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Correlative Studies in Obese Children and Adolescents Concerning Body Composition and Plasma Insulin and Growth Hormone Levels

Extract: Levels of plasma insulin, growth hormone (HGH), glucose, and free fatty acids (FFA) were investigated in 17 obese, nondiabetic children or adolescents after administration of intravenous arginine, oral glucose, and a protein-glucose meal. These results were compared with those obtained in eight normal adolescents. Four of the obese patients had a family history of diabetes but had hormonal responses identical with those observed in obese subjects with a negative family history of diabetes. Subjects were arbitrarily separated into two groups depending on duration of obesity (Table I) (age of onset was different: infancy or early childhood for group B, 5–8 years for group A). Subjects in group B (longstanding obesity) all had a strong family history of obesity with marked increases in body weight, body fat, and excess fat. Fasting levels of insulin were greater than normal (P < 0.001 (Table II)). Patients in group A (short duration), with lesser increments in body weight and body fat, had normal fasting levels of insulin and normal response to intravenous arginine (Fig. 4). All obese subjects had hyperinsulinemia in response to other stimuli, but patients in group B achieved the highest insulin levels (Figs. 2, 3, and 4). All obese patients had significantly decreased levels of HGH during tests and elevated fasting levels of FFA. Patients in group B exhibited a reduced mean decrement in FFA during the oral glucose tolerance test.Whether or not responses seen in patients in group A represent an early stage of the conditions observed in patients in group B cannot be determined by this study, but the biochemical changes reported in established obesity of childhood mimic those found in the adult.Speculation: Obesity in children is associated with excess lipogenesis and hyperinsulinemia, which are interdependent and initiated through maximal nutritional intake in infancy.Eventually muscle becomes resistant to insulin with decreased transport of glucose into the cell and decreased protein synthesis relative to DNA. The reduced levels of growth hormone in the circulation may indicate excessive uptake by muscle, which is followed, in some instances, by an associated proliferation of nuclei.