Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know?

Ahmad Ighbariya, Ram Weiss, Ahmad Ighbariya, Ram Weiss

Abstract

The Metabolic syndrome describes a clustering of typical cardiovascular risk factors. The syndrome is also known as "Insulin Resistance syndrome" as a substantial part of the pathophysiology is driven by resistance to the metabolic effects of insulin. The major cause of insulin resistance in childhood is a typical lipid partitioning pattern characterized by increased deposition of lipids within insulin responsive tissues, such as the liver and skeletal muscle and within the viscera. This lipid deposition pattern is also associated with infiltration of intra-abdominal tissues with cells of the immune system, inducing systemic, low-grade inflammation typically observed in insulin resistant obese children and adolescents. Several clues derived from a careful history and physical examination, along with a basic laboratory workup, provide clues in regards to risk stratification in obese children.

Keywords: Metabolic syndrome; Obesity; children; prediabetes insulin resistance..

Figures

Figure 1. Pathophysiology of insulin resistance and…
Figure 1. Pathophysiology of insulin resistance and its clinical manifestations. Energy excess and a sedentary lifestyle lead to increased body fat. The ability of subcutaneous fat tissue to expand will determine the lipid partitioning profile. Those with greater ability to expand their subcutaneous depot will have less intra-abdominal and liver/muscle fat deposition and will thus be more insulin sensitive. Those with inability to increase subcutaneous fat will have an unfavorable lipid partitioning profile with increased intra abdominal lipid deposition as evidenced by greater waist circumference and liver/muscle lipid deposition, manifesting as greater insulin resistance and a pro inflammatory profile. This adverse profile leads to elevation of plasma glucose, triglycerides and blood pressure and reduced high density lipoprotein-cholesterol. HDL: high density lipoprotein, CRP/IL-6: C-reactive protein/interleukin-6, ALT: alanine amino transferase, SGA: small for gestational age, GDM: gestational diabetes mellitus

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