Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa / Ethnic influence on the prevalence of metabolic syndrome in an obese pediatric population

Introducción: La obesidad en la edad pediátrica es cada vez más prevalente. La población hispana inmigrante tiene un alto riesgo de obesidad y de diabetes tipo 2. Objetivo: Analizar la influencia étnica en la prevalencia del síndrome metabólico (SM) y sus componentes en una población pediátrica obesa. Pacientes y métodos: Estudio retrospectivo de 616 niños y adolescentes obesos ([IMC>2 DE (Hernández 1998-2004)]: 142 hispanos y 474 caucásicos. Se comparan la prevalencia de SM y sus componentes (criterios modificados Cook 2003): obesidad y ≥2 de los siguientes: colesterol HDL<40mg/dl, triglicéridos >110mg/dl, presión arterial sistólica y/o diastólica >p90 (Task Force 2004) y alteración del metabolismo hidrocarbonado (ADA 2011). Se evalúa también: historia familiar de SM, HbA1c, insulinorresistencia (HOMA), función hepática y evolución del IMC al año de tratamiento con cambios en el estilo de vida. Resultados: El 30,5% de los hispanos presentan SM frente al 15,5% de los caucásicos (OR=2,4 [IC del 95%, 1,5-3,8]), p<0,005]) y OR de 2,5 al ajustar por sexo, IMC-DE y pubertad. Los hispanos presentan mayor insulinorresistencia (58,6% vs 42,86%, p<0,005) y peor evolución del IMC al año de seguimiento. No hubo diferencias en el resto de datos analizados. Encontramos una peor adherencia a las medidas de cambio de alimentación y ejercicio físico en el grupo hispano. Conclusiones: La prevalencia de SM es superior en la población pediátrica hispana obesa que en la caucásica. La peor adherencia al tratamiento de los niños y adolescentes obesos hispanos hace que este grupo de pacientes tenga un riesgo potencialmente mayor de enfermedades cardiovasculares en la vida adulta (AU)

Introduction: Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. Objective: To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. Patients and methods: A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. Results: Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<0.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. Conclusion: There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood(AU)

[Ethnic influence on the prevalence of metabolic syndrome in an obese pediatric population]. / Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa.

INTRODUCTION: Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. OBJECTIVE: To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. PATIENTS AND METHODS: A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. RESULTS: Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. CONCLUSION: There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood.

Alteraciones hidrocarbonadas en pacientes impúberes con fibrosis quística / Abnormal glucose tolerance in prepubertal patients with cystic fibrosis

Introducción: El consenso internacional recomienda el cribado de las alteraciones hidrocarbonadas (AH) en fibrosis quística (FQ) mediante sobrecarga oral de glucosa (SOG) anual desde los 10 años de edad y/o iniciada la pubertad. Objetivos: Evaluar la presencia de AH y su posible repercusión clínica (cambios nutricionales y de función pulmonar) en pacientes impúberes con FQ. Pacientes y métodos: Estudio retrospectivo en 19 pacientes impúberes con FQ (68% varones). Según la SOG, clasificamos (Consenso 2010): tolerancia normal glucosa (TNG) o AH (alteración tolerancia glucosa [ATG], alteración indeterminada glucosa (AIG), diabetes [DRFQ]). Analizamos: SOG (glucemia e insulinemia), estado nutricional (IMC), función pulmonar (espirometría forzada) y función pancreática exocrina. Estudio estadístico con programa SPSS, versión-15.0 mediante pruebas no paramétricas. Resultados: Edad media primera SOG: 8,5 años (5,8-9,8); seguimiento medio: 2 años (2-3). Al inicio: el 53% TNG y el 47% AH; evolutivamente: 4/10 pacientes con TNG desarrollan AH (3ATG, 1DRFQ), 3/4 AIG desarrollan 2ATG y 1DRFQ. Edad media aparición AH: 8,6 años (6,4-11,1). El 69% tuvo deterioro nutricional y/o de la función pulmonar el año previo al diagnóstico de AH. Dos pacientes con AH eran suficientes pancreáticos exocrinos. La insulinemia basal y el área bajo la curva de la SOG fueron comparables entre TNG y AH. El índice insulinogénico fue inferior en AH (p=0,006). Todos los pacientes tuvieron un pico de secreción de insulina retrasado. Conclusiones: La frecuente detección de AH en pacientes impúberes con FQ y su repercusión clínica plantean la necesidad de adelantar su cribado. La suficiencia pancreática exocrina no excluye el desarrollo de AH(AU)

Introduction: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). Aims: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. Patients and methods: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. Results: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. Conclusions: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening(AU)

[Abnormal glucose tolerance in prepubertal patients with cystic fibrosis]. / Alteraciones hidrocarbonadas en pacientes impúberes con fibrosis quística.

INTRODUCTION: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). AIMS: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. PATIENTS AND METHODS: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. RESULTS: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. CONCLUSIONS: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening.