Abdominal adiposity and cardiovascular risk factors in adolescents with type 1 diabetes
Introduction
Concomitant with the epidemic of overweight in the general population, a raised weight gain has been also described in type 1 diabetes mellitus (T1DM) children and adolescents [1]. Obesity, and in particular abdominal obesity, can be associated with insulin resistance and clustering of cardiovascular risk factors, known as the metabolic syndrome (MetSy) [2]. Accordingly, a recent definition of MetSy provided in the consensus statement issued by the International Diabetes Federation (IDF) [3], makes central obesity essential for the diagnosis, and proposes a more stringent threshold to define high waist circumference with respect to other definitions [4]. Intensive insulin treatment (IIT), directed to achieve blood glucose levels as close to normal as possible through frequent self-monitoring of blood glucose and continuous subcutaneous insulin infusion (CSII) or multiple insulin injections, is strongly recommended to prevent microvascular and macrovascular diabetic complications, but has been also associated with increased weight gain and excess of visceral adiposity [5], [6].
The present study was aimed at analyzing the prevalence of abdominal adiposity and individual risk factors for cardiovascular disease (CVD) in a large sample of Italian adolescents with T1DM. The prevalence of MetSy and its association with diabetes related variables were also analyzed.
Section snippets
Subjects
Four hundred and seventy seven adolescents (253 males) with T1DM were recruited from 18 care referral centres for diabetes in childhood affiliated to the Study Group on Diabetes of the Italian Society of Pediatric Endocrinology and Diabetology.
Inclusion criteria were: Caucasians of Italian origin, age between 16 and 19 years, type 1 diabetes, and duration of diabetes >12 months. Exclusion criteria were: other types of diabetes, or specific treatments for dyslipidemia or hypertension.
The following
Results
All patients were receiving IIT: 75% multiple insulin injection therapy and 25% continuous subcutaneous insulin infusion. BMI, W/Hr, ID per body weight or per body surface area, and HbA1c did not differ between these groups (data not shown), therefore the sample was considered as a whole.
Clinical features of the patients are shown in Table 1. Females had higher W/Hr and HDL-cholesterol and lower SBP than males.
Prevalence of individual cardiovascular risk factors is summarized in Table 2.
Discussion
The main results of this study in T1DM adolescents are that: (1) abdominal obesity in females and hypertension in males were the most frequent CVD risk factors; (2) prevalence of MetSy was 9.5%, it was more common in females and in overweight/obese patients; (3) W/Hr and high ID per body surface area are independent risk factors for MetSy.
Adolescence is a critical period in determining risk of future vascular complications in T1DM, due to poor adherence to treatment, deteriorating glycemic
Conflict of interest
The authors declare that they have no conflict of interest.
References (27)
- et al.
Geometric method for measuring body surface area. A height-weight formula validated in infants, children, and adults
J Pediatr
(1978) - et al.
Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk
J Pediatr
(2010) - et al.
Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study
Pediatr Diabetes
(2010) - et al.
Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition
Arterioscler Thromb Vasc Biol
(2004) - et al.
Metabolic syndrome-a new world-wide definition. A Consensus Statement from the International Diabetes Federation
Diabet Med
(2006) - et al.
Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach
Arch Dis Child
(2007) - et al.
Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial
JAMA
(1998) - et al.
Visceral obesity, hepatic lipase activity, and dyslipidemia in type 1 diabetes
J Clin Endocrinol Metab
(2003) The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents
Pediatrics
(2004)- et al.
Clinical longitudinal standards from birth to maturity for height, weight, velocity and stages of puberty
Arch Dis Child
(1976)
Establishing a standard definition for child overweight and obesity worldwide: international survey
BMJ
Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children
J Pediatr
Adolescent adherence in type 1 diabetes
Compr Ther
Cited by (50)
Predictive factors of non-HDL cholesterol in children and adolescents with type 1 diabetes mellitius: A cross-sectional study
2019, Diabetes Research and Clinical PracticeCitation Excerpt :However, non-HDL cholesterol is starting to be considered as just as good a predictor of future cardiovascular events as LDL-c, total cholesterol, or HDL-c alone, in both children and adults with DM. It has therefore become a good variable for identifying, even in childhood, which individuals are at greater or lesser risk of cardiovascular complications in young adult life [3]. Alterations in the lipid profile of children and adolescents with DM1 may be influenced by sociodemographic, clinical, anthropometric and dietary factors.
Macrovascular disease and risk factors in youth with type 1 diabetes: time to be more attentive to treatment?
2018, The Lancet Diabetes and EndocrinologyCitation Excerpt :The prevalence of hypertension in youth with type 1 diabetes is 4–7%, which is higher than the 1–5% reported in youth without type 1 diabetes.35 Risk factors for abnormal blood pressure patterns and hypertension in youth with type 1 diabetes include obesity, autonomic dysfunction, and hyperglycaemia.36,37 In adults with type 1 diabetes, target blood pressures are defined as less than or equal to 130/80 mm Hg based on hard cardiovascular events in longitudinal studies.38–40
The prevalence and the clinical profile of metabolic syndrome in children and adolescents with Type 1 diabetes
2019, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :Table 3 showed significant negative correlations between eGDR and age, diabetes duration, weight, BMI, systolic and diastolic BP, HbA1c, A/C ratio and fasting lipid profile (TC, TG, LDL) with no significant correlation with the required insulin dose. Using IDF based criteria, 13.12% of children and adolescents with T1DM in this sample were estimated to have MS. This is different from an Iranian study that showed a prevalence of 23.9% [3] and another one which found MS in 9.5% patients [17]. The different prevalence in MS in different studies may be due to ethnic and racial differences in addition to variations in the MS definition throughout different studies.
Dual-basal-insulin regimen for the management of dawn phenomenon in children with type 1 diabetes: a retrospective cohort study
2023, Therapeutic Advances in Endocrinology and MetabolismThe Burden of Obesity in Type 1 Diabetic Subjects: A Sex-specific Analysis From the AMD Annals Initiative
2023, Journal of Clinical Endocrinology and Metabolism
- 1
The members of the Study-Group on Diabetes of Italian Society of Pediatric Endocrinology and Diabetology are considered co-authors and are listed in Appendix A.