Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Alteration of insulin resistance and serum adiponectin levels after one year follow-up of obese children and adolescents

비만 소아에서 1년 후 추적검사에 따른 인슐린 저항성 및 혈중 아디포넥틴의 변화

  • Jeoung, Min Jee (Department of Pediatrics, College of Medicine, Korea University) ;
  • Shin, Jung Yeon (Department of Pediatrics, College of Medicine, Korea University) ;
  • Kim, Soo Young (Department of Pediatrics, College of Medicine, Korea University) ;
  • Lee, Jung Hwa (Department of Pediatrics, College of Medicine, Korea University) ;
  • Lee, Kee-Hyoung (Department of Pediatrics, College of Medicine, Korea University) ;
  • Lee, Joo Won (Department of Pediatrics, College of Medicine, Korea University)
  • 정민지 (고려대학교 의과대학 소아과학교실) ;
  • 신정연 (고려대학교 의과대학 소아과학교실) ;
  • 김수영 (고려대학교 의과대학 소아과학교실) ;
  • 이정화 (고려대학교 의과대학 소아과학교실) ;
  • 이기형 (고려대학교 의과대학 소아과학교실) ;
  • 이주원 (고려대학교 의과대학 소아과학교실)
  • Received : 2007.02.02
  • Accepted : 2007.07.10
  • Published : 2007.08.15
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Abstract

Purpose : Obesity has become a pandemic and especially the prevalence of childhood obesity has increased remarkably over the past years. Childhood obesity is often accompanied by the expected morbidities such as hyperlipidemia, fatty liver and glucose intolerance. We evaluated the pattern of alteration in the body mass index (BMI), serum adiponectin concentration, insulin resistance (HOMA-IR), and complication rates after one year follow-up. Methods : Forty two obese children (age: 8-15 years, 95th percentile of BMI for age and sex) were examined twice annually on June, 2004 and July, 2005. The body mass index (BMI) and sexual maturityrating (SMR) were determined annually by the same examiner and serum fasting glucose, liver enzyme, lipid profiles, adiponectin, insulin and HOMA-IR were measured and annual results were compared. Upper abdominal sonography was performed to detect fatty liver. Results : BMI ($25.3{\pm}2.9kg/m^2$ vs. $26.0{\pm}2.9kg/m^2$) and HOMA-IR ($3.6{\pm}1.8$ vs. $4.7{\pm}1.9$) have increased significantly after one-year follow-up. The serum adiponectin concentration ($17.2{\pm}5.2g/mL$ vs. $12.6{\pm}5.2g/mL$) has decreased after one year. The prevalence of hyperlipidemia and fatty liver were not changed significantly but that of hyperinsulinemia increased after one-year. HOMA-IR showed a positive correlation with BMI and SMR, but was negatively correlated with serum adiponectin concentration. Conclusion : Obese children in our study showed significant increment of insulin resistance during one year. These results suggest that well-organized and continuous obesity control is required especially for obese adolescent to prevent complication of obesity.

목 적 : 최근 급격히 증가하고 있는 소아비만은 성인기까지 지속될 뿐 아니라 소아기에 이미 고지혈증, 지방간, 인슐린 저항성 등이 나타나며 향후 성인시기에 심혈관질환이나 당뇨병을 초래할 수 있어 더욱 문제가 된다. 본 연구는 동일한 비만 환아들을 1년 후 추적검사 하여 주요 임상지표 및 인슐린저항성의 변화를 알아보고, 이를 통해 관리되지 않은 상태인 소아비만의 자연경과 및 예후를 예측하고자 하였다. 방 법 : 같은 성별과 연령에서 체질량지수(BMI)가 95 백분위수 이상인 8-15세 사이의 비만아 42명을 2004년 6월과 2005년 7월에 소집하여 신체치수 측정과 성 성숙도를 평가하고 혈액 검사를(공복 시의 혈당 및 인슐린, 간효소치, 혈청 지질치, 아디포넥틴)하여 1년 후 변화를 비교분석하였다. 결 과 : 1년 후 대상 비만아의 BMI, 공복 인슐린 농도, 인슐린 저항성 및 고인슐린혈증의 빈도가 유의하게 증가하였으며, 혈중 아디포넥틴 농도는 감소하였다. 인슐린 저항성(HOMA-IR)은 BMI와 유의한 양의 상관관계를 보였으며 사춘기 전 보다 사춘기 시기에서 의미있게 높았다. 혈중 아디포넥틴 농도는 BMI와 음의 상관관계를 보였으며, 사춘기 전 보다 사춘기 시기의 비만아에서 의미있게 낮았다. 결 론 : 연구대상의 비만 소아들은 특별한 관리 없이 1년 후 검사에서 인슐린 저항성이 유의하게 증가하였으며, 혈중 아디포넥틴 농도는 감소하였다. 이는 소아비만이 성인비만으로 이행하면서 발생하는 비만합병증을 예방하기 위해 비만 청소년에 대한 체계적이고도 지속적인 관리가 요구됨을 시사한다.

Keywords

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