Onset of puberty and cardiovascular risk factors in untreated obese children and adolescents: a 1-year follow-up study.

摘要

OBJECTIVE: To determine the course of obesity-associated nonalcoholic fatty liver disease (NAFLD) and the cardiovascular risk factors of hypertension, dyslipidemia, and disturbed glucose metabolism in untreated obese children. DESIGN: Obese children were examined prospectively at baseline and 1 year later. SETTING: Obesity clinic. PARTICIPANTS: A total of 287 untreated obese children; 53.3% were girls, the mean age was 11.4 years, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 28.2. MAIN OUTCOME MEASURES: Homeostasis model assessment of insulin resistance (HOMA-IR) values and prevalence of hypertension, dyslipidemia, impaired fasting glucose level, and NAFLD. RESULTS: At baseline, 20.6% of obese children had hypertension, 22.3% had dyslipidemia, 4.9% had impaired fasting glucose levels, and 29.3% had NAFLD. These prevalences, as well as weight status, remained stable at the 1-year follow-up visit. Increases (SDs) in prevalence of hypertension (16.1% [51.8%]), hypertriglyceridemia (9.7% [59.3%]), and impaired fasting glucose level (8.1% [32.9%]), as well as mean HOMA-IR value (0.42 [1.22]), were observed in 62 children entering puberty. In contrast, mean decreases (SDs) in hypertension (-18.8% [53.2%]), hypertriglyceridemia (-12.5% [53.1%]), impaired fasting glucose level (-6.3% [38.1%]), and NAFLD prevalence (-18.8% [44.5%]), as well as mean HOMA-IR value (-0.83 [2.56]), were observed in 50 children entering late puberty (P < .01 for change of pubertal status in the multivariate model). Changes in HOMA-IR values were only weakly related to changes in prevalence of cardiovascular risk factors or transaminase levels (r < 0.2). CONCLUSIONS: Cardiovascular risk factors worsened at onset of puberty and improved in late puberty in obese children whose weight status did not change. The weak correlation between HOMA-IR value and cardiovascular risk factors suggests that other characteristics may affect these disorders.