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Preserved insulin sensitivity predicts metabolically healthy obese phenotype in children and adolescents

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Abstract

Available data on metabolically healthy obese (MHO) phenotype in children suggest that gender, puberty, waist circumference, insulin sensitivity, and other laboratory predictors have a role in distinguishing these children from metabolically unhealthy obese (MUO) youth. The goal of this study was to identify predictors of MHO phenotype and to analyze glucose and insulin metabolism during oral glucose tolerance test (OGTT) in MHO children. OGTT was performed in 244 obese children and adolescents aged 4.6–18.9 years. Subjects were classified as MHO in case of no fulfilled criterion of metabolic syndrome except anthropometry or as MUO (≥2 fulfilled criteria). Among the subjects, 21.7 % had MHO phenotype, and they were more likely to be female, younger, and in earlier stages of pubertal development, with lower degree of abdominal obesity. Insulin resistance was the only independent laboratory predictor of MUO phenotype (OR 1.59, CI 1.13–2.25), with 82 % sensitivity and 60 % specificity for diagnosing MUO using HOMA-IR cutoff point of ≥2.85. Although no significant differences were observed in glucose regulation, MUO children had higher insulin demand throughout OGTT, with 1.53 times higher total insulin secretion.

Conclusion: Further research is needed to investigate the possibility of targeted treatment of insulin resistance to minimize pubertal cross-over to MUO in obese children.

What is Known:

• Substantial proportion of the obese youth (21–68 %) displays a metabolically healthy (MHO) phenotype.

• Gender, puberty, waist circumference, insulin sensitivity, and lower levels of uric acid and transaminases have a possible role in distinguishing MHO from metabolically unhealthy obese (MUO) children.

What is New:

• Insulin resistance was found to be the only significant laboratory predictor of MUO when adjusted for gender, puberty, and the degree of abdominal obesity.

• Besides basal insulin resistance, MUO children were found to have a significantly higher insulin secretion throughout OGTT in order to maintain glucose homeostasis.

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Abbreviations

BMI:

Body mass index

GlucoseAUC :

Area under the glucose curve

HOMA-IR:

Homeostatic model assessment of insulin resistance index

IDF:

International Diabetes Federation

InsulinAUC :

Area under the insulin curve

ISI:

Matsuda insulin sensitivity index

MHO:

Metabolically healthy obese

MUO:

Metabolically unhealthy obese

OGTT:

Oral glucose tolerance test

SDS:

Standard deviation score

WC:

Waist circumference

WHO:

World Health Organization

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Acknowledgments

We gratefully acknowledge the kind assistance of the doctors and nurses of the Mother and Child Health Care Inistitute of Serbia “Dr Vukan Cupic.” This study was supported by the Ministry of Education, Science, and Technological Development of the Republic of Serbia through project no. 172026, 2011–2014.

Compliance with ethical standards

The authors declare that they have no conflict of interest. Informed consents were obtained for all participants and the study was approved by the Hospital Ethics Committee and performed in accordance with the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare that they have no competing interests.

Authors’ contributions

Rade Vukovic designed the research study, conducted statistical analyses, and wrote the first draft of the manuscript. Tatjana Milenkovic, Katarina Mitrovic, Sladjana Todorovic, Ljiljana Plavsic, Ana Vukovic, and Dragan Zdravkovic contributed to study design and revised the manuscript. All authors reviewed and approved the final version of the manuscript.

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Authors and Affiliations

  1. Department of Endocrinology, Mother and Child Health Care Institute of Serbia “Dr Vukan Cupic”, Radoja Dakica 8, 11070, Belgrade, Serbia

    Rade Vukovic, Tatjana Milenkovic, Katarina Mitrovic, Sladjana Todorovic & Dragan Zdravkovic

  2. Family Planning Center, Mother and Child Health Care Institute of Serbia “Dr Vukan Cupic”, Radoja Dakica 8, 11070, Belgrade, Serbia

    Ljiljana Plavsic

  3. Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Dr Subotica 11, 11000, Belgrade, Serbia

    Ana Vukovic

  4. School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia

    Dragan Zdravkovic

Authors
  1. Rade Vukovic
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  2. Tatjana Milenkovic
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  3. Katarina Mitrovic
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  6. Ana Vukovic
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Correspondence to Rade Vukovic.

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Communicated by Beat Steinmann

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Vukovic, R., Milenkovic, T., Mitrovic, K. et al. Preserved insulin sensitivity predicts metabolically healthy obese phenotype in children and adolescents. Eur J Pediatr 174, 1649–1655 (2015). https://doi.org/10.1007/s00431-015-2587-4

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  • DOI: https://doi.org/10.1007/s00431-015-2587-4

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