QUALITATIVE DIFFERENCES IN GLUCOSE HOMEOSTASIS BETWEEN OBESITY OF PRADER-WILLI SYNDROME (PWS) AND NORMAL CHILDHOOD OBESITY (NL-OB)

Abstract

Obesity is associated with insulin resistance and glucose intolerance. Our studies of Nl-ob and obese PWS children suggest another factor contributes to pathology of glucose homeostasis, in addition to increased adipose tissue. We studied 32 Nl-ob children (age 3-18 yrs) and 18 PWS children (age 6-19 yrs) given a mixed liquid "milkshake" meal (4 Kcal/kg). Serum levels of pancreatic polypeptide (PP), glucose (G), insulin (I) and gastric inhibitory polypeptide (GIP) were obtained at 0,15,30,45,60,90,120,180 min. There was no significant difference between weights of Nl-ob pts. (172±32%; mean±SD) and PWS pts. were 205±61% of ideal body weight for height.

The PWS children with hyperphagia induced obesity had better glucose homeostasis and less insulin resistance than did the age matched, equally obese, normal children. Insulin resistance and glucose intolerance are not a uniform consequence of obesity; a reason for individual differences in susceptibility is not known. The differences between our groups may reflect a relative absence of an insulin hypersecretory-insulin resistance factor in the PWS group. Our data support the hypothesis that GIP hypersecretion may be causal. The PP deficiency may play a secondary role.

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