Biomedical subjects

M I Goran

Publications and source records attributed to M I Goran.

At least 19 recordsLinked to original sources

PubMed2006

Racial differences in the association of subcutaneous and visceral fat on bone mineral content in prepubertal children.

Total fat mass plays a significant role in determining bone mass, but the specific role of central adiposity independent of total fat mass has not been widely studied. Prepubertal (Tanner 1) children (n = 181; 65 boys, 116 girls, 7.8 +/- 1.5 years), including 99 Caucasians and 82 African Americans from Birmingham, Alabama, participated in this study. Body composition, including total body and trunk fat mass, and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry. Subcutaneous abdominal adipose tissue (SAAT) and intra-abdominal adipose tissue (IAAT) were determined by single-slice computed tomography (CT). After adjusting for gender, age, height, total fat, and lean mass, trunk weight was inversely correlated with BMC in Caucasians (r = -0.56, P < 0.0001) and in African Americans (r = -0.37, P < 0.05). In Caucasians, independent of gender, age, height, total fat, and lean mass, there was an inverse correlation between SAAT and BMC (r = -0.58, P < 0.0001) but no significant correlation between IAAT and BMC; in addition, SAAT explained 6% of the variance in BMC. In contrast, in African Americans, SAAT and BMC were not significantly correlated. However, while adjusting for gender, age, height, SAAT, total fat, and lean mass, an inverse association between IAAT and BMC was observed in African Americans (r = -0.50, P < 0.01); IAAT also explained 3% of the variance in BMC. These findings suggest that, in general, total abdominal weight is negatively associated with bone mass, but there appear to be racial differences with regard to the contributions of subcutaneous and visceral fat to BMC in prepubertal children.

Abdominal Fat↗

PubMed2006

Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children.

BACKGROUND: The study of the relationship between anthropometry and visceral adipose tissue (VAT) is of great interest because VAT is associated with many risk factors for noncommunicable diseases and anthropometry is easy to perform in clinical practice. The studies hitherto available for children have, however, been performed on small sample sizes. DESIGN: Pooling of the data of studies published from 1992 to 2004 as indexed on Medline. AIMS: To assess the relationship between anthropometry and VAT and subcutaneous adipose tissue (SAT) as measured by magnetic resonance imaging (MRI) in children and to analyze the effect of age, gender, pubertal status and ethnicity. SUBJECTS AND METHODS: Eligible subjects were 7-16 year-old, with availability of VAT and SAT, gender, ethnicity, body mass index (BMI) and waist circumference (WC). A total of 497 subjects were collected from seven different investigators and 407 of them (178 Caucasians and 229 Hispanics) were analyzed. RESULTS: Despite ethnic differences in MRI data, BMI, WC and age, no difference in VAT was found between Caucasians and Hispanics after correction for SAT and BMI. Univariate regression analysis identified WC as the best single predictor of VAT (64.8% of variance) and BMI of SAT (88.9% of variance). The contribution of ethnicity and gender to the unexplained variance of the VAT-WC relationship was low (< or =3%) but significant (P < or =0.002). The different laboratories explained a low (< or =4.8%) but significant (P < 0.0001) portion of the unexplained variance of the VAT-WC and SAT-BMI relationships. Prediction equations for VAT (VAT (cm(2)) = 1.1 x WC (cm)-52.9) and SAT (SAT (cm(2)) = 23.2 x BMI (kg/m(2))-329) were developed on a randomly chosen half of the population and crossvalidated in the remaining half. The pure error of the estimate was 13 cm(2) for VAT and 57 cm(2) for SAT. CONCLUSIONS: WC can be considered a good predictor of VAT as well as BMI of SAT. The importance of ethnicity and gender on VAT estimation is not negligible.

Adipose Tissue↗

PubMed2006

Cardiovascular fitness and physical activity in children with and without impaired glucose tolerance.

OBJECTIVE: To examine differences in cardiovascular fitness (VO(2max)) and physical activity levels in overweight Hispanic children with normal glucose tolerance (NGT) vs impaired glucose tolerance (IGT). PARTICIPANTS: A total of 173 overweight (BMI percentile 97.0 +/- 3.1) Hispanic children ages 8-13 years with a family history of type 2 diabetes. METHODS: VO(2max) was measured via a maximal effort treadmill test and open circuit spirometry. Physical activity was determined by questionnaire. Glucose tolerance was established by a 2-h oral glucose challenge (1.75 g of glucose/kg body weight). IGT was defined from an oral glucose tolerance test as a 2-h plasma glucose level > or =140 and <200 mg/dl. RESULTS: IGT was detected in 46 of the 173 participants (approximately 27%); no cases of type 2 diabetes were identified. No significant differences were found between youth with NGT and those with IGT in absolute VO(2max) (2.2 +/- 0.6 vs 2.1 +/- 0.5 l/min), VO(2max) adjusted for gender, age, and body composition (2.2 +/- 0.2 vs 2.1 +/- 0.2 l/min), or recreational physical activity levels (8.7 +/- 8.2 vs 6.9 +/- 6.2 h/week). CONCLUSION: Overweight Hispanic youth with IGT exhibit similar levels of VO(2max) and physical activity compared to their NGT counterparts. Longitudinal analyses are necessary to determine whether fitness/activity measures contribute significantly to diabetes risk over time in this group.

Adolescent↗

PubMed2006

Birth weight, puberty, and systolic blood pressure in children and adolescents: a longitudinal analysis.

We examined the association between birth weight and systolic blood pressure (SBP) from pre-puberty to late puberty in a cohort of American children. Ninety-eight children aged 4-12 years at baseline were followed annually for 2-6 years with at least two Tanner stages. Annual measures included SBP, age, gender, race, birth weight, Tanner stage, and body composition using dual-energy X-ray absorptiometry and computed tomography. Birth weight was inversely correlated with SBP in pre-pubertal children (r=-0.23, P<0.05), especially in white children. SBP persisted at a higher level from pre-puberty through late puberty among children with low birth weight (<2500 g). However, SBP significantly increased from pre-puberty to early or late puberty among children with high birth weight (>or=4000 g). After adjusting for visceral fat, one unit change of birth weight category was associated with a 2.6 mm Hg reduction in SBP (P<0.05), but this association was attenuated as puberty progressed. The changes in SBP across puberty followed different trajectories in children with low vs high birth weight. Attenuation in the association between birth weight and SBP from pre-puberty to late puberty may be influenced by sexual maturation.

Adolescent↗

PubMed2005

Insulin sensitivity, insulin secretion and beta-cell function during puberty in overweight Hispanic children with a family history of type 2 diabetes.

OBJECTIVE: To examine cross-sectional differences in insulin sensitivity, insulin secretion and beta-cell function during puberty in overweight Hispanic boys and girls with a family history of type 2 diabetes. STUDY DESIGN AND PARTICIPANTS: This cross-sectional, observational study included 214 8-13-y-old Hispanic children with a BMI percentile > or = 85th percentile and family history of type 2 diabetes. METHODS AND ANALYSES: Participants underwent a physical examination, body composition measures, oral glucose tolerance test (OGTT), and frequently-sampled intravenous glucose tolerance test. Unadjusted and adjusted general linear models (GLM) tested whether insulin/glucose dynamics differed by Tanner stage and gender. RESULTS: Unadjusted group comparisons showed that fasting insulin increased whereas insulin sensitivity (SI) and the disposition index (DI) (a measure of pancreatic beta-cell function) decreased across Tanner stage groups (all P < 0.05). No differences in the acute insulin response to glucose (AIRg), fasting glucose or 2-h glucose were found. After adjusting for covariates, there was no independent effect of Tanner stage on SI (P = 0.9) or AIRg (P = 0.2), but DI was slightly lower in later Tanner stages suggesting decreased beta-cell function in the more mature groups (P = 0.10). CONCLUSIONS: Overweight Hispanic children with a family history of type 2 diabetes may represent a unique population given that pubertal insulin resistance was not evident once analyses controlled for body composition. Longitudinal analyses are required to determine whether the slightly diminished beta-cell function in later Tanner stages plays a role in the development of type 2 diabetes.

Adolescent↗

PubMed2005

Pediatric obesity and insulin resistance: chronic disease risk and implications for treatment and prevention beyond body weight modification.

The study of childhood obesity has continued to grow exponentially in the past decade. This has been driven in part by the increasing prevalence of this problem and the widespread potential effects of increased obesity in childhood on lifelong chronic disease risk. The focus of this review is on recent findings regarding the link between obesity and disease risk during childhood and adolescence. We describe recent reports relating to type 2 diabetes in youth (2), prediabetes (69, 166), metabolic syndrome (33, 35), polycystic ovarian syndrome (77), and nonalcoholic fatty liver disease (58, 146), and the mediating role of insulin resistance in these conditions. In addition, we review the implications of this research for the design of more effective treatment and prevention strategies that focus more on the improvement of obesity-related metabolic abnormalities and chronic disease risk reduction than on the conventional energy balance approach that focuses on weight management.

Adolescent↗

PubMed2001

Energy expenditure, physical activity, and obesity in children.

Although there are physiologic and genetic influences on the various components of energy metabolism and body weight regulation, and a major portion of individual differences in body weight can be explained by genetic differences, it seems unlikely that the increased global prevalence of obesity has been driven by a dramatic change in the gene pool. It is more likely and more reasonable that acute changes in behavior and environment have contributed to the rapid increase in obesity and that genetic factors may be important in the deferring individual susceptibilities to these changes. The most striking behavioral changes that have occurred have been an increased reliance on high-fat and energy-dense "fast foods," with larger portion sizes, coupled with an ever-increasing sedentary lifestyle. The more sedentary lifestyle is caused by an increased reliance on technology and labor-saving devices, which has reduced the need for physical exertion for everyday activities. Examples of energy-saving devices that have resulted in a secular decline in physical activity include: Increased use of automated transport rather than walking or biking Central heating and use of automated equipment, such as washing machines, in the household. Reduction in physical activity in the workplace because of computers, automated equipment, and electronic mail. Increased use of television and computers for entertainment and leisure activities. Use of elevators and escalators rather than stairs. Increased concern for crime, which has reduced the likelihood of outdoor playing. Poor urban planning that does not provide adequate biking paths or even sidewalks in some communities. Thus, the increasing prevalence, numerous health risks, and astounding economic costs of obesity clearly justify widespread efforts toward prevention efforts. These prevention efforts should begin in childhood because the behaviors are learned and continue through the lifetime.

Adolescent↗

PubMed2001

Anti-lipolytic effects of insulin in African American and white prepubertal boys.

OBJECTIVE: Relative to whites, African Americans have lower circulating triglycerides (TG) and greater highdensity lipoprotein cholesterol. The metabolic basis for this difference is not known. This study was conducted to test the hypothesis that insulin-induced suppression of free fatty acids (FFA) results in lower serum TG in African American versus white prepubertal children. RESEARCH METHODS AND PROCEDURES: Insulin, FFA, and TG were determined at baseline and during a frequently sampled, intravenous glucose tolerance test in eight African American and eight white prepubertal males pair-matched for whole-body insulin sensitivity. RESULTS: Baseline TG was lower in African Americans (0.43 +/- 0.10 vs. 0.79 +/- 0.37 mM/L; mean +/- SD; p < 0.01). African Americans had higher peak insulin (218 +/- 102 vs. 100 +/- 30 pM/L; mean +/- SD; p < 0.01) and a greater acute insulin response (9282 +/- 4272 vs. 4230 +/- 1326 pM/L x 10 minutes; mean +/- SD; p < 0.05). FFA and TG values determined at the FFA nadir were lower in African Americans (0.26 +/- 0.02 vs. 0.30 +/- 0.03 mEq/L; mean +/- SD; p < 0.01 for FFA nadir and 0.49 +/- 0.07 vs. 0.77 +/- 0.33 mM/L; mean +/- SD; p < 0.05 for TG). Among all subjects, FFA nadir was correlated with peak insulin (r = -0.54; p < 0.05). After adjusting for FFA nadir, neither baseline nor postchallenge TG differed with ethnicity (p = 0.073 and 0.192, respectively). The ethnic difference in FFA nadir disappeared after adjusting for peak insulin (p = 0.073). DISCUSSION: These data suggest that hyperinsulinemiainduced suppression of FFA among African Americans is a determinant of lower TG in this group.

Arteriosclerosis↗

PubMed2001

Defining health-related obesity in prepubertal children.

OBJECTIVE: The purpose of this study was to develop percentage of fat and waist circumference cut-points in prepubertal children with the intention of defining obesity associated with cardiovascular disease (CVD) risk. RESEARCH METHODS AND PROCEDURES: A cross-sectional analysis of 87 prepubertal children aged 4 to 11 years was used. Percentage of body fat was determined by DXA. Waist circumference was measured to the nearest millimeter. Receiver Operating Characteristic analyses of percentage of fat and waist circumference were used to develop cut-points for individuals with adverse levels of CVD risk factors. RESULTS: The risk factors selected for analyses (i.e., fasting insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and total cholesterol/high-density lipoprotein cholesterol) were significantly related to percentage of body fat and waist circumference. Likelihood ratios were used to identify percentage of fat and waist circumference cut-points associated with adverse cardiovascular risk profiles. Two cut-points, an upper cut-point of 33% body fat and a lower cut-point of 20% body fat, were derived. Waist circumference cut-points indicative of adverse and normal risk-factor profiles were 71 cm and 61 cm, respectively. DISCUSSION: The data indicate that children with > or =33% body fat and children with a waist circumference > or =71 cm were more likely to possess an adverse CVD risk-factor profile than a normal risk-factor profile. The likelihood of children with < 20% body fat or a waist circumference < 61 cm possessing an adverse CVD risk-factor profile as opposed to a normal risk-factor profile was small. The cut-points describe an adequate health-related definition of childhood obesity.

Absorptiometry, Photon↗

PubMed2001

Growth of visceral fat, subcutaneous abdominal fat, and total body fat in children.

OBJECTIVE: To examine the patterns of growth of visceral fat, subcutaneous abdominal fat, and total body fat over a 3- to 5-year period in white and African American children. RESEARCH METHODS AND PROCEDURES: Children (mean age: 8.1 +/- 1.6 years at baseline) were recruited from Birmingham, Alabama, and those with three or more repeated annual measurements were included in the analysis (N = 138 children and 601 observations). Abdominal adipose tissue (visceral and subcutaneous) was measured using computed tomography. Total body fat and lean tissue mass were measured by DXA. Random growth curve modeling was performed to estimate growth rates of the different body fat compartments. RESULTS: Visceral fat and total body fat both exhibited significant growth effects before and after adjusting for subcutaneous abdominal fat and lean tissue mass, respectively, and for gender, race, and baseline age (5.2 +/- 2.2 cm(2)/yr and 1.9 +/- 0.8 kg/yr, respectively). After adjusting for total body fat, the growth of subcutaneous abdominal fat was not significant. Whites showed a higher visceral fat growth than did African Americans (difference: 1.9 +/- 0.8 cm(2)/yr), but there was no ethnic difference for growth of subcutaneous abdominal fat or total body fat. There were no gender differences found for any of the growth rates. DISCUSSION: Growth of visceral fat remained significant after adjusting for growth of subcutaneous abdominal fat, implying that the acquisition of the two abdominal fat compartments may involve different physiologic mechanisms. In contrast, growth of subcutaneous abdominal fat was explained by growth in total body fat, suggesting that subcutaneous fat may not be preferentially deposited in the abdominal area during this phase of growth. Finally, significantly higher growth of visceral fat in white compared with African American children is consistent with cross-sectional findings.

Abdomen↗

PubMed2001

Influence of total vs. visceral fat on insulin action and secretion in African American and white children.

OBJECTIVE: To examine whether total body fat (FAT) in general or visceral fat (VFAT) in particular is associated with greater metabolic risk in white and African American children. RESEARCH METHODS AND PROCEDURES: A total of 68 white and 51 African American children had measures of insulin sensitivity (Si) and acute insulin response (AIR) by a frequently sampled intravenous glucose tolerance test, total body fat by DXA and abdominal fat distribution (visceral vs. subcutaneous) by computed tomography. The influence of FAT and VFAT on insulin parameters were examined by comparing subgroups of children with high or low FAT vs. high or low VFAT and by multiple regression analysis. RESULTS: In whites, fasting insulin, Si, and AIR were significantly influenced by FAT, but not VFAT (e.g., for Si, 9.8 +/- 0.8 in low FAT vs. 4.6 +/- 0.7 x 10(-4)/min/[microIU/mL[ in high FAT, p < 0.05; 6.8 +/- 0.7 in low VFAT vs. 7.5 +/- 0.8 x 10(-4)/min/[microIU/mL] in high VFAT, p > 0.1). In African Americans, fasting insulin and Si were also primarily influenced by FAT (e.g., for Si, 4.9 +/- 0.4 in low FAT vs. 2.8 +/- 0.5 x 10(-4)/min/[microIU/mL] in high FAT, p < 0.05) but not by VFAT, and there were no significant effects of either fat compartment on AIR. In multiple regression analysis, Si was significantly influenced by FAT (negative effect), ethnicity (lower in African Americans), and gender (lower in females), whereas fasting insulin was significantly influenced by VFAT (positive effect), ethnicity (higher in African Americans), and fat free mass (positive effect). DISCUSSION: Body fat in general is the predominant factor influencing Si, but VFAT may have additional effects on fasting insulin. The lack of major effects of VFAT on Si in children may be explained by lower levels of VFAT or because VFAT affects aspects of whole body insulin action that are not measured by the minimal model.

Adipose Tissue↗

PubMed2001

Influence of leptin on changes in body fat during growth in African American and white children.

OBJECTIVE: The aim of this study was to determine whether initial levels or temporal changes in fasting leptin were associated with longitudinal changes in body-fat mass in children. RESEARCH METHODS AND PROCEDURES: The study group consisted of 85 children (42 white and 43 African American) with a mean initial age of 8.1 +/- 0.1 years. The children had between three and six annual visits for repeated measurements of body composition by DXA and fasting leptin level. Fat mass and fasting leptin level were not normally distributed and were log-transformed. Data were analyzed using SAS Proc mixed growth models, with log fat as the dependent variable. RESULTS: Initial leptin level was a significant predictor of the change in fat mass over time (p < 0.0001), with high initial leptin levels resulting in increased fat gain, independent of initial fat levels. This relationship remained significant when the data were analyzed separately by race (whites, p < 0.0001; African Americans, p = 0.008). The relationship between the initial level of leptin and the change in fat mass was not modified by race, sex, or Tanner Stage. The rate of change in leptin during the study was significantly related to the rate of change in fat mass in African Americans (p = 0.008) but not in whites (p = 0.490). DISCUSSION: In conclusion, high fasting leptin level at the start of the study was significantly associated with increasing fat mass in this cohort, indicating that the children may be developing resistance to the effects of leptin.

Absorptiometry, Photon↗

PubMed2001

Body fat, fat distribution and serum lipids, lipoproteins and apolipoproteins in African-American and Caucasian-American prepubertal children.

OBJECTIVE: The purpose of the present study was to determine the impact of body fat mass and fat distribution on serum lipids, lipoproteins and apolipoproteins in African-American and Caucasian-American prepubertal children. SUBJECTS: Study participants included 62 African-American children (age 8.3+/-1.4 y; body mass 37.3+/-13.6 kg; height 133+/-11 cm) and 39 Caucasian children (age 8.6+/-1.2 y; body mass 34.1+/-11.0 kg; height 131+/-9 cm). METHODS: Venous blood samples were obtained after a 12 h overnight fast and serum was analyzed for total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), triacylglycerol (TAG), apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB) and lipoprotein (a) (Lp(a)) concentrations. Body composition and body fat distribution were measured by dual-energy X-ray absorptiometry and computed tomography, respectively. RESULTS: African-American children had lower TAG (46+/-20 vs 61+/-32 mg/dl, P=0.015) and higher Lp(a) (34+/-25 vs 17+/-28 mg/dl, P=0.001) and HDL-C (44+/-11 vs 39+/-8 mg/dl, P=0.041). There were no ethnic differences in TC, ApoA-I and ApoB (P=0.535, P=0.218, P=0.418, respectively). The ethnic difference in TAG and Lp(a) was not explained by total fat or abdominal fat. The ethnic difference in HDL-C was explained by visceral fat and TAG. CONCLUSION: In prepubertal children, neither body fat nor fat distribution explain the ethnic difference in TAG or Lp(a), but visceral fat and TAG may contribute to differences in HDL-C.

Absorptiometry, Photon↗

PubMed2001

Metabolic precursors and effects of obesity in children: a decade of progress, 1990-1999.

Current data suggest that 20% of US children are overweight. An analysis of secular trends suggested a clear upward trend in body weight in children of 0.2 kg/y between 1973 and 1994. In addition, childhood obesity is more prevalent among minority subgroups, such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity-related conditions later in life. Obesity is now considered a disease of epidemic proportions, not just in the United States but also worldwide. In the past 10 y there has been a tremendous increase in the number of studies examining the etiology and health effects of obesity in children. The major objectives of this article are to 1) review highlights in pediatric obesity research from 1990 to 1999; 2) summarize our research on the roles of energy expenditure, physical activity, and aerobic capacity in the etiology of pediatric obesity, and on ethnic differences in the relation between obesity and type 2 diabetes risk factors in children; and 3) discuss areas of future study that will require greater emphasis as the field of childhood obesity research evolves over future years.

Adolescent↗

PubMed2001

A longitudinal study of resting energy expenditure relative to body composition during puberty in African American and white children.

BACKGROUND: Body composition and resting energy expenditure (REE) have not been examined longitudinally during puberty. OBJECTIVE: The purpose of this longitudinal study was to examine the influence of pubertal maturation on REE relative to body composition in African American and white children. DESIGN: The study included 92 white and 64 African American children (mean age at baseline: 8.3 and 7.9 y, respectively) from Birmingham, AL. The children had 2-5 annual measurements of fat mass (FM), lean mass (LM), and REE. The Tanner stages of the children ranged from 1 to 5. Mixed-model repeated-measures analyses were used to test the change in REE relative to body composition with increasing Tanner stage among ethnic and sex groups. RESULTS: LM increased from Tanner stage 1 to subsequent stages. FM relative to LM decreased from Tanner stage 1 to stages 3, 4, and 5 but not from stage 1 to stage 2. The African American children had relatively higher limb LM and lower trunk LM than did the white children. REE declined with Tanner stage after adjustment for ethnicity, sex, FM, and LM. This decline was significant from Tanner stage 1 to stages 3, 4, and 5 but not to Tanner stage 2. After adjustment for age, Tanner stage, FM, and LM or LM distribution, REE was significantly higher in white than in African American children (by approximately 250 kJ/d). CONCLUSION: In a large sample of children at various Tanner stages, we found an ethnic difference in REE after adjustment for age, Tanner stage, FM, and LM that was not explained by the difference in LM distribution.

Basal Metabolism↗

PubMed2001

Comparison of the BOD POD with the four-compartment model in adult females.

PURPOSE: This study was designed to compare the accuracy and bias in estimates of total body density (Db) by hydrostatic weighing (HW) and the BOD POD, and percent body fat (%fat) by the BOD POD with the four-compartment model (4C model) in 42 adult females. Furthermore, the role of the aqueous and mineral fractions in the estimation of body fat by the BOD POD was examined. METHODS: Total body water was determined by isotope dilution ((2)H(2)0) and bone mineral was determined by dual-energy x-ray absorptiometry. Db and %fat were determined by the BOD POD and HW. The 4C model of Baumgartner was used as the criterion measure of body fat. RESULTS: HW Db (1.0352 g x cm(-3)) was not statistically different (P = 0.35) from BOD POD Db (1.0349 g x cm(-3)). The regression between Db by HW and the BOD POD significantly deviated from the line of identity (Db by HW = 0.90 x Db by BOD POD + 0.099; R(2) = 0.94). BOD POD %fat (28.8%) was significantly lower (P < 0.01) than %fat by the 4C model (30.6%). The regression between %fat by the 4C model and the BOD POD significantly deviated from the line of identity (%fat by 4C model = 0.88 x %fat by BOD POD + 5.41%; R(2) = 0.92). BOD POD Db and %fat showed no bias across the range of fatness. Only the aqueous fraction of the fat-free mass (FFM) had a significant correlation with the difference in %fat between the 4C model and the BOD POD. CONCLUSION: These data indicate that the BOD POD underpredicted body fat as compared with the 4C model, and the aqueous fraction of the FFM had a significant effect on estimates of %fat by the BOD POD.

Absorptiometry, Photon↗

PubMed2001

Longitudinal changes in body fat in African American and Caucasian children: influence of fasting insulin and insulin sensitivity.

Obesity is associated with hyperinsulinemia and reduced insulin sensitivity, both risk factors for type 2 diabetes. However, it is not clear whether these risk factors occur as a result of obesity or whether they contribute to the development of obesity. The aims of this study were to determine whether baseline (first visit) or changes in insulin measures over time were associated with longitudinal changes in body fat mass during growth in children. The study group consisted of 137 children (83 Caucasian and 54 African American) with a mean age of 8.1 yr at baseline. The children returned for 3-6 annual visits for measurement of fasting insulin, insulin sensitivity (Si), and acute insulin response (AIR) from the tolbutamide-modified frequent sampling iv glucose tolerance test and for determination of body composition by dual energy x-ray absorptiometry. Data were analyzed using SAS Proc mixed growth models. Total fat mass increased with time by 15.6%/yr (P = 0.013), but the rate of increase was not significantly influenced by race, sex, or Tanner stage. However, fasting insulin (positive effect), Si (negative effect), and AIR (positive effect) were significantly associated with the rate of increase in fat mass. In conclusion, in this cohort of children, growth-related increases in body fat were significantly associated with increases in fasting insulin and AIR and decreases in Si.

Adipose Tissue↗

PubMed2001

Longitudinal study on pubertal insulin resistance.

Previous cross-sectional studies show that puberty is associated with a reduction in insulin sensitivity (S(I)), but no longitudinal studies have examined this change in detail. This study is a longitudinal study in 60 children (33 male and 27 female subjects; 32 Caucasian and 28 African-American) examined at Tanner stage I (age 9.2 +/- 1.4 years) and after 2.0 +/- 0.6 years of follow-up, by which time 29 children remained at Tanner stage I and 31 had progressed to Tanner stage III or IV. Tanner stage was assessed by physical examination. S(I), the acute insulin response (AIR), and the disposition index (DI) were determined by the tolbutamide-modified intravenous glucose tolerance test and minimal modeling, body fat mass was assessed by dual-energy X-ray absorptiometry, visceral fat was determined by computed tomography, and fasting blood was analyzed for hormone levels. In children progressing to Tanner stage III, S(I) fell significantly by 32% (4.4 +/- 3.0 to 3.0 +/- 1.7 x 10(-4)min(-1)/[microIU/ml]), AIR increased by 30%, DI fell by 27%, and there was a significant increase in fasting glucose (93.5 +/- 5.0 to 97.0 +/- 4.1 mg/dl) and insulin (14.3 +/- 8.1 to 18.6 +/- 11.0 microIU/ml). In children remaining at Tanner stage I, there was a slight increase in S(I) (6.4 +/- 3.1 to 7.4 +/- 3.5 x 10(-4)min(-1)/[microIU/ml]) with no significant change in AIR or fasting glucose and insulin. The pubertal fall in S(I) was more consistent in African-Americans; remained significant after controlling for age, sex, and change in fat mass, visceral fat, and fat-free mass; and was similar in children at low, medium, and high body fat. Change in S(I) was not significantly related to change in fasting hormone levels, but change in AIR was significantly related to change in androstendione (r = 0.39; P = 0.04). Pubertal transition from Tanner stage I to Tanner stage III was associated with a 32% reduction in S(I,) and increases in fasting glucose, insulin, and AIR. These changes were similar across sex, ethnicity, and obesity. The significant fall in DI suggests conservation in beta-cell function or an inadequate beta-cell response to the fall in S(I). The fall in S(I) was not associated with changes in body fat, visceral fat, IGF-I, androgens, or estradiol.

Adipose Tissue↗