Endocrine Abstracts

Introduction: Paediatric obesity is associated with significant long-term complications. This study investigated features of metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnoea (OSA) aiming to establish their incidence and identify any predictive factors.

Methods: A retrospective review of case notes was performed for children aged 2-16 years managed for investigation and management of obesity within a single tertiary endocrine centre over 2 years.

Results: 101 children were included (median age at presentation 11.3 years, 49% male, mean body mass index (BMI) standard deviation score (SDS) at presentation 3.5). The following prevalence of comorbidities were noted - biochemical insulin resistance (IR) 60%, impaired glucose tolerance (IGT) 12%, type 2 diabetes mellitus (T2DM) 5%, NAFLD 19% and OSA in 12%. Increasing age correlated with fasting insulin (r=0.42, P<0.001), fasting glucose (r=0.25, P=0.01) and HbA1c (r=0.25, P=0.03); and was predictive of IGT (mean difference 1.9 years, P=0.02). Sex and pubertal status did not affect the incidence of complications arising. BMI SDS was not predictive of complications arising, except for OSA (mean difference 0.5 SDS, P=0.03). A correlation was noted between IR and NAFLD (P=0.02). The positive predictive value (PPV) for acanthosis nigricans (AN) predicting IR was 88% and the negative predictive value (NPV) was 42%. This was similar between the two major ethnic groups studied – Caucasians (PPV 91%, NPV 47%) and south-east Asians (PPV 88%, NPV 40%).

Conclusion: The complications of obesity are relatively common – supporting the need for the recently nationally commissioned Complications of Excess Weight clinics, to help reduce and prevent long-term co-morbidities. Increased age is an important predictor of metabolic syndrome. Therefore, a greater focus on prevention and management strategies is needed at a younger age. AN is a recognised clinical marker of IR, however this study demonstrates that the absence of AN cannot reliably exclude IR. This suggests the need for biochemical testing for IR, even in the absence of AN, in the context of obesity where its prevalence is so high.