Metabolic Syndrome and Type 2 Diabetes Mellitus in Overweight and Obese Children: A Single Centre Experience

Öz

Objective: Childhood obesity is associated with various risks, including insulin resistance, type 2 diabetes mellitus (DM), hypertension, and metabolic syndrome (MetS). This study evaluated MetS and type 2 diabetes mellitus (DM) in overweight and obese children. Methods: Between 2000 and 2013, 474 obese and overweight children aged <18 years were included in this study. The clinical characteristics of the patients with MetS and type 2 DM were evaluated. Results: Of the patients, 50.4% (n = 239) were girls, and the mean age was 10.91±3.06 years. According to the body mass index, 20.5% (n=97) of the patients were overweight and 79.5% (n=377) were obese. Blood pressure, striae, and acanthosis nigricans were significantly higher in the obese group than in the overweight group (p <0.05). MetS was found in 30.8% (n=146) of the patients. The MetS rate was 37.7% (n=142) in the obese patients and 4.1% (n=4) in the overweight patients, and the difference between them was statistically significant (p<0.001) Based on the oral glucose tolerance test; 45 (9.5%) patients had impaired fasting glycaemia, 24 (5%) had impaired glucose tolerance and 4 (0.84%) had type 2 DM. One patient with normal glucose balance at admission, who was diagnosed with type 2 DM in the 4th year, was overweight and had a family history of diabetes, hyperinsulinemia, and high HOMA-IR. Conclusions: The results of our study showed that both obese and overweight children are at risk of developing MetS and type 2 DM, particularly in the presence of risk factors. Close monitoring of these children is important to prevent complications.

Anahtar Kelimeler

• Childhood obesity
• overweight
• metabolic syndrome
• type 2 diabetes mellitus

Kaynakça

1. WHO Obesity and Overweight Fact Sheets (2017). p 3-7. Available online at http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed 10 Aug, 2023) google scholar
2. National Child Measurement Programme. https://digital.nhs. uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year (Accessed 1 Sep 23) google scholar
3. Pinhas-Hamiel O, Hamiel U, Bendor CD, Bardugo A, Twig G, Cukierman-Yaffe T. The Global Spread of Severe Obesity in Toddlers, Children, and Adolescents: A Systematic Review and Meta-Analysis. Obes Facts. 2022;15(2):118-134. doi:10.1159/000521913 google scholar
4. Görçin Karaketir Ş, Lüleci NE, Eryurt MA, Emecen AN, Haklıdır M, Hıdıroğlu S. Overweight and obesity in preschool children in Turkey: A multilevel analysis. J Biosoc Sci. 2023;55(2):344-366. doi:10.1017/S0021932022000025 google scholar
5. Pekcan AG, Karaağaoğlu N, Samur FG. (2011). Türkiye de Okul Çağı Çocuklarında Büyümenin İzlenmesi Projesi TOÇBİ Raporu: TC Sağlık Bakanlığı yayınları. google scholar
6. T.C. Sağlık Bakanlığı. Türkiye çocukluk çağı (İlkokul 2. sınıf öğrencileri) şişmanlık araştırması COSI-TUR 2016. https://hsgm. saglik.gov.tr/depo/haberler/turkiye-cocukluk-cagi-sismanlik/COSI-TUR-2016-Kitap.pdf (Accessed Aug 22). google scholar
7. Türkiye Sağlıklı Beslenme ve Hareketli Hayat Programı” Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Ankara 2019 (Accessed Aug 22) google scholar
8. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539-553. doi:10.1002/ (SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S google scholar

9. Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Chen SSJ, et al. The Prevalence of Obesity Among Children With Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(12):e2247186. Published 2022 Dec 1. doi:10.1001/ jamanetworkopen.2022.47186 google scholar
10. Jolliffe CJ, Janssen I. Vascular risks and management of obesity in children and adolescents. Vasc Health Risk Manag. 2006;2(2):171-187. doi:10.2147/vhrm.2006.2.2.171 google scholar
11. Magnussen CG, Koskinen J, Chen W, Thomson R, Schmidt MD, Srinivasan SR, et al. Paediatric metabolic syndrome predicts adulthood metabolic syndrome, subclinical atherosclerosis, and type 2 diabetes mellitus but is no better than body mass index alone: the Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study. Circulation. 2010;122(16):1604-1611. doi:10.1161/CIRCULATIONAHA.110.940809 google scholar
12. Christian Flemming GM, Bussler S, Körner A, Kiess W. Definition and early diagnosis of metabolic syndrome in children. J Pediatr Endocrinol Metab. 2020;33(7):821-833. doi:10.1515/jpem-2019-0552 google scholar
13. Urbina EM, Kimball TR, Khoury PR, Daniels SR, Dolan LM. Increased arterial stiffness was found in adolescents with obesity or obesity-related type 2 diabetes mellitus. J Hypertens. 2010;28(8):1692-1698. doi:10.1097/HJH.0b013e32833a6132 google scholar
14. Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000 Mar;23(3):381-9. https://doi. org/10.2337/diacare.23.3.381. google scholar
15. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-106. doi:10.4274/jcrpe. v2i3.100 google scholar
16. Wang Q, Yin J, Xu L, Cheng H, Zhao X, Xiang H et al. Prevalence of metabolic syndrome in a cohort of Chinese schoolchildren: comparison of two definitions and assessment of adipokine as components by factor analysis. BMC Public Health. 2013;13:249. Published 2013 Mar 21. doi:10.1186/1471-2458-13-249 google scholar
17. Shafiee G, Kelishadi R, Heshmat R, Qorbani M, Motlagh ME, Aminaee T et al. First report on the validity of a continuous Metabolic syndrome score as an indicator for Metabolic syndrome in a national sample of paediatric population-the CASPIAN-III study. Endokrynol Pol. 2013;64(4):278-284. doi:10.5603/ep.2013.0006 google scholar
18. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003;157(8):821-827. doi:10.1001/archpedi.157.8.821 google scholar
19. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and metabolic syndrome in children and adolescents. N Engl J Med. 2004;350(23):2362-2374. doi:10.1056/ NEJMoa031049 google scholar
20. de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004;110(16):2494-2497. doi:10.1161/01.CIR.0000145117.40114.C7 google scholar
21. Dündar İ, Akıncı A. Prevalence of type 2 diabetes mellitus, metabolic syndrome, and related morbidities in overweight and obese children. J Pediatr Endocrinol Metab. 2022;35(4):435-441. Published 2022 Jan 17. doi:10.1515/jpem-2021-0271 google scholar
22. Sangun Ö, Dündar B, Köşker M, Pirgon Ö, Dündar N. Prevalence of metabolic syndrome in obese children and adolescents using three different criteria and evaluation of risk factors. J Clin Res Pediatr Endocrinol. 2011;3(2):70-76. doi:10.4274/jcrpe.v3i2.15 google scholar
23. Atabek ME, Eklioğlu BS, Akyürek N. Reevaluation of the prevalence of metabolic syndrome in an urban area of Turkey. J Clin Res Pediatr Endocrinol. 2013;5(1):50-54. doi:10.4274/Jcrpe.778 google scholar
24. Cizmecioglu FM, Etiler N, Hamzaoglu O, Hatun S. Prevalence of metabolic syndrome in schoolchildren and adolescents in Turkey: a population-based study. J Pediatr Endocrinol Metab. 2009;22(8):703-714. doi:10.1515/jpem.2009.22.8.703 google scholar
25. Sen Y, Kandemir N, Alikasifoglu A, Gonc N, Ozon A. Prevalence and risk factors of metabolic syndrome in obese children and adolescents: the role of the severity of obesity. Eur J Pediatr. 2008;167(10):1183-1189. doi:10.1007/s00431-007-0658-x google scholar
26. Irakoze L, Manirakiza A, Zhang Y, Liu J, Li J, Nkengurutse L et al. Metabolic Syndrome in the Offspring of Parents with Metabolic Syndrome: A Meta-Analysis. Obes Facts. 2021;14(1):148-162. doi:10.1159/000513370 google scholar
27. Liese AD, Mayer-Davis EJ, Tyroler HA, Davis CE, Keil U, Schmidt MI, et al. Familial components of the multiple metabolic syndrome: the ARIC study [published correction appears in Diabetologia 1998 May;41(5):608]. Diabetologia. 1997;40(8):963-970. doi:10.1007/ s001250050775 google scholar
28. Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004;89(6):2526-2539. doi:10.1210/jc.2004-0276 google scholar
29. Nur Zati Iwani AK, Jalaludin MY, Roslan FA, Mansor F, Md Zain F, Hong JYH, et al. Cardiometabolic risk factors among children affected by overweight, obesity, and severe obesity. Front Public Health. 2023;11:1097675. Published 2023 Apr 27. doi:10.3389/ fpubh.2023.1097675 google scholar
30. Guran T, Turan S, Akcay T, Bereket A. Significance of acanthosis nigricans in childhood obesity. J Paediatr Child Health. 2008;44(6):338-341. doi:10.1111/j.1440-1754.2007.01272.x google scholar
31. Kjellberg E, Roswall J, Bergman S, Almqvist-Tangen G, Alm B, Dahlgren J. The longitudinal birth cohort study found that a significant proportion of children had abnormal metabolic profiles and insulin resistance at 6 years of age. Acta Paediatr. 2019;108(3):486-492. doi:10.1111/apa.14599 google scholar
32. Morrison JA, Glueck CJ, Umar M, Daniels S, Dolan LM, Wang P. Hyperinsulinemia and metabolic syndrome at the mean age of 10 years in black and white schoolgirls and development of impaired fasting glucose and type 2 diabetes mellitus by the mean age of 24 years. Metabolism. 2011;60(1):24-31. doi:10.1016/j. metabol.2009.12.013 google scholar
33. Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Chen SSJ, et al. The Prevalence of Obesity Among Children With Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(12):e2247186. Published 2022 Dec 1. doi:10.1001/ jamanetworkopen.2022.47186 google scholar
34. Babaoğlu K, Hatun S, Arslanoğlu I, Işgüven P, Baş F, Ercan O et al. Evaluation of glucose intolerance in adolescents relative to adults with type 2 diabetes mellitus. J Pediatr Endocrinol Metab. 2006;19(11):1319-1326. doi:10.1515/jpem.2006.19.11.1319 google scholar
35. Jaruratanasirikul S, Thammaratchuchai S, Puwanant M, Mo-Suwan L, Sriplung H. Progression from impaired glucose tolerance to type 2 diabetes in obese children and adolescents: a 3-6-year cohort study in southern Thailand. J Pediatr Endocrinol Metab. 2016;29(11):1267-1275. doi:10.1515/jpem-2016-0195 google scholar
36. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S et al. IDF Consensus Group. The metabolic syndrome in children and adolescents: an IDF consensus report. Pediatr Diabetes. 2007 Oct;8(5):299-306. doi: 10.1111/j.1399-5448.2007.00271.x. PMID: 17850473. google scholar