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Predicting Weight Response in Overweight Children

Doyle M. Cummings, PharmD, FCP, FCCP; Sarah Henes, MA, RD, LDN; Kathryn M. Kolasa, PhD, RD, LDN; John Olsson, MD; David Collier, MD, PhD

Arch Pediatr Adolesc Med. 2008;162(8):764-768.

Objective  To assess the relationship between insulin resistance and body mass index (BMI) z score associated with dietary modification that focuses on limiting sweetened beverage consumption in overweight children.

Design  A retrospective cohort study conducted between July 1, 2004, and April 28, 2006.

Setting  Community-based primary care practices treating children.

Patients  Forty-five children (aged 18 years) at or above the 95th percentile of BMI for age and sex.

Intervention  Children and parents were instructed by a dietitian regarding caloric reduction and modification of sweetened beverage intake.

Main Outcome Measures  Insulin resistance at baseline was calculated from fasting insulin and glucose levels (ie, homeostatic model assessment [HOMA]) and change in BMI z score from baseline to 12-week follow-up.

Results  Change in BMI z score in response to a decrease in sweetened beverages correlated (Pearson product moment correlation coefficient = 0.42; P < .01) with baseline insulin resistance. Those with a decrease in or an unchanged BMI z score had significantly greater insulin resistance than those whose BMI z score increased (mean [SD] HOMA, 6.2 [4.2] vs 2.6 [2.0], P < .01). Linear regression confirmed that HOMA was a significant predictor of change in BMI z score when controlling for age, race, and sex.

Conclusions  Among overweight children in primary care practices, a significant relationship was found between insulin resistance and the change in BMI z score associated with a dietitian-mediated intervention that includes a focus on decreasing sweetened beverage consumption. Estimating insulin resistance may inform dietary recommendations for overweight children.

Author Affiliations: Departments of Family Medicine (Drs Cummings and Kolasa) and Pediatrics (Drs Cummings, Kolasa, Olsson, and Collier and Ms Henes), Brody School of Medicine at East Carolina University, Greenville, North Carolina.

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