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Insulin resistance during puberty: results from clamp studies in 357 children.
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1999
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NutritionMetabolic DisorderInsulin SignalingObesityMetabolic SyndromeBody CompositionHealth SciencesInsulin ManagementDevelopmental EndocrinologyPediatric EndocrinologyTanner StageEndocrinologyTransient Insulin ResistanceInsulin ResistanceChildhood ObesityDiabetesPhysiologyPediatricsPubertyClamp StudiesMedicine
Insulin resistance is a key contributor to adult cardiovascular risk and may begin in childhood, with a normal transient rise during puberty. The authors performed euglycemic clamp studies on 357 healthy 10‑14‑year‑old children to evaluate how Tanner stage, sex, ethnicity, and BMI affect insulin sensitivity. Insulin resistance rises at puberty onset, peaks at Tanner stage 3, and returns near pre‑pubertal levels by stage 5; girls and white boys exhibit higher levels, and although it correlates with BMI and adiposity, these factors do not fully explain the pubertal increase.
Insulin resistance may be an important cause of a constellation of cardiovascular risk factors in adults, and onset of this syndrome may occur in childhood. However, children normally experience transient insulin resistance at puberty. There were 357 normal children (159 girls, 198 boys) age 10-14 years who underwent euglycemic clamp studies to assess the effects of Tanner stage (T), sex, ethnicity, and BMI on insulin resistance. Insulin resistance increased immediately at the onset of puberty (T2), but returned to near prepubertal levels by the end of puberty (T5). Its peak occurred at T3 in both sexes, and girls were more insulin resistant than boys at all T stages. White boys appeared to be more insulin resistant than black boys; no difference was seen between white and black girls. Insulin resistance was strongly related to BMI, triceps skinfold thickness, and waist circumference, and this relationship was independent of Tanner stage or sex. Differences in BMI and adiposity did not, however, entirely explain the insulin resistance of puberty. These results demonstrate that 1) significant differences in insulin resistance are present between boys and girls; 2) insulin resistance increases significantly at T2, T3, and T4, but decreases to near prepubertal levels at T5; and 3) while insulin resistance is related to BMI and anthropometric measures of fatness, these factors do not completely explain the insulin resistance that occurs during the Tanner stages of puberty.