WEDNESDAY, March 13, 2002 (HealthDayNews) -- Many obese children, even those barely into preschool, already start to show the first signs of Type II diabetes.
Those scary findings have alarming implications for the fattening land, says a new study from Yale University.
"Children with a significant degree of obesity are at a very high risk of developing a pre-stage of Type II diabetes," says Dr. Sonia Caprio, a Yale University endocrinologist and co-author of the study. "It's important to recognize it, and intervene early so that one can prevent" the disease from taking hold.
"This study suggests that many obese children have a high risk for developing Type II diabetes," U.S. Health and Human Services Secretary Tommy Thompson says in a statement about the findings, which appear in tomorrow's issue of the New England Journal of Medicine. "Researchers have a lot of information on how to prevent and treat Type II diabetes in adults, but we need to find better ways to prevent and treat the disease in children."
The prevalence of childhood obesity has doubled in the last 30 years, and shows no signs of abating. In 2000, 22 percent of the nation's preschool children were overweight, while 10 percent were clinically obese.
Nearly 16 million Americans have diabetes, according to the Centers for Disease Control and Prevention. Most have Type II diabetes, the weight-related form of the condition where the body has trouble breaking down sugar in the body. It is also known as adult-onset diabetes, but as obesity becomes increasingly common in children, scientists say that name is fast becoming an anachronism.
In the new study, Caprio and her colleagues looked for signs of blood sugar trouble in 55 obese young children, aged 4 to 10, and 112 obese adolescents, aged 11 to 18. All of the children were severely overweight, with a body mass index -- a ratio of weight to height -- in the top 5 percent for their age and sex.
To measure how well they processed sugar, all of the children were given an orange-flavored glucose drink after a 12-hour fast -- a measure called an oral glucose tolerance test. Their blood was then drawn and analyzed for gauges of the performance of insulin, the chief hormone for turning sugar into energy.
The researchers also looked at other markers of insulin sensitivity, including the ratio of a molecule called proinsulin to insulin, and a protein called C-peptide that reflects how much insulin is secreted by the pancreas.
Fourteen (25 percent) of the young children showed signs of impaired glucose tolerance, the result of resistance to insulin. So did 23 (or 21 percent) of the adolescents, the researchers found.
Four of the older children were also discovered to have previously undiagnosed Type II diabetes, including failure of their pancreatic beta cells to produce enough insulin. Three others with impaired glucose tolerance ultimately went on to develop diabetes during the four-year study.
Reduced glucose tolerance was much more common in young girls than in young boys, although there was no such gender difference in the older group.
If untreated, runaway blood sugar can lead to heart attacks, strokes, kidney and nerve damage, and a host of other serious health problems. Although these complications have been well understood in adults, mounting evidence shows that even young diabetics and children teetering on the edge of the disorder are also at risk.
French researchers, for example, recently found that early signs of thick and stiffening arteries, as well as unhealthy changes in the way cells handle energy, are readily apparent in severely overweight children and adolescents.
Caprio's group didn't look for such problems in their study. However, they did find that adolescents with budding glucose intolerance also had elevations in blood fats called triglycerides, which are linked to heart and vessel disease.
Experts said the findings should be a signal to family doctors and pediatricians to take childhood obesity more seriously, and to refer the heaviest children to specialists in diabetes and hormone conditions.
The extra work for doctors "will overwhelm us all, but conceptually it's ideal," said Dr. Francine Kaufman, a pediatric endocrinologist at Childrens Hospital Los Angeles and president-elect of the American Diabetes Association. Controlling obesity "is not about looks, it's about health."
While it's possible to stave off diabetes by losing weight, Kaufman said the deck is heavily stacked against children.
"Lifestyle interventions are going to be extremely difficult when they are sitting in a toxic environment. They have fewer places to go that are safe to play, so they sit around at home and watch [television], they're inactive, and they're bombarded with ads for junk food," she says.
What To Do
The American Academy of Pediatrics in 2000 issued a consensus statement calling for diabetes testing of obese children with at least two risk factors for the blood sugar disorder. These can include family history of the condition and belonging to certain minority groups that may be at increased risk of developing the disease.
For more about childhood obesity and diabetes, try the American Diabetes Association or the Centers for Disease Control and Prevention.
