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Oral glucose effectiveness and metabolic risk in obese children and adolescents

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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.

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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

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Funding

There was no fund supporting the study.

Author information

Authors and Affiliations

  1. Research Unit for Multifactorial Diseases, Bambino Gesù Children’s Hospital, Rome, Italy

    Nicola Spreghini, Maria Rita Spreghini, Giuseppe Stefano Morino & Melania Manco

  2. Dipartimento Pediatrico Universitario Ospedaliero, BambinoGesù Children’s Hospital, Tor Vergata University, Rome, Italy

    Stefano Cianfarani, Elena Inzaghi, Alessio Convertino & Danilo Fintini

  3. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Stefano Cianfarani

  4. Azienda Unità Sanitaria Locale di Viterbo, Viterbo, Italy

    Claudia Brufani

Authors
  1. Nicola Spreghini
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  2. Stefano Cianfarani
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  4. Claudia Brufani
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  5. Giuseppe Stefano Morino
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  9. Melania Manco
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Corresponding author

Correspondence to Melania Manco.

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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.

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

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Spreghini, N., Cianfarani, S., Spreghini, M.R. et al. Oral glucose effectiveness and metabolic risk in obese children and adolescents. Acta Diabetol 56, 955–962 (2019). https://doi.org/10.1007/s00592-019-01303-y

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