Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes

Metabolic Syndrome and Insulin Resistance in Normal Glucose Tolerant Brazilian Adolescents With Family History of Type 2 Diabetes

  1. Regina C.Q. da Silva, MD, MSC,
  2. Walkiria L. Miranda, MSC,
  3. Antonio R. Chacra, MD, PHD and
  4. Sérgio A. Dib, MD, PHD
  1. From the Diabetes Center, São Paulo Federal University, São Paulo, SP, Brazil
  1. Address correspondence and reprint requests to Sérgio Atala Dib, MD, PhD, Escola Paulista de Medicina, Disciplina de Endocrinologia, Rua Botucatu 740 CEP:04034-970, São Paulo, SP, Brasil. E-mail: sadib{at}endocrino.epm.br
Diabetes Care 2005 Mar; 28(3): 716-718. https://doi.org/10.2337/diacare.28.3.716
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading
  • HOMA, homeostasis model assessment
  • HOMA-IR, HOMA of insulin resistance
  • SBP, systolic blood pressure

Metabolic syndrome increases risk for cardiovascular disease (1,2). The diagnosis of metabolic syndrome in patients might hold promise for enhanced prevention of cardiovascular disease. Currently, there is no consensus on the diagnosis of metabolic syndrome in children and adolescents, with variable prevalence of metabolic syndrome from 4.2 to 32% in several populations (3–5). The highest rates of metabolic syndrome were found in adolescents with Latino or African backgrounds (3,6). However, this racial/ethnic predisposition to metabolic syndrome is not well defined. The Brazilian population has a high degree of mis-cegenation that includes a mix of indigenous people, Afro- and Euro-Brazilians, and a widespread Latin ancestry. We do not know if this genetic and environmental diversity can modify the prevalence of metabolic syndrome or its relationship to obesity. In this study, we determine the prevalence of metabolic syndrome in a group of Brazilian adolescents with a family history of type 2 diabetes.

RESEARCH DESIGN AND METHODS

Inclusion criteria were age between 10 and 19 years, good health, and family history of type 2 diabetes. The São Paulo Federal University Ethics Committee reviewed and approved the study. Informed consent and assent were obtained from all participants or relatives. BMI cut points for overweight and obesity by sex and age in children were defined as 25 and 30 kg/m2, respectively, at age 18 years. These criteria were chosen because of the inclusion of Brazilian children and adolescents in the original study (7). The adolescents were stratified into three groups: G0 (normal), G1 (overweight), and G2 (obese) according to the above criteria. Blood pressure was measured on the right arm using a mercury-gravity manometer with proper cuff size. Children whose systolic blood pressure (SBP) or diastolic blood pressure exceeded the 95th percentile for age and sex (8) were considered to have hypertension (high blood pressure). After a 12-h overnight fast, baseline samples were obtained for measurements of plasma glucose, lipids (total, HDL, and LDL cholesterol and triglycerides), and serum insulin. Thereafter, an oral glucose load (1.75 g/kg body wt [up to a maximum of 75 g]) was given, and after 2 h, plasma glucose and serum insulin were measured. Glucose tolerance was classified according to American Diabetes Association criteria (9). Metabolic syndrome was devised as a child-specific definition, by the presence of at least three of the following factors: BMI 97th percentile for age/sex, high blood pressure and hypertriglyceridemia (≥130 mg/dl) (10), low HDL cholesterol (≤35 mg/dl) (10), insulin resistance (defined as homeostasis model assessment [HOMA] of insulin resistance [HOMA-IR] >2.5), impaired glucose tolerance, impaired fasting glucose, or type 2 diabetes (4). Our study was based on a child-specific definition, although we used the cutoff for obesity as the equivalent to a BMI of 30 kg/m2 at age 18 years (7). HOMA, β-cell function, and insulin sensitivity were calculated by the HOMA Model Program (University of Oxford, Oxford, U.K.). HOMA-IR was calculated as (fasting serum insulin [μU/ml]) × (fasting plasma glucose [mmol · l−1 · dl−1])/22.5 (11). Values are expressed as means ± SD, and when not normally distributed, they were ln transformed for analysis (version 1.0, SigmaStat; Systat Software). P values <0.05 were considered statistically significant.

RESULTS

Characteristics of adolescents are presented in Table 1. There was no significant difference in birth weight, age, sex, height, Tanner stage, and physical activity among the three groups. HOMA-IR, in the whole group (n = 99), was found to be correlated with BMI (r = 0.46, P < 0.001), visceral obesity (waist) (r = 0.52, P < 0.001), SBP (r = 0.29, P < 0.005), triglycerides (r = 0.35, P < 0.005), 2-h plasma glucose (r = 0.28, P < 0.05), and 2-h serum insulin (r = 0.47, P < 0.001) on an oral glucose tolerance test. The 2-h plasma glucose, also in the whole group, was correlated with total cholesterol (r = 0.25, P < 0.05), LDL cholesterol (r = 0.25, P < 0.05), and 2-h serum insulin (r = 0.41, P < 0.005). Forward stepwise regression analysis was conducted to examine the effect of the following variables on HOMA-IR in the whole group: BMI, waist, triglycerides, SBP, 2-h plasma glucose, and 2-h serum insulin. The variables that remained significant were waist (R2 = 0.275, P < 0.005) and 2-h serum insulin (R2 = 0.365, P < 0.005). The same was conducted to 2-h plasma glucose (variables: total cholesterol, LDL cholesterol, and 2-h serum insulin). Variables selected in the mode were LDL cholesterol (R2 = 0.172, P < 0.05) and 2-h serum insulin (R2 = 0.212, P < 0.005).

The overall prevalence of metabolic syndrome was 6% (95% CI 5.9–6.1). In G0 and G1, none of the subjects had metabolic syndrome, while in G2 the prevalence was 26.1% (8.2–45.6). In the whole group, the characteristics of metabolic syndrome included obesity (23.4%), HOMA-IR ≥2.5 (22.2%), high blood pressure (18.2%), hypertriglyceridemia (8.1%), and low HDL cholesterol (8.1%). In G0, the highest prevalence was high blood pressure (13%), followed by insulin resistance (10.9%), high triglycerides (6.5%), and low HDL cholesterol (4.3%). In G1, the more prevalent characteristic was insulin resistance (23%), followed by high blood pressure (10%), high triglycerides (6.7%) and low HDL cholesterol (6.7%). In G2, where all of the individuals were obese, the prevalence was insulin resistance (43.5%), high blood pressure (39.1%), low HDL cholesterol (17.4%), and high triglycerides (13%).

CONCLUSIONS

We present data on metabolic syndrome in the adolescent population not well described previously, with most of the present literature focusing on the U.S. or Europe. The prevalence of metabolic syndrome was 6% in the whole group, and 24.2% of these adolescents had at least one feature of metabolic syndrome. In the obese adolescents (G2), the prevalence of metabolic syndrome was 26.1%. Similar metabolic syndrome prevalence has been shown in diverse populations (3–5,12), despite limitations of comparison. Insulin resistance and obesity have been identified as main features of metabolic syndrome in our normal glucose tolerant adolescents. The regression analysis has shown that visceral obesity (waist) and 2-h serum insulin were the main factors for HOMA-IR and LDL cholesterol and 2-h serum insulin for 2-h plasma glucose. HOMA-IR was also correlated with triglycerides, similar to what was found in the Bogalusa Heart Study from a biracial community (13). This last study showed that blood pressure has a positive correlation with fasting insulin (even after adjustment for BMI) at as early as 5 years of age (14). The prevalence of high blood pressure in our adolescents was higher compared with other studies (15).

In summary, we show that the prevalence of metabolic syndrome in a group of normal glucose tolerant Brazilian adolescents with family history of type 2 diabetes is similar to several studies conducted in the U.S. and Europe, although there are differences in the metabolic syndrome characteristics among all groups.

View this table:
  • View inline
  • View popup
Table 1—

Characteristics of normal BMI (G0), overweight (G1), and obese (G2) groups

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted December 6, 2004.
    • Received December 3, 2004.
  • DIABETES CARE

References

  1. ↵
    Isomaa B, Almgren P, Tuomi T, Forsen B, Lahiti K, Nissén M, Taskinen M-R, Groop L: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24:683–689, 2001
    OpenUrlAbstract/FREE Full Text
  2. ↵
    Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 287:356–359, 2002
    OpenUrlCrossRefPubMedWeb of Science
  3. ↵
    Cruz ML, Weigensberg MJ, Huang TT-K, Ball G, Shaibi GQ, Goran MI: The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab 89:108–113, 2004
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    Invitti C, Maffeis C, Gilardini L, Pontiggia B, Mazzilli G, Morabito F, Viberti G: Prevalence of metabolic syndrome in obese children: an analysis using children-specific criteria (Abstract). Diabetes 52 (Suppl. 1):A70, 2003
    OpenUrl
  5. ↵
    Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH: Prevalence of a metabolic syndrome phenotype in adolescents: findings from the Third National Health and Nutrition Examination survey, 1988–1994. Arch Pediatr Adolesc Med 157:821–827, 2003
    OpenUrlCrossRefPubMedWeb of Science
  6. ↵
    Klein DJ, Friedman LA, Harlan WR, Barton BA, Schreiber GB, Cohen RM, Harlan LC, Morrison JA: Obesity and the development of insulin resistance and impaired fasting glucose in black and white adolescent girls: a longitudinal study. Diabetes Care 27:378–383, 2004
    OpenUrlAbstract/FREE Full Text
  7. ↵
    Cole TJ, Bellizi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1–6, 2000
    OpenUrlAbstract/FREE Full Text
  8. ↵
    Hypertension Brazilian Society, Brazilian Society of Cardiology, Brazilian Society of Nephrology: IV. Brazilian Guidelines to Arterial Hypertension. São Paulo, SP, Brazil, 2002
  9. ↵
    Summary of revisions for the 2004 Clinical Practice Recommendations. Diabetes Care 27(Suppl. 1):S3, 2004
    OpenUrl
  10. ↵
    Brazilian Society of Cardiology: III. Brazilian Guidelines to Dyslipidemia. São Paulo, SP, Brazil, 2001
  11. ↵
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419, 1985
    OpenUrlCrossRefPubMedWeb of Science
  12. ↵
    Csábi G, Török K, Jeges S, Molnar D: Presence of metabolic cardiovascular syndrome in obese children. Eur J Pediatr 159:91–94, 2000
    OpenUrlCrossRefPubMedWeb of Science
  13. ↵
    Jiang X, Srinivasan 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 155:190–196, 1995
    OpenUrlCrossRefPubMedWeb of Science
  14. ↵
    Jiang X, Srinivasan SR, Bao W: Association of fasting insulin with blood pressure in young individuals: the Bogalusa Heart Study. Arch Intern Med 153:323–328, 1993
    OpenUrlCrossRefPubMedWeb of Science
  15. ↵
    Oliveira RG, Lamounier JA, Oliveira ADB, Castro MDR, Oliveira JS: Arterial hypertension in children and adolescents: the Belo Horizonte City Study. J Pediatr (Rio J) 75:256–266, 1999
PreviousNext
Back to top
Diabetes Care: 28 (3)

In this Issue

March 2005, 28(3)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Metabolic Syndrome and Insulin Resistance in Normal Glucose Tolerant Brazilian Adolescents With Family History of Type 2 Diabetes
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Metabolic Syndrome and Insulin Resistance in Normal Glucose Tolerant Brazilian Adolescents With Family History of Type 2 Diabetes
Regina C.Q. da Silva, Walkiria L. Miranda, Antonio R. Chacra, Sérgio A. Dib
Diabetes Care Mar 2005, 28 (3) 716-718; DOI: 10.2337/diacare.28.3.716

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Metabolic Syndrome and Insulin Resistance in Normal Glucose Tolerant Brazilian Adolescents With Family History of Type 2 Diabetes
Regina C.Q. da Silva, Walkiria L. Miranda, Antonio R. Chacra, Sérgio A. Dib
Diabetes Care Mar 2005, 28 (3) 716-718; DOI: 10.2337/diacare.28.3.716
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • RESEARCH DESIGN AND METHODS
    • RESULTS
    • CONCLUSIONS
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Hepatic Enzymes, the Metabolic Syndrome, and the Risk of Type 2 Diabetes in Older Men
  • Anthropometry, Glucose Tolerance, and Insulin Concentrations in Indian Children
  • Dietary Calcium, Vitamin D, and the Prevalence of Metabolic Syndrome in Middle-Aged and Older U.S. Women
Show more Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.