Startseite Medizin Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)

  • Nikhil Tandon , M.K. Garg , Yashpal Singh und Raman K. Marwaha EMAIL logo
Veröffentlicht/Copyright: 8. Juni 2013
Journal of Pediatric Endocrinology and Metabolism
Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 26 Heft 11-12

Abstract

Aim: To assess prevalence of metabolic syndrome (MS) in urban Indian adolescents. MS in adolescents is a forerunner of diabetes mellitus and cardiovascular disease in adults, therefore, its identification provides an opportunity to intervene with lifestyle changes to prevent disease progression into adulthood. We randomly selected 900 adolescents (300 for each group) to participate in the study from a total of 15,101 adolescents (10–18 years) who were grouped as normal, overweight, and obese (total population).

Methods: From the 900 adolescents, 695 consented to participate in the study and underwent a detailed anthropometric and biochemical evaluation, therefore, these adolescents constituted the study population. MS was defined by criteria proposed by the International Diabetes Federation (MS-IDF) and the Adult Treatment Panel (MS-ATP). The prevalence of MS in the study population was used to calculate the prevalence of MS in the total population based on the distribution of the different BMI categories in this larger sample (n=15,101).

Results: Calculated prevalence of MS in urban Indian adolescents was 4.3% and 3.0% in the total population using MS-ATP and MS-IDF criteria, respectively. Among the study population, MS was higher in girls than boys (MS-ATP, G: 22.3% vs. B: 16.6%, p=0.03; MS-IDF, G: 20.5% vs. B: 13.5%, p=0.006). The most common component of MS- ATP and MS-IDF was central obesity (89.8% vs. 100.0%, p<0.00001), followed by hypertriglyceridemia (83.0% vs. 82.2%, p=0.35), low high density lipoprotein-cholesterol (71.1% vs. 71.2%, p=0.48), hypertension (44.4% vs. 44.9%, p=0.025), and dysglycemia (40.0% vs. 34.7%, p=0.94). The mean serum insulin levels and HOMA-IR progressively increased with the increasing number of components present in an individual.

Conclusions: Metabolic syndrome is common in urban Indian overweight and obese adolescents.

Keywords: adolescents; HOMA-IR; insulin resistance; metabolic syndrome
Corresponding author: Raman K. Marwaha, Flat No 17, Gautam Apartments, Gautam Nagar, New Delhi 110049, India, Phone: +91 9810296820, Fax: +91 11 26523477, E-mail:

References

1. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94:311–21.10.1016/j.diabres.2011.10.029Suche in Google Scholar PubMed

2. World Life Expectancy. China vs. India: top 10 causes of death. Available at: http://www.worldlifeexpectancy.com/news/india-vs-china-top-10-causes-of-death. Assessed 23 November 2012.Suche in Google Scholar

3. Misra A, Wasir JS, Pandey RM. An evaluation of candidate definitions of the metabolic syndrome in adult Asian Indians. Diabetes Care 2005;28:398–403.10.2337/diacare.28.2.398Suche in Google Scholar PubMed

4. Barker DJ. The intrauterine origins of non-insulin-dependent diabetes and cardiovascular disease. Int J Diabetes Dev Ctries 1993;13:43–51.Suche in Google Scholar

5. Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr 2010;91:1499S–505S.10.3945/ajcn.2010.28701BSuche in Google Scholar PubMed PubMed Central

6. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869–73.10.1056/NEJM199709253371301Suche in Google Scholar PubMed

7. Ford ES, Li C. Defining the metabolic syndrome in children and adolescents: Will the real definition please stand up? J Pediatr 2008;52:160–4.10.1016/j.jpeds.2007.07.056Suche in Google Scholar PubMed

8. Zimmet P. The IDF consensus definition of the metabolic syndrome in children and adolescents. Available at: www.idf.org/webdata/docs/Mets_definition_children.pdf. Assessed 23 November 2012.Suche in Google Scholar

9. Jolliffe CJ, Janssen I. Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J Am Coll Cardiol 2007;49:891–8.10.1016/j.jacc.2006.08.065Suche in Google Scholar PubMed

10. Third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda: National Heart, Lung, and Blood Institute, 2001: 1–3670.10.1001/jama.285.19.2486Suche in Google Scholar PubMed

11. Gupta N, Goel K, Shah P, Misra Al. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev 2012;33:48–70.10.1210/er.2010-0028Suche in Google Scholar PubMed

12. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 2000;320:1240–3.10.1136/bmj.320.7244.1240Suche in Google Scholar PubMed PubMed Central

13. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Hypertension 2003;42:1206–52.10.1161/01.HYP.0000107251.49515.c2Suche in Google Scholar PubMed

14. Kuriyan R, Thomas T, Lokesh DP, Sheth NR, Mahendra A, et al. Waist circumference and waist for height percentiles in urban South Indian children aged 3–16 years. Indian Pediatr 2011;48:765–71.10.1007/s13312-011-0126-6Suche in Google Scholar PubMed

15. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(Suppl 2):555–7610.1542/peds.114.2.S2.555Suche in Google Scholar

16. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9.10.1007/BF00280883Suche in Google Scholar PubMed

17. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes Care 2012;35(Suppl 1):S11–63.10.2337/dc12-s011Suche in Google Scholar PubMed PubMed Central

18. Marwaha RK, Khadgawat R, Tandon N, Kanwar R, Narang A, et al. Reference interval of lipid profile in healthy school children and adolescents. Clin Biochem 2011;44:760–6.10.1016/j.clinbiochem.2011.05.011Suche in Google Scholar PubMed

19. Vikram NK, Misra A, Pandey RM, Luthra K, Wasir JS, et al. Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents. Atherosclerosis 2006;186:193–9.10.1016/j.atherosclerosis.2005.07.015Suche in Google Scholar PubMed

20. Singh R, Bhansali A, Sialy R, Aggarwal A. Prevalence of metabolic syndrome in adolescents from a north Indian population. Diabet Med 2007;24:195–9.10.1111/j.1464-5491.2007.02066.xSuche in Google Scholar PubMed

21. Yatheesha BL, Borade A, Rajam L. Metabolic syndrome in the at risk for overweight and overweight children and adolescents. Pediatric Oncall [serial online] 2010;7:65. Available at: http://www.pediatriconcall.com/fordoctor/Medical_original_articles/metabolic.asp. Accessed 17 May 2013.Suche in Google Scholar

22. Misra A, Vikram NK, Arya S, Pandey RM, Dhingra V, et al. High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat. Int J Obes Relat Metab Disord 2004;28:1217–26.10.1038/sj.ijo.0802704Suche in Google Scholar PubMed

23. Hong TK, Trang NH, Dibley MJ. Prevalence of metabolic syndrome and factor analysis of cardiovascular risk clustering among adolescents in Ho Chi Minh City, Vietnam. Prev Med 2012;55:409–11.10.1016/j.ypmed.2012.09.002Suche in Google Scholar PubMed

24. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 2003;157:821–7.10.1001/archpedi.157.8.821Suche in Google Scholar PubMed

25. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among US adolescents, 1999–2000. Diabetes Care 2004;27:2438–43.10.2337/diacare.27.10.2438Suche in Google Scholar

26. Ford ES, Li C, Zhao G, Pearson WS, Mokdad AH. Prevalence of the metabolic syndrome among US adolescents using the definition from the International Diabetes Federation. Diabetes Care 2008;31:587–9.10.2337/dc07-1030Suche in Google Scholar

27. Rodríguez-Morán M, Salazar-Vázquez B, Violante R, Guerrero-Romero F. Metabolic syndrome among children and adolescents aged 10–18 years. Diabetes Care 2004;27:2516–7.10.2337/diacare.27.10.2516Suche in Google Scholar

28. Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F. High prevalence of the metabolic syndrome in Iranian adolescents. Obesity (Silver Spring) 2006;14:377–82.10.1038/oby.2006.50Suche in Google Scholar

29. Medeiros CC, Ramos AT, Cardoso MA, França IS, Cardoso Ada S, et al. Insulin resistance and its association with metabolic syndrome components. Arq Bras Cardiol 2011;97:380–9.10.1590/S0066-782X2011005000089Suche in Google Scholar

30. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217–30.Suche in Google Scholar

31. Narayanan P, Meng OL, Mahanim O. Do the prevalence and components of metabolic syndrome differ among different ethnic groups? A cross-sectional study among obese Malaysian adolescents. Metab Syndr Relat Disord 2011;9: 389–95.10.1089/met.2011.0014Suche in Google Scholar

32. Taha D, Ahmed O, bin Sadiq B. The prevalence of metabolic syndrome and cardiovascular risk factors in a group of obese Saudi children and adolescents: a hospital-based study. Ann Saudi Med 2009;29:357–60.10.4103/0256-4947.55164Suche in Google Scholar

33. Census of India. Area and population. Available at: http://censusindia.gov.in/Census_And_You/area_and_population.aspx. Accessed 23 November 2012.Suche in Google Scholar

34. Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002;57:185–90.10.1016/S0168-8227(02)00056-6Suche in Google Scholar

35. Subramanyam V, Jayshree R, Rafi M. Prevalence of overweight and obesity inaffluent adolescent girls in Chennai in 1981 and 1998. Indian Pediatr 2003;40:332–6.Suche in Google Scholar

36. Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatr 2002;39:449–52.Suche in Google Scholar

37. Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent school boys in Pune. Indian Pediatr 2004;41:857–8.Suche in Google Scholar

38. Lambert M, Paradis G, O’Loughlin J, Delvin EE, Hanley JA, et al. Insulin resistance syndrome in a representative sample of children and adolescents from Quebec, Canada. Int J Obes Relat Metab Disord 2004;28:833–41.10.1038/sj.ijo.0802694Suche in Google Scholar PubMed

39. Viner RM, Segal TY, Lichtarowicz-Krynska E, Hindmarsh P. Prevalence of the insulin resistance syndrome in obesity. Arch Dis Child 2005;90:10–4.10.1136/adc.2003.036467Suche in Google Scholar PubMed PubMed Central

40. Ranjani H, Sonya J, Anjana RM, Viswanathan M. Prevalence of glucose intolerance among children and adolescents in urban South India (ORANGE-2). Diab Tech Therapeutics 2013;15: 13–9.10.1089/dia.2012.0236Suche in Google Scholar PubMed

41. Sharma S, Lustig RH, Fleming SE. Identifying metabolic syndrome in African American children using fasting HOMA-IR in place of glucose. Prev Chronic Dis 2011;8:A64.Suche in Google Scholar

42. Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG. Prevalence and determinants of insulin resistance among US adolescents: a population-based study. Diabetes Care 2006;29:2427–32.10.2337/dc06-0709Suche in Google Scholar PubMed

43. Murphy MM, Metcalf BS, Voss L, Jeffery AN, Kirkby J, et al. Girls at five are intrinsically more insulin resistant than boys: the programming hypothesis revisited – the Early Bird study (EarlyBird 6). Pediatrics 2004;113:82–6.10.1542/peds.113.1.82Suche in Google Scholar PubMed

44. Whincup PH, Gilg JA, Owen CG, Odoki K, Alberti KG, et al. British South Asians aged 13–16 years have higher fasting glucose and insulin levels than Europeans. Diabet Med 2005;22:1275–7.10.1111/j.1464-5491.2005.01587.xSuche in Google Scholar PubMed

45. Bao W, Srinivasan SR, Berenson GS. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults. The Bogalusa Heart Study. Circulation 1996;93:54–9.10.1161/01.CIR.93.1.54Suche in Google Scholar

46. Caceres M, Teran CG, Rodriguez S, Medina M. Prevalence of insulin resistance and its association with metabolic syndrome criteria among Bolivian children and adolescents with obesity. BMC Pediatr 2008;8:31.10.1186/1471-2431-8-31Suche in Google Scholar PubMed PubMed Central

47. Mokha JS, Srinivasan SR, Mahapatra PD, Dasmahapatra P, Fernandez C, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: The Bogalusa Heart Study. BMC Pediatrics 2010;10:73.10.1186/1471-2431-10-73Suche in Google Scholar PubMed PubMed Central

48. Zhang J, Gao Y, Guo X, Dong A. The changes in plasma leptin, insulin and proinsulin levels in obese adolescents. Zhonghua Nei Ke Za Zhi 2002;41:221–3.Suche in Google Scholar

49. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362–74.10.1056/NEJMoa031049Suche in Google Scholar PubMed

50. Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study. Diabetes 2002;51:204–9.10.2337/diabetes.51.1.204Suche in Google Scholar PubMed

51. Chen W, Srinivasan SR, Li S, Xu J, Berenson GS. Metabolic syndrome variables at low levels in childhood are beneficially associated with adulthood cardiovascular risk: the Bogalusa Heart Study. Diabetes Care 2005;28:126–31.10.2337/diacare.28.1.126Suche in Google Scholar PubMed

52. Jago R, McMurray RG, Drews KL, Moe EL, Murray T, et al. HEALTHY intervention: fitness, physical activity, and metabolic syndrome results. Med Sci Sports Exerc 2011;43:1513–22.10.1249/MSS.0b013e31820c9797Suche in Google Scholar PubMed PubMed Central

53. Wiegand S, l’Allemand D, Hübel H, Krude H, Bürmann M, et al. Metformin and placebo therapy both improve weight management and fasting insulin in obese insulin-resistant adolescents: a prospective, placebo-controlled, randomized study. Eur J Endocrinol 2010;163:585–92.10.1530/EJE-10-0570Suche in Google Scholar PubMed

54. Reinehr T, Kleber M, Toschke AM. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence. Atherosclerosis 2009;207:174–80.10.1016/j.atherosclerosis.2009.03.041Suche in Google Scholar PubMed

Received: 2013-1-16
Accepted: 2013-5-14
Published Online: 2013-06-08
Published in Print: 2013-11-01

©2013 by Walter de Gruyter Berlin Boston

Artikel in diesem Heft

  1. Masthead
  2. Masthead
  3. Review article
  4. Application of imaging modalities for evaluating neuroblastoma
  5. Images in pediatric endocrinology
  6. Lingual thyroid
  7. Original articles
  8. A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism
  9. Fasting glucagon-like peptide-1 in patients with overt hyperthyroidism and euthyroid congenital hypothyroidism
  10. Perinatal complications and higher risks of offspring thyroid dysfunction in early childhood of Graves’ disease mothers with euthyroidism
  11. Clinical characteristics and management of cranial diabetes insipidus in infants
  12. Desmopressin administration in children with central diabetes insipidus: a retrospective review
  13. An electronic surveillance system for monitoring the hospital presentation of nutritional vitamin D deficiency in children in Scotland
  14. Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted
  15. Vitamin D status is associated with early markers of cardiovascular disease in prepubertal children
  16. Evaluation of bone mineral density in children with type 1 diabetes mellitus
  17. Observational study of diabetes management in type 1 diabetic school-age children during holiday versus school days
  18. Relationship of body mass index and GAD65 antibody status on β-cell secretion at diabetes onset in African-American children
  19. Serum dipeptidyl peptidase 4 activity in children with type 1 diabetes mellitus
  20. Concomitant autoantibodies in newly diagnosed diabetic children with transient celiac serology or proven celiac disease
  21. Assessment of user-friendliness of the Norditropin FlexPro for pediatric patients treated with recombinant human growth hormone: results of an open-label user survey
  22. Cognitive impairment and gray/white matter volume abnormalities in pediatric patients with Turner syndrome presenting with various karyotypes
  23. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)
  24. Prevalence of metabolic syndrome in obese Chilean children and association with gene variants of the leptin-melanocortin system
  25. Evaluation of serum neopterin levels and its relationship with adipokines in pediatric obesity-related nonalcoholic fatty liver disease and healthy adolescents
  26. Could GSD type I expand the spectrum of disorders with elevated plasma chitotriosidase activity?
  27. Patient reports
  28. Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
  29. Successful subcutaneous glucagon use for persistent hypoglycaemia in congenital hyperinsulinism
  30. A novel atypical presentation of insulin autoimmune syndrome (Hirata’s disease) in a child
  31. Diagnosis of septo-optic dysplasia in a neonate with hypernatremia, hypoglycemia, and persistent hypothermia
  32. Speech and language delay in two children: an unusual presentation of hyperthyroidism
  33. Lissencephaly presenting with congenital hypothyroidism
  34. PHEX gene mutation in a Chinese family with six cases of X-linked hypophosphatemic rickets
  35. Primary hyperparathyroidism as an extremely rare cause of secondary myelofibrosis in childhood
  36. A family with Camurati-Engelman disease: the role of the missense p.R218C mutation in TGFbeta1 in bones and endocrine glands
  37. A case of SCNN1A splicing mutation presenting as mild systemic pseudohypoaldosteronism type 1
  38. Central precocious puberty in a girl with Prader-Willi syndrome
  39. Type 1 diabetes mellitus in a patient with homozygous sickle cell anemia
  40. Short communication
  41. No impact of obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children
  42. Letter to the Editor
  43. Reliability and validity of homeostasis model assessment for insulin resistance and β-cell dysfunction in critically ill children with hyperglycemia
https://doi.org/10.1515/jpem-2013-0020
Schlagwörter für diesen Artikel
adolescents; HOMA-IR; insulin resistance; metabolic syndrome

Artikel in diesem Heft

  1. Masthead
  2. Masthead
  3. Review article
  4. Application of imaging modalities for evaluating neuroblastoma
  5. Images in pediatric endocrinology
  6. Lingual thyroid
  7. Original articles
  8. A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism
  9. Fasting glucagon-like peptide-1 in patients with overt hyperthyroidism and euthyroid congenital hypothyroidism
  10. Perinatal complications and higher risks of offspring thyroid dysfunction in early childhood of Graves’ disease mothers with euthyroidism
  11. Clinical characteristics and management of cranial diabetes insipidus in infants
  12. Desmopressin administration in children with central diabetes insipidus: a retrospective review
  13. An electronic surveillance system for monitoring the hospital presentation of nutritional vitamin D deficiency in children in Scotland
  14. Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted
  15. Vitamin D status is associated with early markers of cardiovascular disease in prepubertal children
  16. Evaluation of bone mineral density in children with type 1 diabetes mellitus
  17. Observational study of diabetes management in type 1 diabetic school-age children during holiday versus school days
  18. Relationship of body mass index and GAD65 antibody status on β-cell secretion at diabetes onset in African-American children
  19. Serum dipeptidyl peptidase 4 activity in children with type 1 diabetes mellitus
  20. Concomitant autoantibodies in newly diagnosed diabetic children with transient celiac serology or proven celiac disease
  21. Assessment of user-friendliness of the Norditropin FlexPro for pediatric patients treated with recombinant human growth hormone: results of an open-label user survey
  22. Cognitive impairment and gray/white matter volume abnormalities in pediatric patients with Turner syndrome presenting with various karyotypes
  23. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)
  24. Prevalence of metabolic syndrome in obese Chilean children and association with gene variants of the leptin-melanocortin system
  25. Evaluation of serum neopterin levels and its relationship with adipokines in pediatric obesity-related nonalcoholic fatty liver disease and healthy adolescents
  26. Could GSD type I expand the spectrum of disorders with elevated plasma chitotriosidase activity?
  27. Patient reports
  28. Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
  29. Successful subcutaneous glucagon use for persistent hypoglycaemia in congenital hyperinsulinism
  30. A novel atypical presentation of insulin autoimmune syndrome (Hirata’s disease) in a child
  31. Diagnosis of septo-optic dysplasia in a neonate with hypernatremia, hypoglycemia, and persistent hypothermia
  32. Speech and language delay in two children: an unusual presentation of hyperthyroidism
  33. Lissencephaly presenting with congenital hypothyroidism
  34. PHEX gene mutation in a Chinese family with six cases of X-linked hypophosphatemic rickets
  35. Primary hyperparathyroidism as an extremely rare cause of secondary myelofibrosis in childhood
  36. A family with Camurati-Engelman disease: the role of the missense p.R218C mutation in TGFbeta1 in bones and endocrine glands
  37. A case of SCNN1A splicing mutation presenting as mild systemic pseudohypoaldosteronism type 1
  38. Central precocious puberty in a girl with Prader-Willi syndrome
  39. Type 1 diabetes mellitus in a patient with homozygous sickle cell anemia
  40. Short communication
  41. No impact of obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children
  42. Letter to the Editor
  43. Reliability and validity of homeostasis model assessment for insulin resistance and β-cell dysfunction in critically ill children with hyperglycemia
Jetzt anmelden und 20% sparen
Institutioneller Zugang
Wie funktioniert Authentifizierung?
Haben Sie eine Idee, wie wir unsere Website verbessern können?
Bitte schreiben Sie uns.
© 2026 De Gruyter Brill
Heruntergeladen am 12.1.2026 von https://www.degruyterbrill.com/document/doi/10.1515/jpem-2013-0020/html?lang=de
Button zum nach oben scrollen