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Pediatric Drugs
Erschienen in: Pediatric Drugs 5/2003

01.05.2003 | Leading Article

Insulin Resistance Syndrome in Children

Pathophysiology and Potential Management Strategies

verfasst von: Dr Tamás Decsi, Dénes Molnár

Erschienen in: Pediatric Drugs | Ausgabe 5/2003

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Abstract

The simultaneous presence of various cardiovascular risk factors in the same individual is not rare, even in the pediatric age group. The clustering of risk factors can be termed insulin resistance syndrome (IRS) because of the putative central role of tissue insulin insensitivity in the background of the inter-related metabolic disturbances. Fasting hyperinsulinemia, impaired glucose tolerance, dyslipidemia, and hypertension are considered to represent the basic abnormalities of IRS. The most prevalent related disturbances are increased plasma levels of plasminogen activator inhibitor-1, fibrinogen, uric acid, homocysteine, and C-reactive protein, as well as visceral adiposity, microalbuminuria, disturbed essential fatty acid metabolism, low availability of lipid-soluble antioxidant vitamins, and enhanced expression of tumor necrosis factor-α in adipose tissues. Certain genetic abnormalities have been associated with IRS, but explain only a small part of the variability in insulin resistance.
The exact prevalence of IRS in children remains to be defined; it was found to be 9% in one survey among children with obesity seeking medical attention. Modification of lifestyle, i.e. reduction of energy intake and enhancement of physical activity, are unquestionable prerequisites for long-term success in the management of IRS. In at least two randomized controlled studies, metformin proved to be clinically effective in increasing insulin sensitivity in hyperinsulinemic, nondiabetic adolescents. Thiazolidinediones have been successfully tested for the treatment of insulin resistance in adults, but not in children as yet.
Prevention of the development of IRS in children is obviously of great significance for the health status of the community. However, the efficacy of various preventive approaches should be investigated further in carefully designed controlled trials.
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Metadaten
Titel
Insulin Resistance Syndrome in Children
Pathophysiology and Potential Management Strategies
verfasst von
Dr Tamás Decsi
Dénes Molnár
Publikationsdatum
01.05.2003
Verlag
Springer International Publishing
Erschienen in
Pediatric Drugs / Ausgabe 5/2003
Print ISSN: 1174-5878
Elektronische ISSN: 1179-2019
DOI
https://doi.org/10.2165/00128072-200305050-00002

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