Exposure to hyperinsulinemia, increased insulin secretion, and low postprandial glucose were not found to be associated with greater increases in the degree of obesity in children and adolescents as assessed over a 2-year to 4-year period, according to the results of a study published in Diabetes Care.

Researchers sought to determine whether indices of hyperinsulinemia and postprandial glucose levels could predict increases in the degree of obesity in children and adolescents over time.

The study included children and adolescents with obesity who were referred to an obesity clinic from 1998 to 2016. Age at recruitment ranged from 6 to 19 years, and the study participants received standard care involving clinic-based behavioral modification therapy and oral glucose tolerance testing (OGTT).


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Hyperinsulinemia and insulin secretion indices were derived via OGTT and compared with changes in the degree of obesity among study participants. The study authors calculated an age- and sex-dependent body mass index (BMI) standard deviation score (BMI z-score) to measure the degree of obesity. The primary outcome was BMI z-score change between OGTT results.

A total of 591 children and adolescents (63% female) with obesity were included in the analysis. Mean age was 12.33±2.80 years, and mean BMI z-score at baseline was 2.41±0.33 (range, 1.65-3.28). The mean time between OGTT was 1.86±1.29 years, and the mean change in BMI z-score was -0.05±0.27 (range, -1.6 to 0.63).

The correlation coefficient of postprandial hyperinsulinemia (area under the curveinsulin) and change in BMI z-score over time was negative and significant (r=-0.08; P =.04). The correlation coefficient of fasting insulin and change in BMI z-score was negative and not significant (r=-0.04; P =.32).

The correlation coefficient of peak insulin and change in BMI z-score over time was negative and not significant (r=-0.05; P =.22). The correlation coefficient of insulin30min and change in BMI z-score was negative and not significant (r=-0.01; P =.70).

The correlation coefficient of glucose at 180 minutes following OGTT and change in BMI z-score over time was negative and not significant (r=-0.06; P =.14). The change in BMI z-score was comparable among patients who had a 180-minute glucose level <75 mg/dL (n=123) and those who did not (n=468; P =.48).

In a subanalysis of 104 participants with repeated annual OGTT (66 female; 36 White, 25 Black, and 43 Hispanic) and a mean follow-up of 4.25±1.81 years, none of the independent parameters was found to be a predictor of BMI z-score change in univariate or multivariate analyses.

The researchers noted that the study participants were youth with obesity and that concentrations of other nutrients and hormones, such as free fatty acids and gut hormones, were not evaluated. Also, participants’ dietary patterns were not adequately assessed, and the follow-up period may be too short to determine the long-term impact of high insulin secretion and postprandial hyperinsulinemia.

“In children and adolescents with obesity, fasting as well as postprandial hyperinsulinemia, greater insulin secretion, or relatively low postprandial glucose levels are not associated with increasing degrees of obesity over a follow-up of 2 to 4 years,” stated the study authors. “Additional studies performed in children and adolescents who are leaner at baseline and have longer follow-ups are needed to further investigate the relevance of the carbohydrate-insulin model in the pediatric population.”

Reference

Halloun R, Galderisi A, Caprio S, Weiss R. Lack of evidence for a causal role of hyperinsulinemia in the progression of obesity in children and adolescents: a longitudinal study. Diabetes Care. Published online March 2, 2022. doi:10.2337/dc21-2210