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Published on: January 7, 2018
Racial and etiopathologic dichotomies in insulin hypersecretion and resistance in obese children
Chaluntorn Preeyasombat1, Peter Bacchetti, Ann A Lazar
1Department of Pediatrics, University of California-San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0434, USA.
Insights
In obese children, insulin hypersecretion, not resistance, is the primary issue in Black children and those with central nervous system (CNS) insult, impacting glucose tolerance. This highlights distinct insulin dynamics in pediatric obesity.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Obesity Research
Background:
- Childhood obesity is a growing concern with complex metabolic implications.
- Understanding insulin dynamics is crucial for managing metabolic health in pediatric populations.
- Racial and etiopathogenetic factors may influence insulin secretion and sensitivity in obese children.
Purpose of the Study:
- To evaluate insulin secretion and sensitivity in obese children using oral glucose tolerance testing.
- To determine the specific contributions of insulin hypersecretion versus insulin resistance.
- To investigate racial and etiopathogenetic differences in these insulin dynamics.
Main Methods:
- Conducted 3-hour oral glucose tolerance tests in 113 non-diabetic obese children.
- Calculated corrected insulin response (CIRgp) for beta-cell secretion and composite insulin sensitivity index (CISI).
- Modeled CIRgp and CISI considering race, etiology, age, sex, BMI z-score, and pubertal status.
Main Results:
- Obese Black children exhibited significantly higher insulin secretion (CIRgp) compared to white children, independent of insulin sensitivity (CISI).
- Children with central nervous system (CNS) insult showed a trend towards higher insulin secretion (CIRgp).
- Insulin sensitivity (CISI) differences between racial groups were not statistically significant after controlling for other variables.
Conclusions:
- Insulin hypersecretion and insulin resistance are distinct pathophysiological processes in childhood obesity.
- Insulin hypersecretion is a more prominent abnormality than insulin resistance in obese Black children and those with CNS insult.
- These findings underscore the need for tailored approaches to managing metabolic dysfunction in diverse pediatric obesity populations.
Objectives:
To assess insulin dynamics to oral glucose tolerance testing in obese children, denoting individual contributions of insulin hypersecretion versus resistance to racial and etiopathogenetic specificity.
Study Design:
We performed 3-hour oral glucose tolerance testing in 113 nondiabetic obese children (age 13.6 +/- 3.1 years; 41 male, 78 female; 37 black, 41 white; 35 with central nervous system [CNS] insult). The corrected insulin response (CIRgp; measuring beta-cell secretion) and the composite insulin sensitivity index (CISI) were computed and log-transformed, and each was modeled in terms of the other, plus race/etiology, age, sex, body mass index z score, glucose tolerance, pubertal status, and geographic location.
Results:
A scatterplot of logCIRgp versus logCISI showed that racial and etiopathogenetic groups plotted in different areas. CISI (controlled for CIRgp and other variables) was only 13% lower in blacks than in whites ( P = .32). Conversely, CIRgp (controlled for CISI and other variables) was 49% higher in blacks ( P = .028). CNS insult exhibited a 40% higher CIRgp ( P = .054) and 11% higher CISI ( P = .42) than intact white subjects.
Conclusions:
Insulin hypersecretion and resistance are distinct phenomena in childhood obesity. Insulin hypersecretion appears to be the more relevant insulin abnormality both in obese blacks and in CNS insult.
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