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Pediatric Hypertension pp 91–112Cite as

Insulin Resistance and Other Mechanisms of Obesity Hypertension

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Abstract

Insulin has important biological effects on the metabolic regulation of carbohydrates, lipids, and proteins. In addition, it has important influences on the vasculature, kidneys, and the sympathetic nervous system. Insulin resistance (or loss of insulin sensitivity) is typically defined as decreased insulin-mediated glucose disposal in the body in response to physiological (endogenous) or exogenous insulin. Insulin resistance is most commonly associated with obesity, although not all obese individuals are insulin resistant, and insulin resistance may be present in nonobese individuals. It can have important adverse consequences on the vasculature and blood pressure, thought to be mediated via vascular inflammation, nitric oxide action, sympathetic nervous system, and renal sodium retention. The “gold standard” for measurement of insulin sensitivity is glucose clamp studies; and the most widely used index for insulin resistance, is the homeostasis model for insulin resistance (HOMA-IR). The prevalence of insulin resistance and its adverse effects have been found to be higher in children and adolescents with obesity, diabetes, chronic kidney disease, and associated with low-birth weight. Modifications in diet, especially use of DASH diet, physical activity, and drugs such as metformin have been found to be effective in improving insulin resistance. Genetic and epigenetic mechanisms likely influence insulin resistance and are an active area of research.

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Authors and Affiliations

  1. Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, Russ Berrie Medical Sciences Pavilion, 1150 St Nicholas Ave, 10032, New York, NY, USA

    Vidhu V. Thaker

  2. Division of Endocrinology, Boston Childrens Hospital, Harvard Medical School, Boston, MA, USA

    Vidhu V. Thaker

  3. Departments of Medicine and Pediatrics, Thomas Jefferson University, 833 Chestnut Street, Suite 700, 19107, Philadelphia, PA, USA

    Bonita Falkner

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  1. Vidhu V. Thaker
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  2. Bonita Falkner
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Correspondence to Vidhu V. Thaker .

Editor information

Editors and Affiliations

  1. University of Washington School of Medicine, Department of Pediatrics and Seattle Children’s Hospital Division of Nephrology, Seattle, WA, USA

    Joseph T. Flynn

  2. Division of Nephrology MassGeneral for Children at Massachusetts General Hospital, Harvard Medical School Department of Pediatrics, Boston, MA, USA

    Julie R. Ingelfinger

  3. St. Luke’s Health System, Children’s Nephrology and Hypertension, Boise, ID, USA

    Karen M. Redwine

Section Editor information

  1. Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Harvard Medical School, Fruit St. 55, 02114, Boston, MA, USA

    Julie R. Ingelfinger M.D.

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Thaker, V.V., Falkner, B. (2018). Insulin Resistance and Other Mechanisms of Obesity Hypertension. In: Flynn, J., Ingelfinger, J., Redwine, K. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31107-4_39

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