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Published on: January 7, 2018
Obese children with low birth weight demonstrate impaired beta-cell function during oral glucose tolerance test
Claudia Brufani1, Armando Grossi, Danilo Fintini
1Bambino Gesù Children's Hospital-Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy. cbrufani@libero.it
Insights
Children born small for gestational age (SGA) who are obese struggle with insulin resistance and beta-cell dysfunction. This leads to poorer glucose control and adverse metabolic outcomes compared to other groups.
Area of Science:
- Pediatric Endocrinology
- Metabolic Health
- Diabetes Research
Background:
- Birth weight is linked to type 2 diabetes risk.
- Both small for gestational age (SGA) and large for gestational age (LGA) newborns face increased future diabetes risk.
- The impact of birth weight on metabolic function in obese children requires further investigation.
Purpose of the Study:
- To examine how birth weight influences insulin sensitivity and beta-cell function in obese children.
- To compare metabolic responses among obese children categorized as SGA, appropriate for gestational age (AGA), and LGA.
- To understand the specific mechanisms linking birth weight to metabolic dysfunction in pediatric obesity.
Main Methods:
- 257 obese/overweight children (aged 11.6 ± 2.3 yr) were grouped by birth weight percentile: SGA (n=44), AGA (n=161), and LGA (n=52).
- A 3-hour oral glucose tolerance test (OGTT) was performed with measurements of glucose, insulin, and C-peptide.
- Insulin sensitivity and beta-cell function were assessed using HOMA-IR, insulinogenic index, disposition index, and glucose/insulin AUC.
Main Results:
- SGA and LGA children exhibited higher insulin resistance (HOMA-IR) than AGA children.
- SGA subjects showed elevated glucose AUC and reduced insulinogenic and disposition indexes during OGTT.
- While overall insulin AUC did not differ, SGA children had lower early (30 min) and higher late (180 min) insulin responses.
Conclusions:
- Obese children born SGA demonstrate impaired compensatory mechanisms for insulin resistance.
- Deficits in early insulin secretion and reduced disposition index contribute to higher glucose AUC in SGA children.
- SGA obese children experience adverse metabolic outcomes, including poorer glucose regulation, compared to AGA and LGA peers.
Objective:
Epidemiological studies have shown an association between birth weight and future risk of type 2 diabetes, with individuals born either small or large for gestational age at increased risk. We sought to investigate the influence of birth weight on the relation between insulin sensitivity and beta-cell function in obese children.
Subjects And Methods:
A total of 257 obese/overweight children (mean body mass index-sd score, 2.2 +/- 0.3), aged 11.6 +/- 2.3 yr were divided into three groups according to birth weight percentile: 44 were small for gestational age (SGA), 161 were appropriate for gestational age (AGA), and 52 were large for gestational age (LGA). Participants underwent a 3-h oral glucose tolerance test with glucose, insulin, and C-peptide measurements. Homeostasis model of assessment for insulin resistance, insulinogenic index, and disposition index were calculated to evaluate insulin sensitivity and beta-cell function. Glucose and insulin area under the curve (AUC) were also considered. One-way ANOVA was used to compare the three groups.
Results:
SGA and LGA subjects had higher homeostasis model of assessment for insulin resistance than AGA subjects, but they diverged when oral glucose tolerance test response was considered. Indeed, SGA subjects showed higher glucose AUC and lower insulinogenic and disposition indexes. Insulin AUC was not different between groups, but when singular time points were considered, SGA subjects had lower insulin levels at 30 min and higher insulin levels at 180 min.
Conclusions:
SGA obese children fail to adequately compensate for their reduced insulin sensitivity, manifesting deficit in early insulin response and reduced disposition index that results in higher glucose AUC. Thus, SGA obese children show adverse metabolic outcomes compared to AGAs and LGAs.
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