure insulin sensitivity. J Hypertens 1998, 16: 895–906.PubMedCrossRefGoogle Scholar
  29. 29.
    DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol Endocrinol Metab 1979, 237: E214–23.Google Scholar
  30. 30.
    Bergman RN. Lilly Lecture 1989. Toward physiological understanding of glucose tolerance: minimal-model approach. Diabetes 1989, 38: 1512–27.PubMedCrossRefGoogle Scholar
  31. 31.
    Bergman RN, Prager R, Volund A, Olefsky JM. Equivalence of the insulin sensitivity index in man derived by the minimal model method and the euglycemic glucose clamp. J Clin Invest 1987, 79: 790–800.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28: 412–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005, 115: e500–3.PubMedCrossRefGoogle Scholar
  34. 34.
    Conwell LS, Brown WJ, Trost SG, Batch JA. Indexes of insulin resistance and secretion in obese children and adolescent: a validation study. Diabetes Care 2004, 27: 314–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Gungor N, Saad R, Janosky J, Arslanian S. Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents. J Pediatr 2004, 144: 47–55.PubMedCrossRefGoogle Scholar
  36. 36.
    Guzzaloni G, Grugni G, Mazzilli G, Moro D, Morabito F. Comparison between beta-cell function and insulin resistance indexes in prepubertal and pubertal obese children. Metabolism 2002, 51: 1011–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Rössner SM, Neovius M, Montgomery SM, Marcus C, Norgren S. Alternative methods of insulin sensitivity assessment in obese children and adolescents. Diabetes Care 2008, 31: 802–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwartz B, Steinberger J, Jacobs DR, Hong C, Moran A, Sinaiko AR. Measurement of insulin sensitivity in children: comparison between the euglycemic-hyperinsulinemic clamp and surrogate measures. Diabetes Care 2008, 31: 783–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Brandou F, Brun JF, Mercier J. Limited accuracy of surrogates of insulin resistance during puberty in obese and lean children at risk for altered glucoregulation. J Clin Endocrinol Metab 2005, 90: 761–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Siervogel RM, Demerath EW, Schubert C, et al. Puberty and body composition. Horm Res 2003, 60 (Suppl): 36–45.PubMedCrossRefGoogle Scholar
  41. 41.
    Scacchi M, Pincelli AI, Cavagnini F. Growth hormone in obesity. Int J Obes Relat Metab Disord 1999, 23: 260–71.PubMedCrossRefGoogle Scholar
  42. 42.
    Ronti T, Lupattelli G, Mannarino E. The endocrine function of adipose tissue: an update. Clin Endocrinol (Oxf) 2006, 64: 355–65.Google Scholar
  43. 43.
    Martos-Moreno GA, Barrios V, Argente J. Normative data for adiponectin, resistin, interleukin 6, and leptin/receptor ratio in a healthy Spanish pediatric population: relationship with sex steroids. Eur J Endocrinol 2006, 155: 429–34.PubMedCrossRefGoogle Scholar
  44. 44.
    Mann DR, Johnson AO, Gimpel T, Castracane VD. Changes in circulating leptin, leptin receptor, and gonadal hormones from infancy until advanced age in humans. J Clin Endocrinol Metab 2003, 88: 3339–45.PubMedCrossRefGoogle Scholar
  45. 45.
    Böttner A, Kratzsch J, Müller G, et al. Gender differences of adiponectin levels develop during the progression of puberty and are related to serum androgen levels. J Clin Endocrinol Metab 2004, 89: 4053–61.PubMedCrossRefGoogle Scholar
  46. 46.
    Mayes JS, Watson GH. Direct effects of sex steroid hormones on adipose tissues and obesity. Obes Rev 2004, 5: 197–216.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2009

Authors and Affiliations

  • S. Pilia
    • 1
  • M. R. Casini
    • 1
  • M. L. Foschini
    • 1
  • L. Minerba
    • 2
  • M. C. Musiu
    • 1
  • V. Marras
    • 1
  • P. Civolani
    • 1
  • S. Loche
    • 1
    Email author
  1. 1.Pediatric Endocrinology UnitMicrocitemico HospitalASL Cagliari
  2. 2.Department of Public HealthUniversity of CagliariCagliariItaly

Personalised recommendations