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Characterisation of morbidity in a UK, hospital based, obesity clinic
  1. M A Sabin1,
  2. A L Ford1,
  3. J M P Holly1,
  4. L P Hunt1,
  5. E C Crowne2,
  6. J P H Shield2
  1. 1University of Bristol, UK
  2. 2Bristol Royal Hospital for Children, UK
  1. Correspondence to:
    Dr J Shield
    Consultant Senior Lecturer, Bristol Royal Hospital for Children, St Michael’s Hill, Bristol BS2 8BJ, UK; j.p.h.shield{at}bristol.ac.uk

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: Of the 126 children evaluated, 10.3% (n = 13) had impaired glucose tolerance (IGT); the majority (n = 11) 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. Twenty five per cent (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); HDL cholesterol was also related to birth weight SDS. 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 homoeostasis. 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.

  • IGT, impaired glucose tolerance
  • OGTT, oral glucose tolerance test
  • MS, metabolic syndrome
  • obesity
  • impaired glucose tolerance
  • metabolic syndrome

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Footnotes

  • Published Online First 24 October 2005

  • Competing interests: Dr Shield has provided paid consultancy to Roche, Abbott, and NovoNordisk Pharmaceuticals

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