Insulin Resistance and Parental Obesity as Predictors to Response to Therapeutic Life Style Change in Obese Children and Adolescents 10-18 Years Old

Orit Pinhas-Hamiel, Liat Lerner-Geva, Nancy Copperman, Marc S. Jacobson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To study insulin resistance and parental obesity as predictors of improvement in weight status in obese children and adolescents undergoing therapeutic life change intervention (TLC). Design: A retrospective chart review. Subjects: One hundred thirty-four adolescents 10 to 18 years old above the 95th percentile for body mass index (BMI), referred to the Center for Atherosclerosis Prevention from January through December 2003. Measurements: BMI, fasting insulin, homeostasis model assessment insulin resistance (HOMA-IR). Weight management success was defined as BMI Z-score at final exam minus BMI Z-score at initial exam ≤0. Ninety-nine were successful (group S) (reduced or maintained BMI Z-score) and 35 were not successful (NotS) (increased BMI Z-score). Results: At baseline there were no differences between the groups in mean age, Tanner stage, gender, severity of obesity, lipid, and blood pressure levels. Insulin resistance was significantly higher in the NotS group compared to the S group as reflected by higher basal fasting insulin levels (21.8 ± 12.3 vs. 15.8 ± 9.0, p = .02), higher HOMA-IR (4.5 ± 2.6 vs. 3.3 ± 2.0, p = .02). After adjustment for age, gender, elevated blood pressure, abnormal lipid profile, baseline BMI Z-score, length of follow-up, and parental morbidity, an increase of 10 units of insulin resulted in a 3.13-fold (95% confidence interval [CI] 1.79-6.01) increased odds of failure. An increase in 1 unit of HOMA-IR resulted in 1.64-fold odds (95% CI 1.27-2.21) of failure. In the same multivariate logistic regression model the existence of obesity-associated morbidity in both parents was associated with 12.6-fold (95% CI 1.93-82.6) increased odds of failure. Conclusions: Failing to respond to standard therapeutic lifestyle change intervention was dependent on baseline insulin resistance, and parental obesity-related comorbidity.

Original languageEnglish
Pages (from-to)437-443
Number of pages7
JournalJournal of Adolescent Health
Volume43
Issue number5
DOIs
StatePublished - Nov 2008
Externally publishedYes

Funding

FundersFunder number
NASH foundation clinical scholars

    Keywords

    • Childhood
    • HOMA
    • Hyperinsulinemia
    • Insulin resistance
    • Obesity
    • Prediction
    • Success
    • Weight loss

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