Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1441 (doi:10.1542/peds.2005-0139)

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Improvement of Glucose Homeostasis After Weight Loss in Obese Children

Nicola Santoro, MD
Michele Di Nardo, MD
Alessandra Amato, MD
Laura Perrone, MD
Emanuele Miraglia del Giudice, MD
Seconda Università di Napoli
Department of Pediatrics
Via L. De Crecchio no. 4
80138 Napoli, Italy

To the Editor.—

We read with great interest the Pediatrics article by Reinehr et al.¹ The authors provided important information about the changes in insulin sensitivity in obese children and adolescents according to degree of weight loss,¹ showing that a decrease of at least 0.5 of SD score BMI (mean: –0.67; 30% of those who were overweight) is required to observe a significant improvement in insulin sensitivity (65% increase). No data concerning obese subjects with impaired glucose tolerance (IGT) were provided.

Given that type 2 diabetes in children, once considered rare, has become increasingly common in association with obesity² and IGT represents the frequently missed link between insulin resistance and type 2 diabetes, it might be useful to study the effect of weight loss on glucose metabolism in children with IGT.

Fifteen severely obese children and adolescents with IGT were included in the study (mean age: 12.2 ± 2 years; mean z score BMI at baseline: 4.9 ± 1.3). IGT was defined as a serum glucose level of 140 mg/dL and <200 mg/dL after a 2-hour oral glucose-tolerance test according to American Diabetes Association guidelines. The subjects were submitted to a nutritionally balanced hypocaloric diet (60% of the recommended dietary energy allowances for age and gender). The oral glucose-tolerance test was repeated after 6 months. Glucose tolerance appeared normalized in 14 children (8 girls), which showed a statistically significant reduction of their z score BMI (mean: –1.6 ± 0.6; range: –2.1 to –1.2) (Table 1). Insulin resistance, calculated by using the homeostasis model assessment, improved and plasma insulin levels decreased (Table 1).

View this table: [in this window] [in a new window]   TABLE 1. Baseline and Follow-up Features of the Subjects Who Reversed Their IGT

 
The patient who still showed IGT after the follow-up was a 10.5-year-old boy. Despite the reduction of his z score BMI from 4.35 to 2.7, he was not able to restore normal glucose tolerance.

When insulin resistance increases, insulin secretion must increase for glucose tolerance to remain normal. Deterioration in glucose tolerance occurs when a compensatory increase in insulin secretion is incomplete.³ Adiposity reduction, which restores insulin sensitivity, prevents the impairment of pancreatic islet cell function.

Our observation, which suggests that the reduction of 30% of excess weight is enough to reverse IGT in severely obese children and adolescents, adds data that are consistent with and integrate those reported by Reinehr et al.¹ To lose weight when IGT has manifested represents the last opportunity for an obese child to normalize the glucose homeostasis before the appearance of type 2 diabetes with its associated irreversible deterioration in ß-cell function.^3,4

REFERENCES

1. Reinehr T, Kiess W, Kapellen T, Andler W. Insulin sensitivity among obese children and adolescents, according to degree of weight loss. Pediatrics. 2004;114 :1569 –1573[Abstract/Free Full Text]
2. Sokol RJ. The chronic disease of childhood obesity: the sleeping giant has awakened [commentary]. J Pediatr. 2000;136 :711 –713
3. Gungor N, Arslanian S. Progressive beta cell failure in type 2 diabetes mellitus of youth. J Pediatr. 2004;144 :656 –659[CrossRef][Medline]
4. Rosenbaum M, Nonas C, Horlick M, et al. Beta-cell function and insulin sensitivity in early adolescence: association with body fatness and family history of type 2 diabetes mellitus. J Clin Endocrinol Metab. 2004;89 :5469 –5476[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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Improvement of Glucose Homeostasis After Weight Loss in Obese Children: In Reply

Thomas Reinehr, Werner Andler, Wieland Kiess, and Thomas Kapellen
Pediatrics 2005 115: 1441-1442. [Extract] [Full Text]  

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in Pediatrics Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Santoro, N. Articles by del Giudice, E. M. Search for Related Content PubMed PubMed Citation Articles by Santoro, N. Articles by del Giudice, E. M. Related Collections Endocrinology Social Bookmarking                         What's this?