Dietary determinants of hepatic fat content and insulin resistance in overweight/obese children: a cross-sectional analysis of the Prevention of Diabetes in Kids (PREDIKID) study

AbstractPaediatric non-alcoholic fatty liver disease has increased in parallel with childhood obesity. Dietary habits, particularly products rich in sugars, may influence both hepatic fat and insulin resistance (homeostatic model assessment for insulin resistance (HOMA-IR)). The aim of the study was to examine the association of the consumption of foods and food components, dairy desserts and substitutes (DDS), sugar-sweetened beverages (SSB), as well as total and added sugars, with hepatic fat and HOMA-IR. Dietary intake (two non-consecutive 24 h-recalls), hepatic fat (MRI) and HOMA-IR were assessed in 110 overweight/obese children (10·6 (sd 1·1) years old). Linear regression analyses were used to examine the association of dietary intake with hepatic fat and HOMA-IR adjusted for potential confounders (sex, age, energy intake, maternal educational level, total and abdominal adiposity and sugar intake). The results showed that there was a negative association between cereal intake and hepatic fat (β=–0·197, P<0·05). In contrast, both SSB consumption (β=0·217; P=0·028) and sugar in SSB (β=0·210, P=0·035), but not DDS or sugar in DDS or other dietary components, were positively associated with hepatic fat regardless of potential confounders including total sugar intake. In conclusion, cereal intake might decrease hepatic fat, whereas SSB consumption and its sugar content may increase the likelihood of having hepatic steatosis. Although these observations need to be confirmed using experimental evidence, these results suggest that healthy lifestyle intervention programs are needed to improve dietary habits as well as to increase the awareness of the detrimental effects of SSB consumption early in life.

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Abstract 5057: Habitual Dietary Intake of Fatty Acids in Relation to Insulin Resistance among Japanese Adults

Circulation ◽

10.1161/circ.118.suppl_18.s_1136-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takashi Muramatsu ◽

Hiroshi Yatsuya ◽

Kunihiro Matsushita ◽

Hirotsugu Mitsuhashi ◽

Hideaki Toyoshima ◽

...

Keyword(s):

Insulin Resistance ◽

Fatty Acid ◽

Linoleic Acid ◽

Dietary Intake ◽

Linolenic Acid ◽

Model Assessment ◽

Alpha Linolenic Acid ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Japanese Adults

Background: Asians including Japanese are more susceptible to glucose intolerance or type 2 diabetes mellitus (DM) than Caucasians. However little is known about the effects of dietary fatty acid (FA) intake on insulin resistance (IR) in Japanese. Objective: Our aim was to investigate associations between IR and habitual dietary intake of FAs among middle-aged Japanese adults. Methods: We designed a cross-sectional survey of 3383 Japanese adults aged 35– 66 years. IR was measured with homeostasis model assessment (HOMA-R) and nutrient intake was estimated by a self-administered diet history questionnaire. All amounts of nutrients were energy-adjusted as the residuals from regression model. Results: Log-transformed HOMA-R had a significant negative correlation with polyunsaturated fatty acid (PUFA). Multivariate-adjusted regression analysis demonstrated that IR had a significant positive association with saturated fatty acid (SFA) and inverse associations with n-6 series PUFA independently of age, sex, BMI, lipid profiles, other macronutrients and lifestyle. Multivariate-adjusted odds ratios of IR, defined as a top quartile of HOMA-R distribution, across the quartiles of energy-adjusted intakes were 1.0, 0.89, 0.73 and 0.57 for linoleic acid ( P for trend = 0.007) and 1.0, 0.90, 0.68 and 0.61 for alpha-linolenic acid ( P for trend = 0.010), respectively. Marine-derived n-3 PUFA and the ratio of n-6 to n-3 PUFA had no consistent association with IR. Conclusions: Our cross-sectional data suggest that a modification of dietary fat intake to substitute PUFA, in particular linoleic acid and alpha-linolenic acid, for SFA may have a clinical efficacy to prevent IR among a Japanese population.

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Assessment of Adiponectin and Leptin as Biomarkers of Positive Metabolic Outcomes after Lifestyle Intervention in Overweight and Obese Children

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-0476 ◽

2008 ◽

Vol 93 (8) ◽

pp. 3051-3057 ◽

Cited By ~ 79

Author(s):

Valentina M. Cambuli ◽

M. Cristina Musiu ◽

Michela Incani ◽

Monica Paderi ◽

Roberto Serpe ◽

...

Keyword(s):

Insulin Resistance ◽

Childhood Obesity ◽

Lifestyle Intervention ◽

Dietary Habits ◽

Normal Weight ◽

Model Assessment ◽

Obese Children ◽

Homeostasis Model Assessment ◽

Metabolic Outcomes

Abstract Background: A number of metabolic changes are caused by childhood obesity, including insulin resistance, diabetes, and dyslipidemia. To counteract them, lifestyle modification with changes in dietary habits and physical activity is the primary intervention. Anthropometric parameters may not identify all positive changes associated with lifestyle modifications, whereas circulating adipokines may represent an alternative as biomarkers. The aim of this study was to evaluate adiponectin and leptin levels as markers of positive metabolic outcomes in childhood obesity. Methods: Changes in clinical, anthropometric, and metabolic parameters, including adiponectin and leptin, were assessed in 104 overweight and obese children before and after 1 yr of lifestyle intervention. Obesity and overweight were defined according to the Italian body mass index reference tables for age and sex. Fifty-four normal-weight children were evaluated as controls. Forty-eight of the children (47.5%) returned for follow-up at 1 yr. Results: Compared with normal-weight children, overweight and obese subjects differed significantly at baseline for glycemia, insulinemia, homeostasis model assessment for insulin resistance, adiponectinemia (5.8 vs. 18.2 μg/ml in controls), low-density lipoprotein-cholesterol, and triglycerides. These parameters were all higher in the overweight/obese children. At follow-up, most parameters improved in overweight/obese children. The most significant changes were observed in adiponectin concentration, which increased by 245% (P < 0.0001), reaching the levels observed in normal-weight children. Leptin levels showed changes unrelated to positive metabolic outcomes, remaining high at 1 yr of follow-up in overweight/obese children. Regardless of changes in weight status, children with lifestyle intervention reported changes in homeostasis model assessment for insulin resistance and in adiponectin that were associated with loss of fat mass. Conclusions: After lifestyle intervention, adiponectin increased regardless of changes in weight, whereas no consistent changes was observed in serum leptin. Therefore, circulating adiponectin may represent a good biomarker to evaluate the efficacy of lifestyle intervention in overweight/obese children.

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Intake of total dietary sugar and fibre is associated with insulin resistance among Danish 8–10- and 14–16-year-old girls but not boys. European Youth Heart Studies I and II

Public Health Nutrition ◽

10.1017/s1368980010000285 ◽

2010 ◽

Vol 13 (10) ◽

pp. 1669-1674 ◽

Cited By ~ 15

Author(s):

Iben Kynde ◽

Nina F Johnsen ◽

Niels Wedderkopp ◽

Ib C Bygbjerg ◽

Jørn W Helge ◽

...

Keyword(s):

Insulin Resistance ◽

Dietary Intake ◽

Dietary Fibre ◽

Linear Models ◽

Total Sugar ◽

Selective Reporting ◽

Model Assessment ◽

Cross Sectional ◽

Added Sugar ◽

European Youth

AbstractObjectiveTo examine the dietary intake of total sugar, added sugar, non-added sugar and starch as well as dietary fibre and glycaemic index (GI) and their respective associations with insulin resistance.DesignMixed linear models were used to study both cross-sectional and prospective associations between carbohydrate components and insulin resistance separately in girls and boys. Diet was assessed by a single 24 h recall interview and insulin resistance was calculated using the homoestasis model assessment (HOMA).SettingThe Danish part of the European Youth Heart Studies (EYHS) I and II.SubjectsGirls and boys at 8–10 and 14–16 years from EYHS I (n 651) and 8–10-year-olds from baseline followed up 6 years later in EYHS II (n 233).ResultsAmong girls, a difference in dietary total sugar of 43 g/MJ was associated with a 1 sd difference of HOMA and a difference in dietary fibre of −8 g/MJ was associated with a 1 sd difference of HOMA, independent of age, maturity and other confounders (both P = 0·03). No baseline associations were found among boys and no prospective associations were found in either sex.ConclusionsDietary intake of total sugar may play an adverse role and fibre may play a beneficial role in concurrent insulin resistance among girls but not boys. Sex differences may be due to differences in maturity, physical activity, food patterns and selective reporting behaviours.

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Influence of subclinical hypothyroidism on metabolic parameters in obese children and adolescents

Clinical and Experimental Pediatrics ◽

10.3345/cep.2019.01536 ◽

2020 ◽

Vol 63 (3) ◽

pp. 110-114

Author(s):

Ozlem Kara

Keyword(s):

Insulin Resistance ◽

Children And Adolescents ◽

Subclinical Hypothyroidism ◽

Serum Insulin ◽

Control Group ◽

Model Assessment ◽

Obese Children ◽

Cross Sectional ◽

Sh Group ◽

The Mean

Background: Subclinical hypothyroidism (SH) is a common condition in obese children. However, its effect on glucose and lipid metabolism in obese children remains controversial.Purpose: The present study aimed to investigate the association between SH and metabolic parameters.Methods: A total of 215 obese children and adolescents aged 6–18 years were included in this retrospective cross-sectional study. The patients’ anthropometric measurements such as thyrotropin (TSH), free thyroxine (fT4), fasting plasma glucose, and insulin levels, as well as homeostasis model assessment for insulin resistance (HOMA-IR) index, and lipid profiles were evaluated. The patients were allocated to the SH group (fT4 normal, TSH 5–10 mIU/L) (n=77) or the control group (fT4 normal, TSH<5 mIU/L) (n=138). The glucose and lipid metabolisms of the 2 groups were compared.Results: SH was identified in 77 of 215 patients (36%). Mean body mass index was similar in both groups. The mean serum insulin, HOMA-IR, and triglyceride (TG) levels were higher and the mean high-density lipoprotein cholesterol level was lower in the SH group than in the control group (P=0.007, P=0.004, P=0.01, and P=0.02, respectively). A positive correlation was observed between TSH level and insulin level, HOMA-IR, and TG level.Conclusion: SH was identified in some of the obese children and adolescents. A clear association was observed between SH, insulin resistance, and dyslipidemia in obese children.

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Acanthosis nigricans and insulin resistance in obese children

Paediatrica Indonesiana ◽

10.14238/pi50.5.2010.274-7 ◽

2010 ◽

Vol 50 (5) ◽

pp. 274 ◽

Cited By ~ 1

Author(s):

Kristellina Sangirta Tirtamulia ◽

Adrian Umboh ◽

Sarah Maria Warouw ◽

Vivekenanda Pateda ◽

Frecillia Regina

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Acanthosis Nigricans ◽

Resistance Index ◽

Skin Condition ◽

Cross Sectional Study ◽

Model Assessment ◽

Obese Children ◽

Cross Sectional

Background Acanthosis nigricans (AN) is a skin condition characterized by darkening and thickening of skin. AN has been reported to be linked to insulin resistance (IR), that associated with type 2 diabetes, in obese children in many country.Objective To determine the relation between acanthosis nigricans and insulin resistance in obese children.Methods We conducted a cross sectional study in Wenang District, Manado, from October 2009 until January 2010. We examined 54 obese children aged 10-14 years for insulin resistance using Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR). We analyzed the results byT-test and phi coefficient correlation. The value of P<O.05 was significant in statistical analysis.Results Acanthosis nigricans was positive in 33 children. Insulin resistance was found in 34 from 54 subjects, 28 of them has AN and 6has no AN. Obese children with AN had higher HOMA-IR than children without AN. Presence of AN was associated with IR (P<O.OOl, r=0.57).Conclusions There is a weak correlation between AN and IR in obese children. It is important to identify obese children with IR for early intervention and prevention of type 2 diabetes, but AN could not be a reliable marker of IR.

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Triglyceride/glucose index is a reliable alternative marker for insulin resistance in South American overweight and obese children and adolescents

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0037 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1163-1170 ◽

Cited By ~ 4

Author(s):

João Carlos Locateli ◽

Wendell Arthur Lopes ◽

Caroline Ferraz Simões ◽

Gustavo Henrique de Oliveira ◽

Karine Oltramari ◽

...

Keyword(s):

Insulin Resistance ◽

Children And Adolescents ◽

Fasting Glucose ◽

Surrogate Marker ◽

South American ◽

Model Assessment ◽

Obese Children ◽

Cross Sectional ◽

Tyg Index ◽

Triglyceride Glucose Index

Abstract Background The aim of the present study was to investigate the correlation between the triglyceride/glucose index (TyG index) and homeostasis model assessment of insulin resistance (HOMA-IR). Additionally, we compared the ability of the TyG index and triglycerides/high-density lipoprotein cholesterol (TG/HDL-c) index and the combination of these two indices (TyG index plus TG/HDL-c) to predict insulin resistance (IR) in South American overweight and obese children and adolescents. Methods A cross-sectional study was carried out in 345 overweight adolescents aged 10–18 years, from both the sexes. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL])/2, while the TG/HDL-c index was calculated by the division of TG (mg/dL) by HDL-c (mg/dL). HOMA-IR was calculated with the formula: fasting insulin (FI) (U/mL) × fasting glucose (mmol/L)/22.5. The cut-off point used to determine the presence of IR was HOMA-IR ≥ 3.16. Results The TyG index showed a positive correlation with HOMA-IR. The area under the receiver operating characteristic (ROC) curve of the TyG index was 0.74, indicating good sensitivity (75.7%) and specificity (67.4%). Furthermore, the TyG index cut-off point of >4.44 was established for IR prediction in this population. Conclusions The TyG index is a simple and cost-effective surrogate marker of IR in South American overweight children and adolescents. Moreover, due to its good accessibility, it can be used in large epidemiological studies.

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Therapeutic Effect of Metformin and Vitamin E Versus Prescriptive Diet in Obese Adolescents with Fatty Liver

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000086 ◽

2011 ◽

Vol 81 (6) ◽

pp. 398-406 ◽

Cited By ~ 17

Author(s):

Akcam ◽

Boyaci ◽

Pirgon ◽

Kaya ◽

Uysal ◽

...

Keyword(s):

Insulin Resistance ◽

Vitamin E ◽

Fatty Liver ◽

Liver Steatosis ◽

Tnf Alpha ◽

Dietary Advice ◽

Model Assessment ◽

Fasting Insulin ◽

Alcoholic Fatty Liver ◽

Obese Adolescents

Objective: The aim of the study was to determine whether metformin or vitamin E treatment for six months is effective in reducing body weight, blood pressure, and also ameliorating insulin resistance, adiponectin, and tumor necrosis factor (TNF)-alpha in obese adolescents with non-alcoholic fatty liver disease (NAFLD). Methods: Sixty-seven obese adolescents with liver steatosis (age range, 9 - 17 years) were included in the study. The metformin group received an 850-mg dose of metformin daily and the vitamin E group received 400 U vitamin E /daily, in capsule form for 6 months, plus an individually tailored diet, exercise, and behavioral therapy. Results: After 6 months later, there was a significant decline in body mass index, and fasting insulin and homeostatic model assessment (HOMA) values in all three groups. Moreover, in comparingson of changes in HOMA among the groups, the metformin- treated group showed significantly improved metabolic control and insulin sensitivity (HOMA) at the end of the study. There were no significant differences for changes of adiponectin, TNF-alpha, in all three groups after 6 months study. Conclusion: These data suggest that metformin treatment is more effective than dietary advice and vitamin E treatment in reducing insulin resistance, and also in ameliorating metabolic parameters such as fasting insulin and lipid levels, in obese adolescents having NAFLD.

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Circulating fatty acid profiles are associated with protein energy wasting in maintenance hemodialysis patients: a cross-sectional study

Scientific Reports ◽

10.1038/s41598-020-80812-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ban-Hock Khor ◽

◽

Sharmela Sahathevan ◽

Ayesha Sualeheen ◽

Mohammad Syafiq Md Ali ◽

...

Keyword(s):

Insulin Resistance ◽

Fatty Acids ◽

Fatty Acid ◽

Nutritional Status ◽

Serum Albumin ◽

Saturated Fatty Acids ◽

Maintenance Hemodialysis ◽

Model Assessment ◽

Cross Sectional ◽

Markers Of Inflammation

AbstractThe metabolic impact of circulating fatty acids (FAs) in patients requiring hemodialysis (HD) is unknown. We investigated the associations between plasma triglyceride (TG) FAs and markers of inflammation, insulin resistance, nutritional status and body composition. Plasma TG-FAs were measured using gas chromatography in 341 patients on HD (age = 55.2 ± 14.0 years and 54.3% males). Cross-sectional associations of TG-FAs with 13 markers were examined using multivariate linear regression adjusted for potential confounders. Higher levels of TG saturated fatty acids were associated with greater body mass index (BMI, r = 0.230), waist circumference (r = 0.203), triceps skinfold (r = 0.197), fat tissue index (r = 0.150), serum insulin (r = 0.280), and homeostatic model assessment of insulin resistance (r = 0.276), but lower malnutrition inflammation score (MIS, r = − 0.160). Greater TG monounsaturated fatty acid levels were associated with lower lean tissue index (r = − 0.197) and serum albumin (r = − 0.188), but higher MIS (r = 0.176). Higher levels of TG n-3 polyunsaturated fatty acids (PUFAs) were associated with lower MIS (r = − 0.168) and interleukin-6 concentrations (r = − 0.115). Higher levels of TG n-6 PUFAs were associated with lower BMI (r = − 0.149) but greater serum albumin (r = 0.112). In conclusion, TG monounsaturated fatty acids were associated with poor nutritional status, while TG n-3 PUFAs were associated with good nutritional status. On the other hand, TG saturated fatty acids and TG n-6 PUFAs had both favorable and unfavorable associations with nutritional parameters.

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Higher Sodium Intake Assessed by 24 Hour Urinary Sodium Excretion Is Associated with Non-Alcoholic Fatty Liver Disease: The PREVEND Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm8122157 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2157 ◽

Cited By ~ 1

Author(s):

Eline H. van den Berg ◽

Eke G. Gruppen ◽

Hans Blokzijl ◽

Stephan J.L. Bakker ◽

Robin P.F. Dullaart

Keyword(s):

Insulin Resistance ◽

Liver Disease ◽

Fatty Liver ◽

Sodium Excretion ◽

Fatty Liver Disease ◽

Sodium Intake ◽

Dietary Sodium ◽

Model Assessment ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

A higher sodium intake is conceivably associated with insulin resistant conditions like obesity, but associations of non-alcoholic fatty liver disease (NAFLD) with a higher sodium intake determined by 24 hours (24 h) urine collections are still unclear. Dietary sodium intake was measured by sodium excretion in two complete consecutive 24 h urine collections in 6132 participants of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort. Fatty Liver Index (FLI) ≥60 and Hepatic Steatosis Index (HSI) >36 were used as proxies of suspected NAFLD. 1936 (31.6%) participants had an FLI ≥60, coinciding with the increased prevalence of type 2 diabetes (T2D), metabolic syndrome, hypertension and history of cardiovascular disease. Sodium intake was higher in participants with an FLI ≥60 (163.63 ± 61.81 mmol/24 h vs. 136.76 ± 50.90 mmol/24 h, p < 0.001), with increasing incidence in ascending quartile categories of sodium intake (p < 0.001). Multivariably, an FLI ≥60 was positively associated with a higher sodium intake when taking account for T2D, a positive cardiovascular history, hypertension, alcohol intake, smoking and medication use (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.44–1.64, p < 0.001). Additional adjustment for the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) diminished this association (OR 1.30, 95% CI 1.21–1.41, p < 0.001). HSI >36 showed similar results. Associations remained essentially unaltered after adjustment for body surface area or waist/hip ratio. In conclusion, suspected NAFLD is a feature of higher sodium intake. Insulin resistance-related processes may contribute to the association of NAFLD with sodium intake.

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Association of Serum Bilirubin Level with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study of 1672 Obese Children

Journal of Clinical Medicine ◽

10.3390/jcm10132812 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2812

Author(s):

Cristina Bellarosa ◽

Giorgio Bedogni ◽

Annalisa Bianco ◽

Sabrina Cicolini ◽

Diana Caroli ◽

...

Keyword(s):

Metabolic Syndrome ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Serum Bilirubin ◽

Cross Sectional Study ◽

Sectional Study ◽

Obese Children ◽

Cross Sectional ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.

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