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Oral glucose effectiveness and metabolic risk in obese children and adolescents

  • Nicola Spreghini
  • Stefano Cianfarani
  • Maria Rita Spreghini
  • Claudia Brufani
  • Giuseppe Stefano Morino
  • Elena Inzaghi
  • Alessio Convertino
  • Danilo Fintini
  • Melania MancoEmail author
Original Article
  • 57 Downloads

Abstract

Aim

To investigate whether GE is affected in children/adolescents with obesity and abnormalities of the metabolic syndrome (MetS).

Methods

Cross-sectional study of oral GE (oGE), insulin sensitivity and secretion (calculated on 5 time-points oral glucose tolerance test) and metabolic abnormalities in 1012 patients with overweight/obesity (aged 6.0–17.9 years old). A MetS risk score was calculated on the basis of distribution of fasting glucose, triglycerides, HDL-cholesterol, total cholesterol, systolic and diastolic blood pressure. Non-alcoholic fatty liver disease (NAFLD) was suspected based on thresholds of alanine aminotransferases.

Results

Four-hundred and eighty patients (47.73%) had low-MetS risk score, 488 medium (48.22% with 1–2 risk factors) and 41 (4.05% with ≥ 3 factors) high risk. oGE was significantly lower in subjects with obesity [3.81 (1.46) mg/dl/min− 1] than in those with overweight [4.98 (1.66) mg/dl/min− 1; p value < 0.001]. oGE was negatively correlated with BMI (ρ = − 0.79; p < 0.001) and BMI z score (ρ = − 0.56; p < 0.001) and decreased significantly among MetS risk classes (p = 0.001). The median difference of oGE from low to medium risk was estimated to be as − 4.9%, from medium to high as − 13.38% and from low to high as − 17.62%. oGE was not statistically different between NAFLD+ and NAFLD− cases.

Conclusions

In children and adolescents with obesity oGE decreases. Noteworthy, it decreases as the Met score increases. Therefore, reduced oGE may contribute to the higher risk of these individuals to develop type 2 diabetes.

Keywords

Glucose effectiveness Glucose metabolism Metabolic syndrome 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

AUC

Area under curve

BMI

Body mass index

EHC

Euglycemic Hyperinsulinemic Clamp

HDL-cholesterol

High-density lipoprotein cholesterol

HGP

Hepatic glucose production

HIRI

Hepatic Insulin Resistance Index

HOMA-IR

Homeostasis model assessment for insulin resistance

IVGTT

Intravenous glucose tolerance test

ISI

Insulin sensitivity index

IFG

Impaired fasting glucose

IGT

Impaired glucose tolerance

IR

Insulin resistance

MetS

Metabolic syndrome

NAFLD

Non-alcoholic fatty liver disease

NGT

Normal glucose tolerance

oDI

Oral disposition index

OGTT

Oral glucose tolerance test

T2D

Type 2 diabetes

TG

Triglycerides

Notes

Funding

There was no fund supporting the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the Ethics Committee of Bambino Gesù Children’s Hospital, which approved the study, and with the 1964 Helsinki Declaration and the European Convention of Human Rights and Biomedicine for Research in Children as revised in 2008. To ensure data protection and confidentiality, data extracted from the medical records were de-identified before analysis.

Informed consent

Written informed consent was obtained from the parents before any testing procedure.

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  • Nicola Spreghini
    • 1
  • Stefano Cianfarani
    • 2
    • 3
  • Maria Rita Spreghini
    • 1
  • Claudia Brufani
    • 4
  • Giuseppe Stefano Morino
    • 1
  • Elena Inzaghi
    • 2
  • Alessio Convertino
    • 2
  • Danilo Fintini
    • 2
  • Melania Manco
    • 1
    Email author
  1. 1.Research Unit for Multifactorial DiseasesBambino Gesù Children’s HospitalRomeItaly
  2. 2.Dipartimento Pediatrico Universitario Ospedaliero, BambinoGesù Children’s HospitalTor Vergata UniversityRomeItaly
  3. 3.Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden
  4. 4.Azienda Unità Sanitaria Locale di ViterboViterboItaly

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