Öz
Amaç: Çalışmanın
amacı prediyabetik obez çocuk ve ergenlerde kemik mineral dansitometresinin
(KMD) metabolik faktörlerle ilişkisini araştırmaktır.
Gereç ve Yöntem: Çalışmaya 6-18 yaş arasında 131 adet çocuk ve ergen dahil edildi.
Prediyabet kriteri açlık kan glikozunun ≥100-125 mg/dL aralığında olması yada
glikoz yükleme testi 2. saat glikoz değerinin ≥140-199 mg/dL arasında olması
olarak belirlendi. Bu ölçütlere göre tip 2 diyabet tanısı alan 5 hasta çalışma
dışı tutulurken geri kalanlar prediyabet ve normal glikoz toleranslı (NGT)
hastalar olmak üzere iki guruba ayrıldılar. KMD kalkaneustan kantitatif
ultrason ölçüm cihazı ile yapıldı. Her iki grupta KMD ve metabolik parametreler
karşılaştırıldı.
Bulgular: Gruplar arasında KMD açısından anlamlı bir fark yoktu. Prediyabet
ölçütleri KMD‘yi etkilemiyor üstelik ağırlık, boy, yaş, cinsiyet ve ergenlik
gibi KMD üzerine olası etkileri olabilecek parametrelere göre düzenleme
sonrasında bu durum değişmiyordu. Lineer regresyon analizinde beden kitle
indeksi (BKİ) ile KMD arasında pozitif ilişki bulundu. Bel çevresi ve diğer
metabolik faktörler ile KMD arasında ise bir ilişki bulunamadı.
Sonuç: Prediyabetik aralıktaki glikoz
değeri ile KMD arasında herhangi bir ilişki yoktur. Obez çocuklarda fazla BKİ
ile KMD arasındaki pozitif korelasyonu açıklayacak bilinen metabolik
parametreler dışında alternatif etkenler olabilir.
Anahtar Kelimeler
Kaynakça
- Boot AM, de Ridder MA, van der Sluis IM, van Slobbe I, Krenning EP,Keizer-Schrama SM. Peak bone mineral density, lean body mass and fractures. Bone 2010;46(2):336-41.
- Hui SL, Slemenda CW, Johnston CC Jr. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988;81(6):1804-9.
- Haemer MA, Grow HM, Fernandez C, et al. Addressing prediabetes in childhood obesity treatment programs: Support from research and current practice. Child Obes 2014;10(4):292-303.
- Clark EM, Ness AR, Tobias JH. Adipose tissue stimulates bone growth in prepubertal children. J Clin Endocrinol Metab 2006;91(7):2534-41.
- Leonard MB, Shults J, Wilson BA, Tershakovec AM, Zemel BS. Obesity during childhood and adolescence augments bone mass and bone dimensions. Am J Clin Nutr 2004; 80(2):514-23. Janicka A, Wren TA, Sanchez MM, et al. Fat mass is not beneficial to bone in adolescents and young adults. J Clin Endocrinol Metab 2007;92(1):143-7.
- Pollock NK, Laing EM, Baile CA, Hamrick MW, Hall DB, Lewis RD. Is adiposity advantageous for bone strength? A peripheral quantitative computed tomography study in late adolescent females. Am J Clin Nutr 2007;86(5):1530-8.
- Pollock NK, Bernard PJ, Wenger K, et al. Lower bone mass in prepubertal overweight children with prediabetes. J Bone Miner Res 2010;25(12):2760-9.
- Haffner SM, Bauer RL. The association of obesity and glucose and insulin concentrations with bone density in premenopausal and postmenopausal women. Metabolism 1993;42(6):735-8.
- Stolk RP, Van Daele PL, Pols HA, et al. Hyperinsulinemia and bone mineral density in an elderly population: The Rotterdam Study. Bone 1996;18(6):545-9.
- Afghani A, Cruz ML, Goran MI. Impaired glucose tolerance and bone mineral content in overweight Latino children with a family history of type 2 diabetes. Diabetes Care 2005;28(2):372-8.
- Lawlor DA, Sattar N, Sayers A, Tobias JH. The association of fasting insulin, glucose, and lipids with bone mass in adolescents: Findings from a cross-sectional study. J Clin Endocrinol Metab 2012;97(6):2068-76.
- Lee JH, Lee YH, Jung KH, et al. Bone mineral density in prediabetic men. Korean Diabetes J 2010;34(5):294-302.
- American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;31(Suppl 1):S55-60.
- May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008. Pediatrics 2012;129(6):1035-41.
- Dimitri P, Wales J, Bishop N. Fat and bone in children - differential effects of obesity on bone size and mass according to fracture history. J Bone Miner Res 2010; 25(3):527-36.
- Pollock NK, Bernard PJ, Gutin B, Davis CL, Zhu H, Dong Y. Adolescent obesity, bone mass, and cardiometabolic risk factors. J Pediatr 2011;158(5):727-34.
- Nóbrega da Silva V, Goldberg TB, Mosca LN, Bisi Rizzo Ada C, Teixeira Ados S, Corrente JE. Metabolic syndrome reduces bone mineral density in overweight adolescents. Bone 2014;66(1):1-7.
- Cheng C, Kushner H, Falkner BE. The utility of fasting glucose for detection of prediabetes. Metabolism 2006;55(4):434-8.
- Tsay J, Pomeranz C, Hassoun A, et al. Screening markers of impaired glucose tolerance in the obese pediatric population. Horm Res Paediatr 2010;73(2):102-7.
- Lorentzon M, Landin K, Mellström D, Ohlsson C. Leptin is a negative independent predictor of areal BMD and cortical bone size in young adult Swedish men. J Bone Miner Res 2006;21(12):1871-8.
Öz
Aim: The
aim of this study was to evaluate the relationships between bone mineral
density (BMD) vs metabolic risk factors in obese adolescents with
prediabetes.
Materials and Methods: A total of 131 obese children and adolescents, aged 6-18 years of age
were enrolled the study. Prediabetes was determined by a fasting blood glucose
level of ≥100 to 125 mg/dL or 2-hour oral glucose tolerance test value of ≥140
to 199 mg/dL. Five patients who were diagnosed as having type 2 diabetes were
excluded and remaining participants were classified as normal glucose tolerance
(NGT) and prediabetic. BMD was measured on calcaneus using quantitative
ultrasound. BMD and metabolic parameters were investigated and compared in
these two groups.
Results: There
was no significant difference in BMD between children and adolescents with
prediabetes (n = 37) or NGT (n = 89). The parameters of prediabetes did not
affect BMD and these results did not change when we adjusted for weight,
height, age, sex, pubertal status. The multivariate linear regression analysis
revealed that the only independent factor associated with higher BMD was higher
BMI (OR=0.007 95%CI 0.002-0.013 p=0.013). No significant associations were
found between BMD and waist circumference or biochemical measurements.
Conclusion: Plasma glucose within the
prediabetic range is not associated with bone mineral density in obese
children. Thus, the positive association of BMI with BMD may be by means of
alternative pathways.
Anahtar Kelimeler
Kaynakça
- Boot AM, de Ridder MA, van der Sluis IM, van Slobbe I, Krenning EP,Keizer-Schrama SM. Peak bone mineral density, lean body mass and fractures. Bone 2010;46(2):336-41.
- Hui SL, Slemenda CW, Johnston CC Jr. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988;81(6):1804-9.
- Haemer MA, Grow HM, Fernandez C, et al. Addressing prediabetes in childhood obesity treatment programs: Support from research and current practice. Child Obes 2014;10(4):292-303.
- Clark EM, Ness AR, Tobias JH. Adipose tissue stimulates bone growth in prepubertal children. J Clin Endocrinol Metab 2006;91(7):2534-41.
- Leonard MB, Shults J, Wilson BA, Tershakovec AM, Zemel BS. Obesity during childhood and adolescence augments bone mass and bone dimensions. Am J Clin Nutr 2004; 80(2):514-23. Janicka A, Wren TA, Sanchez MM, et al. Fat mass is not beneficial to bone in adolescents and young adults. J Clin Endocrinol Metab 2007;92(1):143-7.
- Pollock NK, Laing EM, Baile CA, Hamrick MW, Hall DB, Lewis RD. Is adiposity advantageous for bone strength? A peripheral quantitative computed tomography study in late adolescent females. Am J Clin Nutr 2007;86(5):1530-8.
- Pollock NK, Bernard PJ, Wenger K, et al. Lower bone mass in prepubertal overweight children with prediabetes. J Bone Miner Res 2010;25(12):2760-9.
- Haffner SM, Bauer RL. The association of obesity and glucose and insulin concentrations with bone density in premenopausal and postmenopausal women. Metabolism 1993;42(6):735-8.
- Stolk RP, Van Daele PL, Pols HA, et al. Hyperinsulinemia and bone mineral density in an elderly population: The Rotterdam Study. Bone 1996;18(6):545-9.
- Afghani A, Cruz ML, Goran MI. Impaired glucose tolerance and bone mineral content in overweight Latino children with a family history of type 2 diabetes. Diabetes Care 2005;28(2):372-8.
- Lawlor DA, Sattar N, Sayers A, Tobias JH. The association of fasting insulin, glucose, and lipids with bone mass in adolescents: Findings from a cross-sectional study. J Clin Endocrinol Metab 2012;97(6):2068-76.
- Lee JH, Lee YH, Jung KH, et al. Bone mineral density in prediabetic men. Korean Diabetes J 2010;34(5):294-302.
- American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;31(Suppl 1):S55-60.
- May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008. Pediatrics 2012;129(6):1035-41.
- Dimitri P, Wales J, Bishop N. Fat and bone in children - differential effects of obesity on bone size and mass according to fracture history. J Bone Miner Res 2010; 25(3):527-36.
- Pollock NK, Bernard PJ, Gutin B, Davis CL, Zhu H, Dong Y. Adolescent obesity, bone mass, and cardiometabolic risk factors. J Pediatr 2011;158(5):727-34.
- Nóbrega da Silva V, Goldberg TB, Mosca LN, Bisi Rizzo Ada C, Teixeira Ados S, Corrente JE. Metabolic syndrome reduces bone mineral density in overweight adolescents. Bone 2014;66(1):1-7.
- Cheng C, Kushner H, Falkner BE. The utility of fasting glucose for detection of prediabetes. Metabolism 2006;55(4):434-8.
- Tsay J, Pomeranz C, Hassoun A, et al. Screening markers of impaired glucose tolerance in the obese pediatric population. Horm Res Paediatr 2010;73(2):102-7.
- Lorentzon M, Landin K, Mellström D, Ohlsson C. Leptin is a negative independent predictor of areal BMD and cortical bone size in young adult Swedish men. J Bone Miner Res 2006;21(12):1871-8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2018 |
| Gönderilme Tarihi | 23 Şubat 2017 |
| Yayımlandığı Sayı | Yıl 2018 |