الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
to detect the prevalence of obesity among 1274 school children and adolescents age
This study is a descriptive study consists of 2 phases: The first phase aimed d (6-18 years) in Ismailia city using multistage cluster sampling. Obesity was defined as BMI ≥ 95th percentile for age and sex. The second phase consists of 92 school children who proved to be obese according to the previously mentioned definition, fulfilled the inclusion and exclusion criteria and accepted to participate in the study. The 2nd phase aimed to detect the prevalence of impaired glucose homeostasis and insulin resistance among obese children; abnormal glucose homeostasis and IRS were considered according to WHO criteria.
The prevalence of obesity among school children and adolescents was 10.5%, it was higher in females 12.3% compared to males 9%, and increased with age as adolescents aged between 15-18 years had higher prevalence (14.3%) than children aged between 6-9 years 8.1%.
In our study, 42.4% of obese children had IRS (fulfilled at least three or more of the used diagnostic criteria), 56.4% were females and 43.6% were males, 40.2% had obesity alone (one component). Two components were identified in 17.4%, three components in 31.4% and all four components in 11%.
Impaired fasting glucose was identified in 6.5%, hyperinsulinism in 35.9%, impaired glucose tolerance in 15.2% and overall impaired glucose homeostasis was identified in 40.2%. None of the subjects had silent diabetes. Hypertension was noted in 27.2%, high serum triglycerides in 21.7%, low HDL in 28.3%, high cholesterol level in 13% and overall dyslipidemia was identified in 37%.
There were no significant differences between boys and girls concerning insulin resistance components except for IGH which was more common in females
The prevalence of IRS increased directly with the degree of obesity as 64.7% of the morbid obese subjects (BMI ≥ 40) had IRS.
There is positive correlation between waist/hip ratio and IRS.
There was a statistical significant difference between IRS and non-IRS subjects as regard acanthosis nigricans (AN), as AN was present in 64.1% of subjects with IRS so it was proposed as an insulin resistance marker. about72% of subjects with IRS had family history of type 2 DM compared to 41.5% without IRS a difference was statistically significant, while there was no statistical difference between the two groups as regard history of gestational DM or low birth weight.
The prevalence of insulin resistance syndrome was 23.8% in prepubertal age group compared to 47.8% in pubertal group. The prevalence of IGH, hyperinsulinism and IGT were 14.3, 14.3 and 9.5% in the prepubertal age group and 47.9, 42.2, and 16.9% in pubertal age group respectively. The differences in the rates of prepubertal and pubertal children as to IGH, hyperinsulinism and IGT were significant; however IFG occurred only in pubertal group 6.5%. Hypertension was not significantly different between both groups. Overall dyslipidemia in prepubertal and pubertal group was identified in 28.6 and 39.4% respectively with no significant difference.
The prevalence of impaired insulin sensitivity (IR) defined as (HOMA.IR ≥ 3.16) was 51.1%. The mean level of HOMA-IR was highest in tanner stage 4 (5.4) while the lower level was in stage 1 (3.2) and HOMA had high sensitivity and specificity for measuring insulin resistance. The present HOMA cutoff point for diagnosis of insulin resistance of 3.16 yielded a sensitivity of 86% and a specificity of 76%.
In conclusion clinical concerns over obesity in childhood and adolescence should focus on the presence of additional IRS components, including abnormalities of glucose homoeostasis, hypertension, and dyslipidemia. We suggest that clinicians should consider screening all significantly obese children and adolescents regardless of age or pubertal status for IRS. Fasting measures have acceptable sensitivity and specificity if fasting insulin is measured as well as glucose. Those with three or more IRS components may form an appropriate group for intervention, which may include medical therapy for hyperinsulinemia, dyslipidemia, or hypertension as well as multidisciplinary weight control programs. The value of such interventions needs to be assessed by formal clinical trials with long term follow up of outcome.