The Journal of Pediatrics
Volume 152, Issue 5 , Pages 612-617.e1, May 2008

Insulin Resistance, Hyperinsulinemia, and Energy Intake in Overweight Children

  • Joan C. Han, MD

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Margaret S. Rutledge, BS

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Merel Kozlosky, MS, RD

      Affiliations

    • Nutrition Department, Clinical Center, National Institutes of Health, DHHS, Bethesda, MD.
    • ,
  • Christine G. Salaita, MS, RD

      Affiliations

    • Nutrition Department, Clinical Center, National Institutes of Health, DHHS, Bethesda, MD.
    • ,
  • Jennifer K. Gustafson, BS

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Margaret F. Keil, MS, CRNP

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Abby F. Fleisch, MD

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Mary D. Roberts, MD

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Cong Ning, MD, PhD

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Jack A. Yanovski, MD, PhD

      Affiliations

    • Unit on Growth and Obesity, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, Bethesda, MD
    • Corresponding Author InformationReprint requests: Jack A. Yanovski, MD, PhD, Head, Unit on Growth and Obesity, PDEGEN, NICHD, NIH, Hatfield, CRC, Room 1E-3330, 10 Center Drive, MSC-1103, Bethesda, MD 20892-1103.

Received 27 September 2007; received in revised form 5 November 2007; accepted 13 December 2007. published online 07 March 2008.

Objective

To examine the relationship between energy intake during a buffet meal and indexes of insulin dynamics in overweight children.

Study design

Ninety-five nondiabetic, overweight (body mass index ≥95th percentile) children (age 10.3 ± 1.4 years) selected lunch from a 9835-kcal buffet eaten ad libitum after an overnight fast. The associations between energy intake and measures of insulin dynamics, in the postabsorptive state and during a 2-hour hyperglycemic clamp, were determined. Covariates in the statistical model included race, sex, skeletal age, fat-free mass, fat mass, socioeconomic status, and number of foods in the buffet rated as acceptable.

Results

Energy intake was positively associated with the fasting homeostasis model assessment for insulin resistance index (β = 0.24, P = .042), fasting insulin/glucose ratio (β = 0.24, P = .044), first-phase insulin (β = 0.23, P = .032), and first-phase C-peptide (β = 0.21, P = .046); energy intake was negatively associated with clamp-derived insulin sensitivity (β = −0.29, P = .042). Each 10% decrease in clamp-derived insulin sensitivity predicted a 27-kcal greater energy intake.

Conclusions

Insulin resistance and hyperinsulinemia are associated with greater energy intake after an overnight fast in overweight children. These associations suggest mechanisms whereby insulin resistance may contribute to excessive weight gain in children.

Abbreviations: BMI, Body mass index, C/I ratio, C-peptide–to–insulin molar ratio, HOMA-IR, Homeostasis model assessment for insulin resistance index, I/G ratio, Insulin-to-glucose ratio, M, Metabolic rate, SIclamp, Hyperglycemic clamp-derived insulin sensitivity index

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 Supported by the Intramural Research Program of the NIH with the grant ZO1 HD-00641 (to JAY) from the National Institute of Child Health and Human Development and by a supplement from the National Center for Minority Health and Health Disparities (to JAY), National Institutes of Health. AFF was supported by the NIH Clinical Research Training Program, a public-private partnership funded jointly by the NIH and a grant to the Foundation for the NIH from Pfizer Pharmaceuticals Group. J.C.H., M.K., and J.A.Y. are Commissioned Officers in the United States Public Health Service, DHHS.

PII: S0022-3476(07)01170-5

doi:10.1016/j.jpeds.2007.12.036

Refers to article:

  • Which Comes First? The Obesity or the Insulin? The Behavior or the Biochemistry?

    Robert H. Lustig
    The Journal of Pediatrics May 2008 (Vol. 152, Issue 5, Pages 601-602)

The Journal of Pediatrics
Volume 152, Issue 5 , Pages 612-617.e1, May 2008

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