Highlights From The First World Congress on the Insulin Resistance Syndrome

Zachary T. Bloomgarden, MD

January 29, 2004

The IRS in Childhood

Alan R. Sinaiko, MD, University of Minneapolis Medical School, Minnesota, discussed the IRS in childhood,^[62] pointing out that childhood obesity has increased progressively over the past decade, with evidence of atherosclerosis and glycemic abnormality. There is strong correlation between BMI at ages 8, 13, and 25, so it is incorrect to advise parents not to be concerned when their children are overweight. Boys show a particular decrease in insulin sensitivity during adolescence. At particular risk are overweight insulin-resistant children, who have higher systolic blood pressure, triglyceride, and fasting insulin, and lower HDL, "so there is something about being both insulin resistant and overweight."

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References

Table. Definitions of the IRS
ATP III: Metabolic Syndrome ≥ 3 of the following criteria:
Waist circumference > 102 cm in men and > 88 cm in women Serum triglyceride ≥ 150 mg/dL HDL-C < 40 mg/dL in men, < 50 mg/dL in women BP ≥ 130/85 mm Hg Serum glucose ≥ 110 mg/dL
WHO: Metabolic Syndrome
Diabetes, IFG, IGT, or HOMA insulin resistant and ≥ 2 of the following criteria: Waist-hip ratio > 0.90 in men or > 0.85 cm in women Serum triglyceride ≥ 150 mg/dL or HDL-C < 35 mg/dL in men, < 39 mg/dL in women Urinary AER > 20 mcg/min Blood pressure ≥ 140/90 mm Hg
ACE: Insulin Resistance Syndrome Presence of ≥ 1 of the following factors:
Diagnosis of CVD, hypertension, PCOS, NAFLD, or acanthosis nigricans Family history of type 2 diabetes, hypertension, or CVD History of gestational diabetes or glucose intolerance Non-Caucasian ethnicity Sedentary lifestyle BMI > 25 kg/m² and/or waist circumference > 40 inches in men, > 35 inches in women Age > 40 years
and ≥ 2 of the following criteria:
Triglycerides > 150 mg/dL HDL-C: Men < 40 mg/dL, women < 50 mg/dL BP > 130/85 mm Hg Fasting glucose 110-125 mg/dL or 120 min post-glucose challenge 140-200 mg/dL (diabetes is excluded from the ACE IRS)
EGIR: Insulin Resistance Syndrome Fasting hyperinsulinemia (highest 25%) and≥ 2 of the following criteria:
Fasting plasma glucose ≥ 6.1 millimoles/liter (mM)/L, but nondiabetic BP ≥ 140/90 mm Hg or treated for hypertension Triglycerides > 2 mM/L or HDL-cholesterol < 1 mM/L or treated for dyslipidemia Waist circumference ≥ 94 cm in men and ≥ 80 cm in women

ACE = American College of Endocrinology; ATP = Adult Treatment Panel; BMI = body mass index; BP = blood pressure; CVD = cardiovascular disease; EGIR = European Group for the Study of Insulin Resistance; HDL-C = high-density lipoprotein cholesterol; HOMA = homeostasis model assessment; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; IRS = insulin resistance syndrome; NAFLD = nonalcoholic fatty liver disease; PCOS = polycystic ovary syndrome

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Highlights From The First World Congress on the Insulin Resistance Syndrome

The IRS in Childhood

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