Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

소아 및 청소년 비만증에서 인슐린 저항성에 미치는 요인

Affecting Factors of Insulin Resistance in Obese Children and Adolescents

  • 김덕희 (연세대학교 의과대학 소아과학교실) ;
  • 은호선 (연세대학교 의과대학 소아과학교실) ;
  • 최인경 (연세대학교 의과대학 소아과학교실) ;
  • 김호성 (연세대학교 의과대학 소아과학교실) ;
  • 차봉수 (연세대학교 의과대학 내과학교실) ;
  • 김동기 (연세대학교 의과대학 의학통계학과)
  • Kim, Duk Hee (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Eun, Ho Seon (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Choi, In Kyung (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Kim, Ho Seung (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Cha, Bong Soo (Department of Internal Medicine, College of Medicine, Yonsei University) ;
  • Kim, Dong Kee (Department of Medical Statistics, College of Medicine, Yonsei University)
  • 투고 : 2005.06.20
  • 심사 : 2005.08.04
  • 발행 : 2005.10.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 인슐린 저항성은 소아 및 청소년 비만증에서 내당능 장애, 당뇨병증, 심혈관계질환을 일으키는 중요한 위험요인 중 하나로 알려져 있다. 따라서 이 연구의 목적은 비만증 청소년이 소아에 비해 인슐린저항성이 증가하는가 그리고 성별에 따른 차이점을 규명하며 인슐린저항성에 영향을 미치는 요인들을 분석하고자 한다. 방 법 : 5-16세의 학생 9,837명을 신체검사하여 92명의 비만증 소아와 187명의 비만증 청소년을 선별하였고, 이들을 대상으로 당부하검사, 공복상태의 혈당, 인슐린농도, 총콜레스테롤, LDL-콜레스테롤, HDL-콜레스테롤, 중성지방의 농도, leptin, hs-CRP 및 adiponectin 농도를 측정하였다. 결 과 : 당부하검사를 통한 비만증 소아 및 청소년에서 성별에 따른 인슐린의 농도는 여자에서 인슐린의 농도가 높았다(P<0.05). 비만증 소아에서 4명(4.3%), 비만증 청소년에서 25명(13.3%)에서 내당능 장애로 나타났으며, 당뇨병으로 진단된 경우는 1례도 없었다. 인슐린 저항성은 여자, leptin, adiponectin, 중성지방의 농도와 밀접한 상관관계가 있었다(P<0.05). 결 론 : 비만증에서 인슐린 저항성은 소아보다 청소년에서 컸으며, 남자보다 여자에서 컸다. 또한 leptin 및 중성지방의 농도가 높을수록, adiponectin의 농도가 낮을수록 인슐린 저항성이 컸다. 소아 및 청소년 비만증에서 인슐린 저항성에 미치는 요인들에 관하여 좀 더 많은 연구가 필요하다.

Purpose : Insulin resistance is the most important risk factor linked to the development of impaired glucose tolerance(IGT), diabetes mellitus and cardiovascular diseases in childhood and adolescent obesity, The purpose of this study was to see whether insulin resistance of obese adolescent is higher than that of obese children. and to analyze gender difference and affecting factors of insulin resistance. Methods : Of the 9,837 school children from 5 to 16 tears old, 92 obese children and 187 adolescent, underwent a two-hour oral glucose tolerance test and plasma glucose, insulin, lipid profiles, leptin and high sensitive C-reactive protein(hs-CRP) were measure. Results : Plasma insulin levels of female were higher compared to those of males during oral glucose tolerance test(P<0.05). Four(4.3%) in obese children and twenty five(13.3%) in obese adolescents met the criteria of IGT. Female, leptin, adiponectin and triglyceride concentrations were strongly correlated with homeostatic model assessment insulin-resistance(HOMA-IR) by multiple linear regression analysis(P<0.05). Conclusion : Obese adolescents might have higher insulin concentrations compared to obese children and obese girls higher insulin concentrations than obese boys. Obese boys and children with impaired glucose tolerance have higher insulin concentrations than those with normal glucose tolerance. HOMA-IR was significantly correlated with female, plasma leptin, adiponectin and triglyceride concentrations.

키워드

과제정보

연구 과제 주관 기관 : 보건복지부

참고문헌

  1. Rosenbloom AL, Joe JR, Young RS, Winter NE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999;22:345-54 https://doi.org/10.2337/diacare.22.2.345
  2. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States : Prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord 1998;22:39-47
  3. Steinberger J, Moorehead C, Katch V, Rocchini AP. Relationship between insulin resistance and abnormal lipid profile in obese adolescents. J Pediatr 1995;126:690-5 https://doi.org/10.1016/S0022-3476(95)70394-2
  4. Sinaiko AR, Jacobs DR Jr, Steinberger J, Moran A, Luepker R, Rocchini A, et al. Insulin resistance syndrome in childhood : associations of the euglycemic insulin clamp and fasting insulin with fatness and other risk factors. J Pediatr 2001;139:700-7 https://doi.org/10.1067/mpd.2001.118535
  5. Steinberger J, Daniels SR. Obesity, Insulin resistance, Diabetes and Cardiovascular risk in children. Circulation 2003;107:1448-53 https://doi.org/10.1161/01.CIR.0000060923.07573.F2
  6. Reaven GM, Brand RJ, Chen Y-DI, Mathur AK, Goldfine I. Insulin resistance and insulin secretion are determinants of oral glucose tolerance in normal individuals. Diabetes 1993;42:1324-32 https://doi.org/10.2337/diabetes.42.9.1324
  7. Scott CR, Smith JM, Cradock MM, Pihoker C. Characteristics of youth-onset non-insulin-dependent diabetes mellitus at diagnosis. Pediatrics 1997;100:84-91 https://doi.org/10.1542/peds.100.1.84
  8. Ferrannini E. Insulin deficiency in non-insulin dependent diabetes mellitus : problems and prospects. Endocrinol Rev 1998;19:477-90 https://doi.org/10.1210/er.19.4.477
  9. Weyer C, Tataranni PA. Bogardus C, Pratley RE. Insulin resistance and insulin secretory dysfunction are independent predictors of worsening of glucose tolerance during each stage of type 2 diabetes development. Diabetes care 2001;24:89-94 https://doi.org/10.2337/diacare.24.1.89
  10. Starke A. Determination of insulin sensitivity : Methodological considerations. J Cardiovascular Pharmachol 1992;20(Suppl 11):S17-21 https://doi.org/10.1097/00005344-199212031-00003
  11. Haaffner SM, Mittinen H, Stern M. The homeostasis model in San Antonio Heart Study. Diabetes Care 1997;20:1087-92 https://doi.org/10.2337/diacare.20.7.1087
  12. Laakso M. How good a marker is insulin level for insulin resistance? Am J Epid 1993;9:959-65
  13. Vanhala P, Vanhala M, Kumpusalo E, Keinanen-Kiukaanniemi S. The quantitative insulin sensitivity check index QUICKI predicts the onset of type 2 diabetes better than fasting insulin in obese subjects : a 5 year follow-up study. J Clin Endocrinol Metab 2002;87:5834-7 https://doi.org/10.1210/jc.2002-020591
  14. Yeni-Komshian H, Abbasi F, Carantoni M, Reaven GM. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 2000;23:171-5 https://doi.org/10.2337/diacare.23.2.171
  15. Matthews DR, Hosker JP, Rudenski AS, Naylor BA. Homeostatsis model assessment : Insulin resistance and ${\beta}$-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologiia 1985;28:412-9 https://doi.org/10.1007/BF00280883
  16. Kisselbah AH, Krakower GR. Regional adiposity and morbidity. Physiol Rev 1994;74:761-811
  17. Guo SS, Chumlea WC, Roche AF, Siervogel RM. Age and maturity-related changes in body composition during adolescence into adulthood : the Fels Longitudinal Study. Int J obese Related Metabol Dis 1997;21:1167-75 https://doi.org/10.1038/sj.ijo.0800531
  18. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1. diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-43 https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S
  19. Hanefeld M. The metabolic syndrome; roots, myths, and facts. In The Metabolic syndrome. Hanfeld M, Leonhardt W. Eds Jena Gustab Fischer 1997;13-24
  20. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and mortality assocated with the metabolic syndrome. Diabetes Care 2001;24:683-9 https://doi.org/10.2337/diacare.24.4.683
  21. Ford ES, Giles WH, Dietz WH. Prevalence of metabolic syndrome among US adults. JAMA 2002;287:356-9 https://doi.org/10.1001/jama.287.3.356
  22. Greenfield HS, Doberne L, Kraemer F, Tobey T, Reaven G. Assessment of insulin resistance with the insulin suppression test and the euglycemic clamp. Diabetes 1981;387-92 https://doi.org/10.2337/diabetes.30.5.387
  23. Canfarani S, Geremia C, Germani D, Scire G, Maiorana A, Boemi S. Insulin resistance and insulin-like growth factors in children with intrauterine growth retardation. Is catch-up growth a risk factor? Horm Res 2001;55(Suppl 1):7-10 https://doi.org/10.1159/000063455
  24. Galli-Tsinoppoulou A, Karamouzis M, Nousia-Arvanitkkis S. Insulin resistance and hyperinsulinemia in prepubertal obese children. J Ped Endocrino Metab 2003;16:555-60
  25. Borona E, Targher G, Alberiche M, Bonnadona RC, Saggiani F, Zenere MA, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity. Diabetes Care 2000;23:57-63 https://doi.org/10.2337/diacare.23.1.57
  26. Haffner SM, Gonzalez C, Mittinen H, Kennedy E, Stern MP. A prospective analysis of the HOMA-IR model : the Mexico city diabetes study. Diabetes Care 1996;19:1138-41 https://doi.org/10.2337/diacare.19.10.1138
  27. Steinberger J, Daniels SR. Obesity, Insulin resistance, Diabetes, and Cardiovascular Risk in children. An American heart association scientific statement from the atherosclerosis hypertension, and obesity in the young committee (council on cardiovascular disease in the young) and the diabetes committee(council on nutrition, physical activity, and metabolism). Circulation 2003;107:1448-53 https://doi.org/10.1161/01.CIR.0000060923.07573.F2
  28. Jiang X, Srinivasan SR, Berenson GS. Relation of obesity to insulin secretion and clearance in adolescents : the Bogalusa Heart Study. Int J Obes Relat Metab Disord 1996;20:951-66
  29. Stalder M, Pometta D, Suenram A. Relationship between plasma insulin levels and high density lipoprotein cholesterol levels in healthy men. Diabetologia 1981;21:544-8
  30. Jiang X, Srnivasan SR, Webber LS, Wattigney WA, Berenson GS. Association of fasting insulin level with serum lipid and lipoprotein levels in children, adolescents, and young adults : the Bogalusa Heart Study. Arch Intern Med 1995;155:190-6 https://doi.org/10.1001/archinte.155.2.190
  31. Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonsfonns RC, et al. Prediabetes in obese youth : a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet 2003;362:951-7 https://doi.org/10.1016/S0140-6736(03)14364-4
  32. Valmete AM, Strong W, Sinaiko AR, Durvam MD, Augusta NC. Obesity and insulin resistance in young people Am H J 2001;142:440-4 https://doi.org/10.1067/mhj.2001.117828
  33. Young-Hyman D, De Luca F, Schlundt DG, Counts D, Herman L. Evaluation of the insulin resistance syndrome in 5- to 10- year-old overweight/obese African-american children. Diabetes Care 2001;24:1359-64 https://doi.org/10.2337/diacare.24.8.1359
  34. Krssak M, Falk Petersen K, Dresner A, DiPietro L, Vogel SM, Rothman DL, et al. Intramyocellular lipid concentrations are correlated with insulin sensitivity in humans : a 1H-NMR spectroscopy study. Diabetologia 1999;42:113-6 https://doi.org/10.1007/s001250051123
  35. Greco A, Mingione G, Giancaterini A, Manco M, Morroni A, Cinti S, et al. Insulin resistance in morbid obesity : reversal with intracellular fat depletion. Diabetes 2002;51:144-51 https://doi.org/10.2337/diabetes.51.2007.S144
  36. Yamauchi T, Kamon J, Minokoshi Y, Ito Y, Waki H, Uchida S, et al. Adiponectin stimulates glucose utilization and fatty-acid oxidation by activating AMP-activated protein kinase. Nat Med 2002;8:1288-95 https://doi.org/10.1038/nm788
  37. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346:802-10 https://doi.org/10.1056/NEJMoa012578
  38. Ferrannini E, Nannipiri M, William Kgonzales C, Haffner SM, Stern MP. Mode of onset of type 2 diabetes from normal or impaired glucose tolerance. Diabetes 2004;53:160-5 https://doi.org/10.2337/diabetes.53.1.160