Metabolic Aspects of Patients Followed for Severe Obesity

Objective: To evaluate metabolic aspects of obese patients and their correlation with results. Patients and Methods: Selected patients under 18 yrs of age with severe obesity, defined using obesity cut off in Italian BMI centile chart (SIEDP), were enrolled in a montly multidisciplinary day hospital follow up. Patients underwent physical examination and were screened for dyslipidemia, hyperinsulinemia, hypertension and other common problems correlated with obesity. The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. In 74 patients we performed an OGTT to establish glucose tolerance status and the whole body insulin sensitivity index (WBISI) was calculated. We present 123 patients (67 males and 56 females) mean age 11.2±3.03 yrs (4.2–18.5), mean BMI 31.2±4.9 (21.4-46.6), mean SDSBMI 2.48±0.49 (1.11-4.21). Results: Eight patients (10.8%) presented an impaired glucose tolerance. SDSBMI seems to be directly correlated to fasting insulin, HOMA-IR, systolic and diastolic blood pressure (P<0.001) and inversely correlated to WBISI (P<0.05). No correlations were found with SDSBMI and cholesterolemia, HDL-C, LDL-C, triglycerides, rhythm of cortisol, transaminases (ALT and ASP), thyroid hormones. Waist-to-hip ratio (WHR) was correlated only to ALT and ASP. We found a direct correlation of fasting insulin, HOMA-IR with triglycerides, ALT* and blood pressure values and inverse correlation with HDL-C levels (P<0.001, *P<0.05). Patients were followed for a mean period of 10±7 months (0.8-34.3) and 66.3% improved, 16.8% maintained and 16.8% worsened their SDSBMI. Interestingly initial mean HOMA-IR was the same in the first and the second groups, that presented a good result, but higher in the third (3.2±2.3; 3.2±2.5 and 5.1±3.0 respectively). Conclusion: Our data confirmed that obesity is strictly correlated to insulin-resistance and probably this characteristic may influence the obesity evolution.