TY - JOUR
T1 - Insulin Resistance and Parental Obesity as Predictors to Response to Therapeutic Life Style Change in Obese Children and Adolescents 10-18 Years Old
AU - Pinhas-Hamiel, Orit
AU - Lerner-Geva, Liat
AU - Copperman, Nancy
AU - Jacobson, Marc S.
N1 - Funding Information:
This study was funded in part by the NASH foundation clinical scholars grant.
PY - 2008/11
Y1 - 2008/11
N2 - 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.
AB - 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.
KW - Childhood
KW - HOMA
KW - Hyperinsulinemia
KW - Insulin resistance
KW - Obesity
KW - Prediction
KW - Success
KW - Weight loss
UR - http://www.scopus.com/inward/record.url?scp=53449101982&partnerID=8YFLogxK
U2 - 10.1016/j.jadohealth.2008.03.002
DO - 10.1016/j.jadohealth.2008.03.002
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AN - SCOPUS:53449101982
SN - 1054-139X
VL - 43
SP - 437
EP - 443
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 5
ER -