Obesity, Overweight, and Dyslipidemia in Children and Adolescents

Table of Contents

1. OBESITY, OVERWEIGHT, AND DYSLIPIDEMIA IN CHILDREN AND ADOLESCENTS
2. DEFINITIONS
3. BODY MASS INDEX (BMI)
4. EPIDEMIOLOGY
5. ETIOLOGY
6. ASSESSMENT
7. CO-MORBIDITIES
   1. CO-MORBIDITIES ,continued
   2. CO-MORBIDITIES , continued
8. HYPERLIPIDEMIA
9. DIET AND EXERCISE RECOMMENDATIONS
10. PHARMACOLOGIC INTERVENTIONS
11. REFERRING TO SUBSPECIALISTS
12. TAKE HOME POINTS
13. RESOURCES & REFERENCES
14. ABOUT THE MODULE

CO-MORBIDITIES ,continued

11. Diabetes mellitus (Anand, 2006; Kahn, 2000; Laffel, 2009)

Diagnosis

Based on the ADA guidelines, which mirror definitions for adult onset diabetes and require one of the following

• Fasting plasma glucose > 126 mg/dL
• Symptoms of hyperglycemia and a random venous plasma glucose > 200 mg/dL
• Abnormal oral glucose tolerance test defined as a plasma glucose > 200 mg/dL measured two hours after a glucose load of 1.75 g/kg

Insulin resistance

Defined by a presence of impaired fasting glucose or impaired glucose tolerance which are risk factors for the development of diabetes

• Impaired fasting glucose - Fasting plasma glucose 100 mg/dL to 125 mg/dL
• Impaired glucose tolerance - Two hour plasma glucose 140 mg/dL to 199 mg/dL

View the Chart Distinguishing between type 2 and type 1 diabetes

Diabetes Mellitus Risk Factors

Risk factors associated with the development for type 2 diabetes in childhood

• Obesity - the most important risk factor for the development of type 2 diabetes
• Positive family history
• Specific ethnic groups (non-Hispanic black, Hispanic, Native American, or Asian American)
• Female gender
• Insulin resistance

Diabetes Screening

AAP and ADA guidelines state that children should be screened every two years beginning at 10 years of age or at the onset of puberty (whichever comes first) if they are overweight or obese and have two or more of the following risk factors:

• Type 2 diabetes in a first or second degree relative
• Member of a high-risk ethnic group - Native American, non-Hispanic black, Hispanic or Asian American
• Signs of insulin resistance (hypertension, dyslipidemia, acanthosis nigricans, PCOS)

Clinical judgment should be used to test for type 2 diabetes in children who do not meet the above criteria (for example: overweight or obese with only one risk factor).

Screening test: fasting plasma glucose

Patients with diabetes, like patients with obesity, are at increased risk for:

• HTN
• Dyslipidemia
• NAFLD

The risk for early development of atherosclerosis and the development of cardiovascular disease are increased the most in a patient with diabetes and hypertension