European Journal of Pediatrics

, Volume 171, Issue 9, pp 1331–1337 | Cite as

The absence of insulin resistance in metabolic syndrome definition leads to underdiagnosing of metabolic risk in obese patients

  • Selim Kurtoglu
  • Leyla Akin
  • Mustafa Kendirci
  • Nihal Hatipoglu
  • Ferhan Elmali
  • Mümtaz Mazicioglu
Original Article

Abstract

This study explores in a group of obese children and adolescents aged 10 to16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.

Keywords

Metabolic syndrome Insulin resistance IDF definition Children Adolescent 

Abbreviations

MS

Metabolic syndrome

IDF

International Diabetes Federation

IR

Insulin resistance

OGTT

Oral glucose tolerance test

HOMA-IR

Homeostasis model assessment of insulin resistance

QUICKI

Quantitative insulin sensitivity check index

FGIR

Fasting glucose/insulin ratio

WC

Waist circumference

ISI

Insulin sensitivity index

HDL-C

High-density lipoprotein cholesterol

PG

Post-load glucose

IGT

Impaired glucose tolerance

IFG

Impaired fasting glucose

Notes

Conflict of interest

Authors have nothing to be declared.

References

  1. 1.
    Abbasi F, Brown BW Jr, Lamendola C, McLaughlin T, Reaven GM (2002) Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol 40:937–943PubMedCrossRefGoogle Scholar
  2. 2.
    Atabek ME, Pirgon O, Kurtoglu S (2006) Prevalence of metabolic syndrome in obese Turkish children and adolescents. Diabetes Res Clin Pract 72:315–321PubMedCrossRefGoogle Scholar
  3. 3.
    Bloomgarden ZT (2004) Definitions of the insulin resistance syndrome: the 1st World Congress on the Insulin Resistance Syndrome. Diabetes Care 27:824–830PubMedCrossRefGoogle Scholar
  4. 4.
    Cizmecioglu FM, Etiler N, Hamzaoglu O, Hatun S (2009) Prevalence of metabolic syndrome in schoolchildren and adolescents in Turkey: a population-based study. J Pediatr Endocrinol Metab 22:703–714PubMedCrossRefGoogle Scholar
  5. 5.
    Cook S, Auinger P, Li C et al (2008) Metabolic syndrome rates in United States adolescents, from the National Health and Nutrition Examination Survey, 1999–2002. J Pediatr 152:165–170PubMedCrossRefGoogle Scholar
  6. 6.
    Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH (2003) Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 157:821–827PubMedCrossRefGoogle Scholar
  7. 7.
    Cruz ML, Goran MI (2004) The metabolic syndrome in children and adolescents. Curr Diabet Rep 4:53–62CrossRefGoogle Scholar
  8. 8.
    Cruz ML, Shaibi GQ, Weigensberg MJ, Spruijt-Metz D, Ball GD, Goran MI (2005) Pediatric obesity and insulin resistance: chronic disease risk and implications for treatment and prevention beyond body weight modification. Annu Rev Nutr 25:435–468PubMedCrossRefGoogle Scholar
  9. 9.
    Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R (2005) Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 111:1448–1454PubMedCrossRefGoogle Scholar
  10. 10.
    Daniels SR, Arnett DK, Eckel RH et al (2005) Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 111:1999–2012PubMedCrossRefGoogle Scholar
  11. 11.
    Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe Study Group (1999) Will new diagnostic criteria for diabetes mellitus change phenotype of Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe Study Group: glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 354:617–621CrossRefGoogle Scholar
  12. 12.
    Discigil G, Tekin N, Soylemez A (2009) Obesity in Turkish children and adolescents: prevalence and non-nutritional correlates in an urban sample. Child Care Health Dev 35:153–158PubMedCrossRefGoogle Scholar
  13. 13.
    Druet C, Ong K, Levy Marchal C (2010) Metabolic syndrome in children: comparison of the International Diabetes Federation 2007 consensus with an adapted National Cholesterol Education Program definition in 300 overweight and obese French children. Horm Res Paediatr 73:181–186PubMedCrossRefGoogle Scholar
  14. 14.
    Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 365:1415–1428PubMedCrossRefGoogle Scholar
  15. 15.
    Ford ES, Li C (2008) Defining the metabolic syndrome in children and adolescents: will the real definition please stand up? J Pediatr 152:160–164PubMedCrossRefGoogle Scholar
  16. 16.
    Ford ES, Li C, Zhao G, Pearson WS, Mokdad AH (2008) Prevalence of the metabolic syndrome among U.S. adolescents using the definition from the International Diabetes Federation. Diabetes Care 31:587–589PubMedCrossRefGoogle Scholar
  17. 17.
    Goran MI, Gower BA (2001) Longitudinal study on pubertal insulin resistance. Diabetes 50:2444–2450PubMedCrossRefGoogle Scholar
  18. 18.
    Gunczler P, Lanes R (2006) Relationship between different fasting-based insulin sensitivity indices in obese children and adolescents. J Pediatr Endocrinol Metab 19:259–265PubMedCrossRefGoogle Scholar
  19. 19.
    Hatipoglu N, Ozturk A, Mazicioglu MM, Kurtoglu S, Seyhan S, Lokoglu F (2008) Waist circumference percentiles for 7- to 17-year-old Turkish children and adolescents. Eur J Pediatr 167:383–389PubMedCrossRefGoogle Scholar
  20. 20.
    Haymond MW (2003) Measuring insulin resistance: a task worth doing. But how? Pediatr Diabetes 4:115–118PubMedCrossRefGoogle Scholar
  21. 21.
    Hrebícek J, Janout V, Malincíková J, Horáková D, Cízek L (2002) Detection of insulin resistance by simple quantitative insulin sensitivity check index QUICKI for epidemiological assessment and prevention. J Clin Endocrinol Metab 87:144–147PubMedCrossRefGoogle Scholar
  22. 22.
    Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 85:2402–2410PubMedCrossRefGoogle Scholar
  23. 23.
    Kelishadi R, Ardalan G, Adeli K, Motaghian M, Majdzadeh R, Mahmood-Arabi MS, Delavari A, Riazi MM, Namazi R, Ramezani MA, CASPIAN Study Group (2007) Factor analysis of cardiovascular risk clustering in pediatric metabolic syndrome: CASPIAN study. Ann Nutr Metab 51:208–215PubMedCrossRefGoogle Scholar
  24. 24.
    Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C (2005) 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 115:500–503CrossRefGoogle Scholar
  25. 25.
    Kim G, Caprio S (2011) Diabetes and insulin resistance in pediatric obesity. Pediatr Clin North Am 58:1355–1361PubMedCrossRefGoogle Scholar
  26. 26.
    Lee JM (2006) Insulin resistance in children and adolescents. Rev Endocr Metab Disord 7:141–147PubMedCrossRefGoogle Scholar
  27. 27.
    Matsuda M, DeFronzo RA (1999) Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 22:1462–1470PubMedCrossRefGoogle Scholar
  28. 28.
    Nelson RA, Bremer AA (2010) Insulin resistance and metabolic syndrome in the pediatric population. Metab Syndr Relat Disord 8:1–14PubMedCrossRefGoogle Scholar
  29. 29.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555PubMedCrossRefGoogle Scholar
  30. 30.
    Ozturk A, Mazicioglu MM, Hatipoglu N et al (2008) Reference body mass index curves for Turkish children 6 to 18 years of age. J Pediatr Endocrinol Metab 21:827–836PubMedCrossRefGoogle Scholar
  31. 31.
    Pirkola J, Tammelin T, Bloigu A et al (2008) Prevalence of metabolic syndrome at age 16 using the International Diabetes Federation paediatric definition. Arch Dis Child 93:945–951PubMedCrossRefGoogle Scholar
  32. 32.
    Rodríguez-Morán M, Salazar-Vázquez B, Violante R, Guerrero-Romero F (2004) Metabolic syndrome among children and adolescents aged 10–18 years. Diabetes Care 27:2516–2517PubMedCrossRefGoogle Scholar
  33. 33.
    Saad R, Gungor N, Arslanian S (2005) Progression from normal glucose tolerance to type 2 diabetes in a young girl: longitudinal changes in insulin sensitivity and secretion assessed by the clamp technique and surrogate estimates. Pediatr Diabetes 6:95–99PubMedCrossRefGoogle Scholar
  34. 34.
    Sağlam H, Tarım O (2008) Prevalence and correlates of obesity in schoolchildren from the city of Bursa, Turkey. J Clin Res Pediatr Endocrinol 1:80–88PubMedGoogle Scholar
  35. 35.
    Sangun Ö, Dündar B, Köşker M, Pirgon Ö, Dündar N (2011) Prevalence of metabolic syndrome in obese children and adolescents using three different criteria and evaluation of risk factors. J Clin Res Pediatr Endocrinol 3:70–76PubMedCrossRefGoogle Scholar
  36. 36.
    Sen Y, Kandemir N, Alikasifoglu A, Gonc N, Ozon A (2008) Prevalence and risk factors of metabolic syndrome in obese children and adolescents: the role of the severity of obesity. Eur J Pediatr 167:1183–1189PubMedCrossRefGoogle Scholar
  37. 37.
    Sinaiko AR, Steinberger J, Moran A, Hong CP, Prineas RJ, Jacobs DR Jr (2006) Influence of insulin resistance and body mass index at age 13 on systolic blood pressure, triglycerides, and high-density lipoprotein cholesterol at age 19. Hypertension 48:730–736PubMedCrossRefGoogle Scholar
  38. 38.
    Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K et al (2002) Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 346:802–810PubMedCrossRefGoogle Scholar
  39. 39.
    Tailor AM, Peeters PH, Norat T, Vineis P, Romaguera D (2010) An update on the prevalence of the metabolic syndrome in children and adolescents. Int J Pediatr Obes 5:202–213PubMedCrossRefGoogle Scholar
  40. 40.
    Taylor RW, Jones IE, Williams SM, Goulding A (2000) Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr 72:490–495PubMedGoogle Scholar
  41. 41.
    Weiss R, Dziura J, Burgert TS et al (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350:2362–2374PubMedCrossRefGoogle Scholar
  42. 42.
    Zannolli R, Rebeggiani A, Chiarelli F, Morgese G (1993) Hyperinsulinism as a marker in obese children. Am J Dis Child 147:837–841PubMedGoogle Scholar
  43. 43.
    Zimmet P, Alberti KG, Kaufman F, IDF Consensus Group et al (2007) The metabolic syndrome in children and adolescents—an IDF consensus report. Pediatr Diabetes 8:299–306PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Selim Kurtoglu
    • 1
  • Leyla Akin
    • 1
  • Mustafa Kendirci
    • 1
  • Nihal Hatipoglu
    • 1
  • Ferhan Elmali
    • 2
  • Mümtaz Mazicioglu
    • 3
  1. 1.Department of Pediatric Endocrinology, Faculty of MedicineErciyes UniversityKayseriTurkey
  2. 2.Department of Biostatistics, Faculty of MedicineErciyes UniversityKayseriTurkey
  3. 3.Department of Family Medicine, Faculty of MedicineErciyes UniversityKayseriTurkey

Personalised recommendations