Characterisation of morbidity in a UK, hospital-based, obesity clinic

Matthew A Sabin ¹, Anna L Ford ¹, Jeffrey M P Holly ¹, Linda P Hunt ¹, Elizabeth C Crowne ² and Julian P H Shield ^2*

¹ University of Bristol, United Kingdom
² Bristol Royal Hospital for Children, United Kingdom

^* To whom correspondence should be addressed. E-mail: j.p.h.shield{at}bristol.ac.uk.

Accepted 11 October 2005

Abstract

Aim: To identify clinical features which predict those most at risk of co-morbidities within an obesity clinic.

Methods: Children attending an obesity clinic had fasting glucose, insulin and lipids measured prior to a standard oral glucose tolerance test (OGTT). History and examination established birth weight, family history of Type 2 diabetes/obesity, pubertal status and presence of acanthosis nigricans. Central and total fat mass was estimated by bio-impedance.

Results: 10.3% (n=13) of children evaluated (n=126) had impaired glucose tolerance (IGT): the majority (11 or 85%) of these would not have been identified on fasting glucose alone. Those with IGT were more likely to have a parental history of Type 2 diabetes (Relative Risk 3.5). IGT was not associated with acanthosis nigricans. 25% (n=19) of those evaluated (n=75) had evidence of the "metabolic syndrome" (MS). HDL cholesterol and triglyceride levels were related to insulin sensitivity (HOMA-R, p=0.002 and 0.001) and HDL cholesterol was also related to birth weight SDS (p=0.01). We observed a trend for those with MS to have a lower birth weight SDS. The severity of obesity did not influence the likelihood of IGT or MS.

Conclusions: Significant numbers of obese children have associated co-morbidities. Analysis of fasting blood glucose samples alone is not satisfactory to adequately evaluate glucose homeostasis. The overall level of obesity does not predict co-morbidities. Special attention should be given to those with parental diabetes and a history of low birth weight who are more likely to have IGT and abnormal lipid profiles respectively.

Keywords: impaired glucose tolerance, metabolic syndrome, obesity

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Arch. Dis. Child. 2006 91: 95. [Extract] [Full Text] [PDF]

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