Insulin Resistance and Other Mechanisms of Obesity Hypertension

Reference work entry

Abstract

Insulin has important biological effects on the metabolic regulation of carbohydrates, lipids, and proteins. In addition, it has important influences on the vasculature, kidneys, and the sympathetic nervous system. Insulin resistance (or loss of insulin sensitivity) is typically defined as decreased insulin-mediated glucose disposal in the body in response to physiological (endogenous) or exogenous insulin. Insulin resistance is most commonly associated with obesity, although not all obese individuals are insulin resistant, and insulin resistance may be present in nonobese individuals. It can have important adverse consequences on the vasculature and blood pressure, thought to be mediated via vascular inflammation, nitric oxide action, sympathetic nervous system, and renal sodium retention. The “gold standard” for measurement of insulin sensitivity is glucose clamp studies; and the most widely used index for insulin resistance, is the homeostasis model for insulin resistance (HOMA-IR). The prevalence of insulin resistance and its adverse effects have been found to be higher in children and adolescents with obesity, diabetes, chronic kidney disease, and associated with low-birth weight. Modifications in diet, especially use of DASH diet, physical activity, and drugs such as metformin have been found to be effective in improving insulin resistance. Genetic and epigenetic mechanisms likely influence insulin resistance and are an active area of research.

Keywords

Insulin resistance Metabolic syndrome Obesity Diabetes Hypertension Blood pressure 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Molecular Genetics, Department of PediatricsColumbia University Medical CenterNew YorkUSA
  2. 2.Division of EndocrinologyBoston Childrens Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Departments of Medicine and PediatricsThomas Jefferson UniversityPhiladelphiaUSA

Section editors and affiliations

  • Julie R. Ingelfinger
    • 1
  1. 1.Pediatric Nephrology UnitMassGeneral Hospital for Children at MGH, Harvard Medical SchoolBostonUSA

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