Thomas Reinehr1, Joachim Woelfle, Rainer Wunsch, Christian L Roth. 1. Department of Pediatric Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Dr. F. Steiner Strasse 5, D-45711 Datteln, Germany. T.Reinehr@kinderklinik-datteln.de
Abstract
CONTEXT: Fibroblast growth factor 21 (FGF-21), a potent activator of glucose uptake, has been proposed to be related to insulin resistance, metabolic syndrome (MetS), nonalcoholic fatty liver disease (NAFLD), and weight status. OBJECTIVE: Our objective was to study the relationships between FGF-21, parameters of MetS, and NAFLD before and after weight loss in obese children. DESIGN AND SETTING: This was a cross-sectional comparison between obese and normal-weight children and longitudinal 1-yr follow-up study in obese children participating in a lifestyle intervention in a primary care setting. PATIENTS: Patients included 60 obese and 40 lean children of same age, gender, and pubertal stage. INTERVENTION: The outpatient 1-yr intervention program was based on exercise, behavior, and nutrition therapy. MAIN OUTCOMES MEASURES: We evaluated fasting serum FGF-21, weight status [body mass index (BMI) expressed as sd score (SDS)], body fat, insulin resistance index (homeostasis model assessment), leptin, transaminases, free fatty acids (FFA), waist circumference, blood pressure, and lipids. RESULTS: Compared with the normal-weight children, obese children demonstrated significantly (P < 0.001) increased FGF-21, leptin, and homeostasis model assessment levels. FGF-21 was significantly (P < 0.05) correlated to BMI, SDS-BMI, FFA, and leptin both in cross-sectional and longitudinal analyses but not to any additional analyzed parameter. Children with and without MetS or NAFLD did not differ significantly with respect to their FGF-21 concentrations. A decrease of SDS-BMI was associated with a significant (P = 0.038) decrease of FGF-21 levels (mean -34%). CONCLUSIONS: FGF-21 concentrations are reversibly increased in obese children and are related to leptin and FFA. However, our data do not support a significant relationship between FGF-21, insulin resistance, and features of MetS or NAFLD in children.
CONTEXT: Fibroblast growth factor 21 (FGF-21), a potent activator of glucose uptake, has been proposed to be related to insulin resistance, metabolic syndrome (MetS), nonalcoholic fatty liver disease (NAFLD), and weight status. OBJECTIVE: Our objective was to study the relationships between FGF-21, parameters of MetS, and NAFLD before and after weight loss in obesechildren. DESIGN AND SETTING: This was a cross-sectional comparison between obese and normal-weight children and longitudinal 1-yr follow-up study in obesechildren participating in a lifestyle intervention in a primary care setting. PATIENTS: Patients included 60 obese and 40 lean children of same age, gender, and pubertal stage. INTERVENTION: The outpatient 1-yr intervention program was based on exercise, behavior, and nutrition therapy. MAIN OUTCOMES MEASURES: We evaluated fasting serum FGF-21, weight status [body mass index (BMI) expressed as sd score (SDS)], body fat, insulin resistance index (homeostasis model assessment), leptin, transaminases, free fatty acids (FFA), waist circumference, blood pressure, and lipids. RESULTS: Compared with the normal-weight children, obesechildren demonstrated significantly (P < 0.001) increased FGF-21, leptin, and homeostasis model assessment levels. FGF-21 was significantly (P < 0.05) correlated to BMI, SDS-BMI, FFA, and leptin both in cross-sectional and longitudinal analyses but not to any additional analyzed parameter. Children with and without MetS or NAFLD did not differ significantly with respect to their FGF-21 concentrations. A decrease of SDS-BMI was associated with a significant (P = 0.038) decrease of FGF-21 levels (mean -34%). CONCLUSIONS:FGF-21 concentrations are reversibly increased in obesechildren and are related to leptin and FFA. However, our data do not support a significant relationship between FGF-21, insulin resistance, and features of MetS or NAFLD in children.
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