“中華誦18320xx全國(guó)學(xué)生規(guī)范漢字(1)-文庫(kù)吧
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【正文】 n in the past 30 years. Type 2 Diabetes in the Young The evolving epidemic Prevalence Trends ? 10 fold increase from 19821994 in Cincinnati ? J. Ped. 128:608615, 1996 ? % of diabetic children w/ T2 increased from % (1994) to 20% (1998) (Florida) ? Pub. Health Rep. 117:373379, 2022 ? ~1/3rd of children w/ diabetes have T2 in OH, AR, CA(Hispanics) ? Diabetes Care 22:345354, 1999 Type 2 Diabetes in the Young The evolving epidemic Prevalence ? Other factors: ? Gender ? Girls times more likely than boys ? Diabetes Care 22:345354, 1999 ? Family History ? 2/3rd of children w/ T2DM with at least one parent with T2DM ? Diabetes Care 23:381389, 2022 Type 2 Diabetes in the Young The evolving epidemic Prevalence ? Other factors (1998 study from India) ? Low birthweight ? High prepubertal weight Type 2 Diabetes in the Young The evolving epidemic Screening ? Prevalence of T2DM in young low but growing ? Prevalence of overweight growing rapidly ? Screening of all children not cost effective ? ~$10,000 per case found (Japan/Taiwan study) ? ADA/AAP Consensus Position ? Diabetes Care 2022 ? Testing 10yr if BMI 85th pct with 1o or 2o relative with DM, at risk ethnic group, or signs of insulin resistance (metabolic syndrome) Obesity and the Metabolic Syndrome in Children and Adolescents R. Weiss et al. NEJM 350:236274,2022 Obesity and the Metabolic Syndrome in Children and Adolescents ? Metabolic Syndrome ? Cluster of metabolic abnormalities associated with insulin resistance ? Diagnosis of Metabolic Syndrome in Adults ? Three or more of the following: ? Abdominal Obesity ? men 40” waist circumference ? women 35” waist circumference ? Hypertriglyceridemia (150 mg/dl) ? Low HDL ? men 40 mg/dl ? women 50 mg/dl ? Prehypertension (130/85 mmHg) ? Prediabetes ( 110 mg/dl) Obesity and the Metabolic Syndrome in Children and Adolescents Methods ? 439 obese children/adolescents ? 31 overweight siblings ? 20 nonobese siblings ? 41% white, 31% black, 27% Hispanic ? Administered oral GTT ? Measured BP, plasma lipids, Creactive protein Obesity and the Metabolic Syndrome in Children and Adolescents Criteria for Metabolic Syndrome in Children ? Obesity (instead of waist circumference) ? Obese = zscore for BMI ? Moderate Obese = zscore ? Severe Obese = zscore ? Metabolic values ? TG: 95th pct ? HDLC: 5th pct ? Glucose intolerance following OGTT ? Insulin resistance = [fasting glu]x[fasting plasma insulin]/ Obesity and the Metabolic Syndrome in Children and Adolescents Anthropometric amp。 Metabolic Characteristics Nonobese Overweight Moderate Obese Severe Obese BMI Glucose (mg/dl,) Insulin uU/ml,.001 Insulin resistance .001 Triglycerides Mg/dl, .0
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