Relative Body Mass Index Improves the BMI Percentile Performance for Detection and Monitoring of Excess Adiposity in Adolescents.

Obesity is defined as excess adipose tissue; however, commonly used methods may under-detect adiposity in adolescents. This study compared the performance of body mass index percentile (BMI%) and relative body mass index (RBMI) in identifying excess body fat percentage (BF%) and estimated RBMI cut points to better stratify severity of adiposity. In 567 adolescents ages 11-19 year, BF% measured by DXA was used to compare BMI% and RBMI performance at different degrees of adiposity. RBMI cut points for adiposity detection were derived via ROC curve analysis. BF% was strongly correlated with BMI% (r = 0.889, p < 0.001) and RBMI (r = 0.901, p < 0.001). However, RBMI exhibited less dispersion and better discriminated the relationship with BF% independent of age, race, and gender. Both BMI% and RBMI performed similarly for detecting high BF% (≥25 BF% in males; ≥30 BF% in females). Nonetheless, the relationship of BMI% with BF% was diminished among leaner adolescents. RBMI detected overweight in 21.3% more females and 14.2% more males. RBMI improved the detection of excess adiposity in individuals otherwise classified as having normal weight or overweight by BMI%. RBMI is a valuable and accessible tool for earlier detection, intervention, and effective follow-up of excess adiposity in youth at higher risk for complications.

Impact of a Multidisciplinary Approach on Cardiometabolic Risk Reduction in a Multiracial Cohort of Adults: A 1-Year Pilot Study.

Evidence examining specific effects of a multidisciplinary team (MDT) on cardiometabolic risk factors (CMRFs) among multi-ethnic patients in real-world clinical settings is lacking. This one-year retrospective chart review (2018) analyzed 598 adults (African American 59%, Hispanic 35%, and Caucasian 6%) with mean age of 43.8 ± 14.0 years. Qualifying patients with primary inclusion criteria of having body mass indices and blood pressure (BP) measurements in the first and last quarter of the study period were treated under an MDT protocol and compared to those qualifying for MDT but treated solely by a primary care provider (PCP). MDT included endocrinologist-directed visits, lifestyle counseling, and shared medical appointments. MDT patients experienced a greater reduction (ß; 95% CI) in weight (-4.29 kg; -7.62, -0.97), BMI (-1.43 kg/m2; -2.68, -0.18), systolic BP (-2.18 mmHg; -4.09, -0.26), and diastolic BP (-1.97 mmHg; -3.34, -0.60). Additionally, MDT patients had 77%, 83%, and 59% higher odds of reducing ≥5% of initial weight, 1 BMI point, and ≥2 mmHg DBP, respectively. Improvements in hemoglobin A1C measurements were observed in the MDT group (insufficient data to compare with the PCP group). Compared to PCP only, MDT co-management improves CMRF related to adiposity and hypertension in a multiethnic adult cohort in real-world clinical settings. Patient access to best practices in cardiometabolic care is a priority, including the incorporation of culturally adapted evidence-based recommendations translated within a multi-disciplinary infrastructure, where competing co-morbidities are better managed, and associated research and education programs can promote operational sustainability.

The prevalence of impaired glucose metabolism in Hispanics with two or more risk factors for metabolic syndrome in the primary care setting.

PURPOSE: The purposes of this observational prospective study were (a) to identify the prevalence of undiagnosed impaired glucose metabolism (IGM) including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM) in 55 Hispanic subjects with two or more risk factors for the metabolic syndrome, (b) to examine the association between glucose metabolism and cardiometabolic risk factors (CMRF), including metabolic syndrome components, and (c) to identify predictors of IGM. DATA SOURCES: Subjects underwent a physical examination and a 2-h 75-g oral glucose tolerance test. Data were analyzed using SAS v9.1 with p < or = .05 considered significant. Nonparametric tests were applied including Mann-Whitney-Wilcoxon test and Spearman correlation coefficient. Stepwise logistic multiple regression was used to predict IGM. CONCLUSIONS: Twenty-five patients (46%) had IGM (18% IFG, 15% IGT, and 13%T2DM). Normal fasting glucose was found in 48% of subjects who had IGM. Lipid abnormalities were present in 98% including elevated triglycerides (TG 66%), total cholesterol (48%), low-density lipoprotein (68.8%), and low high-density lipoprotein (67.9%). Twenty-nine percent had body mass index (BMI) >25 kg/m(2) and 62% had BMI >30 kg/m, hypertension (24%), and elevated high-sensitivity C-reactive protein (63%), and mean number of cardiometabolic risk factors (#CMRF) was 4.5. Mean values for each risk factor were no different between groups except for #CMRF (p = .0001) and TG (p = .0001). Total #CMRF was the best predictor of IGM. IMPLICATIONS FOR PRACTICE: The prevalence of IGM is extremely high in Hispanics with metabolic syndrome. Screening for IGM with fasting blood glucose alone underestimates the prevalence of IGM in this population. In subjects with multiple CMRF, screening at lower levels of BMI is warranted.

Biphasic insulin aspart 30 for the treatment of type 1 diabetes mellitus.

BACKGROUND: Type 1 diabetes mellitus is associated with acute and long-term complications, to which pre- and postprandial hyperglycemia are independent contributors. The objective of this review was to evaluate evidence-based information using biphasic insulin aspart 30 in the treatment of type 1 diabetes mellitus. METHODS: The study reviewed the Cochrane Database and scientific literature (PubMed) published until January 2008 using the words biphasic insulin aspart 30 insulin or premixed aspart insulin. CONCLUSIONS: Biphasic insulin aspart 30 is similar in efficacy to biphasic human insulin in improving hemoglobin A(1c) levels, with the advantage of a better postprandial glucose profile. EXPERT OPINION: There is evidence supporting the efficacy and safety of biphasic insulin aspart 30 insulin. However, the need for well-designed clinical trials aimed at understanding the potential differences in safety and efficacy between patients with type 1 and type 2 diabetes is crucial.

Racial disparity in glucagon-like peptide 1 and inflammation markers among severely obese adolescents.

OBJECTIVE: Compared with Caucasians, obese African-American adolescents have a higher risk for type 2 diabetes. Subclinical inflammation and reduced glucagon-like peptide 1 (GLP-1) concentration are linked to the pathogenesis of the disease. We determined the relationship between insulin resistance, beta-cell activity, and subclinical inflammation with GLP-1 concentrations and whether racial disparities in GLP-1 response were present in 49 obese adolescents (14 +/- 3 years; 76% African American; 71% female). RESEARCH DESIGN AND METHODS: Subjects underwent physical examination and an oral glucose tolerance test. We measured levels of high-sensitivity CRP (CRP(hs)), fibrinogen, glucose, GLP-1(total), GLP-1(active), and insulin. Insulin and glucose area under the curve (AUC), insulinogenic index (DeltaI30/DeltaG30), and composite insulin sensitivity index (CISI) were computed. Subjects were categorized by race and as inflammation positive (INF+) if CRP(hs) or fibrinogen were elevated. RESULTS: No racial differences were seen in mean or relative BMI. Thirty-five percent of subjects had altered fasting or 2-h glucose levels (African American vs. Caucasian, NS), and 75% were INF+ (African American vs. Caucasian, P = 0.046). Glucose and insulin, CISI, and DeltaI30/DeltaG30 values were similar; African Americans had lower GLP-1(total) AUC (P = 0.01), GLP-1(active) at 15 min (P = 0.03), and GLP-1(active) AUC (P = 0.06) and higher fibrinogen (P = 0.01) and CRP(hs) (NS) compared with Caucasians. CONCLUSIONS: African Americans exhibited lower GLP-1 concentrations and increased inflammatory response. Both mechanisms may act synergistically to enhance the predisposition of obese African Americans to type 2 diabetes. Our findings might be relevant to effective deployment of emerging GLP-1-based treatments across ethnicities.

Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy in obese children.

OBJECTIVE: To assess the use of oral glucose tolerance testing (OGTT) to predict efficacy of insulin sensitization (metformin) or suppression (octreotide) because insulin resistance and insulin hypersecretion may impact pharmacotherapeutic efficacy in obese children. STUDY DESIGN: Forty-three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin sensitivity was expressed as composite insulin sensitivity index (CISI), and secretion as corrected insulin response (CIRgp). Those without CNS insult received metformin (weight-based dosing) for 6 to 16 months. Those with CNS insult received octreotide SQ 15 microg/kg/d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI. RESULTS: Metformin: With CIRgp and CISI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P < .001), and by 0.14 over the next year (P = .33). Each 2-fold increase in CIRgp or CISI attenuated BMI z-score reduction, but with wide uncertainty (P = .24). Black children exhibited little response. Octreotide: With CIRgp and CISI = 1, BMI z-score decreased by 0.23 in the first 4 months (P = .052). Efficacy was dependent on an interaction between CIRgp and CISI (P = .051). CONCLUSIONS: Efficacy of metformin was predicted by pretreatment insulin resistance. Efficacy of octreotide was predicted by insulin hypersecretion and sensitivity.