Original Article
Overweight Is Highly Prevalent In Children with Type 1 Diabetes And Associates with Cardiometabolic Risk

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Objectives

To determine the prevalence of traditional cardiometabolic risk factors and to assess the effect of overweight/obesity on the occurrence of these risk factors in a cohort of children with type 1 diabetes mellitus (T1DM).

Study design

Two hundred eighty-three consecutive patients (3 to 18 years of age) attending an outpatient clinic for T1DM care were included. The prevalence of cardiometabolic risk factors, the metabolic syndrome, and high alanine aminotransferase, were assessed before and after stratification for weight status.

Results

Of all children (median age, 12.8 years; interquartile range, 9.9 to 16.0; median diabetes duration, 5.3 years; interquartile range, 2.9 to 8.6), 38.5% were overweight/obese (Z-body mass index ≥1.1). Overall, median HbA1c levels were 8.2% (interquartile range, 7.4 to 9.8), and HbA1c ≥7.5% was present in 73.9%. Microalbuminuria was found in 17.7%, high triglycerides (>1.7 mmol/L) in 17.3%, high LDL-cholesterol (>2.6 mmol/L) in 28.6%, low HDL-cholesterol (<1.1 mmol/L) in 21.2%, and hypertension in 13.1% of patients. In the overweight/obese children with T1DM, versus normal-weight children, a higher prevalence of hypertension (23.9% vs 5.7%), the metabolic syndrome (25.7% vs 6.3%), and alanine aminotransferase >30 IU/L (15.6% vs 4.5%) was found (all P < .05).

Conclusions

Overweight/obesity and cardiometabolic risk factors were highly prevalent in a pediatric cohort with T1DM. Hypertension, the metabolic syndrome, and high alanine aminotransferase were significantly more prevalent in overweight/obese compared with normal-weight children with T1DM.

Section snippets

Methods

We studied a cohort of consecutive children (age 3 to 18 years) with T1DM who attended a Dutch specialized Pediatric Diabetes Center in Rotterdam in the period 2007 to 2008. Data were collected according to a standardized treatment protocol and cross-sectional analyses were performed to assess cardiometabolic risk factors within this cohort.

T1DM was diagnosed according to criteria of the American Diabetes Association (ADA), including measurements of autoantibodies (islet cell antibodies [ICA],

Results

The baseline characteristics are shown in Table I. The majority (77.0%) of children was Dutch native 3.5% was Turkish and 7.1% Moroccan. The remaining group (12.4%) consisted of children with other ethnic backgrounds or children of parents with 2 different origins. In the present cohort, 38.5% of the children were classified as overweight/obese, and 9.2% were obese (Z-BMI ≥2 ). Overweight/obese children differed with respect to their normal-weight counterparts for age, diabetes duration, age of

Discussion

In our study, the proportion of obese children with T1DM (Z-BMI ≥2) was twice as high as recently described in a comparable Norwegian cohort, whereas the prevalence of BMI >90th percentile was similar to that found in a German pediatric T1DM cohort.9, 10 In a multi-ethnic cohort with diabetes (mainly type 1) in the United States, the proportion of obese children (as determined by high waist circumference) ranged from 15% of non-Hispanic white children, to 56% in Native American children.23

The

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    The authors declare no conflicts of interest.

    Both authors contributed equally to this article.

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