Advertisement

A new formula to improve the screening of impaired glucose tolerance in youths with overweight or obesity

Published:October 06, 2022DOI:https://doi.org/10.1016/j.numecd.2022.09.015

      Abstract

      Aim

      To assess a new formula to improve the screening of isolated impaired glucose tolerance (IGT) in youth with overweight/obesity (OW/OB).

      Methods and results

      A cross-sectional study was performed in 1189 Caucasian youths with OW/OB aged 5–17 years, in whom impaired fasting glucose and high glycosylated hemoglobin were excluded. The sample was divided into training set (TS) (n = 883) and validation set (VS) (n = 306). Fasting (FG) and post-load plasma glucose, alanine aminotransferase (ALT), lipids and familial history for type 2 diabetes (FD) were available in all individuals. In the TS youths with IGT (n = 58, 7.0%) showed higher prevalence of female sex (FS), FD, and higher levels of FG, post-load glucose, ALT and lower levels of HDL-cholesterol vs individuals without IGT. The linear formula was obtained by logistic regression analysis in the TS: 0.05∗ALT + 0.07∗FG + 0.87∗FD + (0.06∗HDL∗ − 1) + 1∗FS. The best cut-off was 5.84. The performance of the formula vs IGT was: sensitivity: 0.74 and specificity: 0.71. Similar results were obtained in the VS.

      Conclusions

      Using metabolic and anamnestic data we obtained a simple formula with a good performance for screening isolated IGT. This formula may support pediatricians to identify youths with OW/OB in whom the OGTT may be useful for detecting IGT.

      Keywords

      Abbreviations:

      ADA (American Diabetes Association), ALT (Alanine-aminotransferase), AUC (area under curve), BMI (Body mass index), FD (Familial diabetes), FS (female sex), IFG (impaired fasting glucose), IGT (impaired glucose tolerance), HbA1c (glycosilated hemoglobin 1 c), HDL-c (High density lipoprotein-cholesterol), OB (obesity), OGTT (oral glucose tolerance test), OW (overweight), SDS (standard deviation score), TG (triglycerides), TS (training set), VS (validation set)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Diabetes Association
        13. Children and adolescents: standards of medical care in diabetes-2021.
        Diabetes Care. 2021; 44: S180-S199https://doi.org/10.2337/dc21-S013
        • Di Bonito P.
        • Pacifico L.
        • Chiesa C.
        • Valerio G.
        • Miraglia Del Giudice E.
        • Maffeis C.
        • et al.
        Impaired fasting glucose and impaired glucose tolerance in children and adolescents with overweight/obesity.
        J Endocrinol Invest. 2017 Apr; 40: 409-416https://doi.org/10.1007/s40618-016-0576-8
        • Di Bonito P.
        • Licenziati M.R.
        • Corica D.
        • Wasniewska M.G.
        • Di Sessa A.
        • Del Giudice E.M.
        • et al.
        Phenotypes of prediabetes and metabolic risk in Caucasian youths with overweight or obesity.
        J Endocrinol Invest. 2022 May 17; https://doi.org/10.1007/s40618-022-01809-3
        • Weiss R.
        • Taksali S.E.
        • Tamborlane W.V.
        • Burgert T.S.
        • Savoye M.
        • Caprio S.
        Predictors of changes in glucose tolerance status in obese youth.
        Diabetes Care. 2005; 28: 902-909https://doi.org/10.2337/diacare.28.4.902
        • de Groot C.J.
        • Grond J.V.
        • Delgado Y.
        • Rings E.H.
        • Hannema S.E.
        • van den Akker E.L.
        High predictability of impaired glucose tolerance by combining cardiometabolic screening parameters in obese children.
        J Pediatr Endocrinol Metab. 2017; 30: 189-196https://doi.org/10.1515/jpem-2016-0289
        • Love-Osborne K.
        • Butler N.
        • Gao D.
        • Zeitler P.
        Elevated fasting triglycerides predict impaired glucose tolerance in adolescents at risk for type 2 diabetes.
        Pediatr Diabetes. 2006; 7: 205-210https://doi.org/10.1111/j.1399-5448.2006.00179.x
        • Morandi A.
        • Maschio M.
        • Marigliano M.
        • Miraglia Del Giudice E.
        • Moro B.
        • Peverelli P.
        • et al.
        Screening for impaired glucose tolerance in obese children and adolescents: a validation and implementation study.
        Pediatr Obes. 2014; 9: 17-25https://doi.org/10.1111/j.2047-6310.2012.00136.x
        • Cacciari E.
        • Milani S.
        • Balsamo A.
        • Spada E.
        • Bona G.
        • Cavallo L.
        • et al.
        Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr).
        J Endocrinol Invest. 2006; 29: 581-593https://doi.org/10.1007/BF03344156
        • Saleh M.
        • Kim J.Y.
        • March C.
        • Gebara N.
        • Arslanian S.
        Youth prediabetes and type 2 diabetes: risk factors and prevalence of dysglycaemia.
        Pediatr Obes. 2022; 17e12841https://doi.org/10.1111/ijpo.12841
        • Wu E.L.
        • Kazzi N.G.
        • Lee J.M.
        Cost-effectiveness of screening strategies for identifying pediatric diabetes mellitus and dysglycemia.
        JAMA Pediatr. 2013; 167: 32-39https://doi.org/10.1001/jamapediatrics.2013.419
        • Haemer M.A.
        • Grow H.M.
        • Fernandez C.
        • Lukasiewicz G.J.
        • Rhodes E.T.
        • Shaffer L.A.
        • et al.
        Addressing prediabetes in childhood obesity treatment programs: support from research and current practice.
        Child Obes. 2014; 10: 292-303https://doi.org/10.1089/chi.2013.0158
        • Nobili V.
        • Mantovani A.
        • Cianfarani S.
        • Alisi A.
        • Mosca A.
        • Sartorelli M.R.
        • et al.
        Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease.
        J Hepatol. 2019; 71: 802-810https://doi.org/10.1016/j.jhep.2019.06.023
        • Mauvais-Jarvis F.
        Gender differences in glucose homeostasis and diabetes.
        Physiol Behav. 2018; 187: 20-23https://doi.org/10.1016/j.physbeh.2017.08.016