Abstract
Summary: In order to determine the relations between insulin and weight changes after diet, oral glucose tolerance tests (OGTT) were carried out before and after diet hi 37 obese children aged from 6–16 years, whose weights corrected for height exceeded by at least 2 SD the weights of normal children of the same age and sex.
Five children had not followed the diet and increased during the period of observation both their initial weight excess (from +4.8 to +5.5 SD) and their hyperinsulinemia (total insulin of the OGTT: 359 μU/ml before, 443 μU/ml after).
In 32 children, diet resulted in significant weight loss (from +3.3 to +1.0 SD). Among these, two types of response to diet could be distinguished. 1) In 25 children, the initially elevated insulin responses returned to normal or near normal values (mean sum of all five insulin values 282 μU/ml before, 144 μU/ml after diet), insulin and weight changes being positively correlated. The younger children had better results than the older ones. 2) Seven children, although also having lost weight, showed an increase of insulin responses from initially normal to secondarily elevated values (mean total insulin 133 μU/ml before, 260 μU/ml after diet).
Age of onset, duration of obesity, and duration of diet were not related to either weight or insulin changes. The results indicate that in the majority of cases hyperinsulinism observed in childhood obesity is reversible by diet in correlation with weight loss.
Speculation: Dietetic factors seem to play an important role in inducing reduction of hyperinsulinism and weight loss in obese children, vet they are not the only ones. Several not only physiologic but also psychologic and environmental factors are involved hi the treatment of obesity and might be responsible for the paradoxical evolution of some subjects whose insulin responses were not decreased but increased during diet. Further follow-up and new investigation of these patients will be necessary to reveal whether they constitute a group of different etiology and prognosis in terms of obesity.
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Deschamps, I., Desjeux, J., Machinot, S. et al. Effects of Diet and Weight Loss on Plasma Glucose, Insulin, and Free Fatty Acids in Obese Children. Pediatr Res 12, 757–760 (1978). https://doi.org/10.1203/00006450-197807000-00003
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DOI: https://doi.org/10.1203/00006450-197807000-00003