Efeitos da metformina no tratamento da obesidade e na resistência à insulina em crianças e adolescentes: Uma Revisão Sistemática

Louise Cominato, Tulio Konstantyner, Aline de Paula Souza Bezerra de Lima, Daniela Bruno Conforti, Lucas Kieling Bittencourt, Marcella Rocha Machado de Oliveira, Veridiana Tagliari de Angelo

Resumo


 

Introdução: Obesidade atinge crianças e adolescentes, aumentando a resistência à insulina e risco para DM2. Tratamentos atuais apresentam baixa eficácia em relação à perda de peso.

Objetivo: Avaliar ação da metformina no IMC e na resistência à insulina em crianças e adolescentes obesos.

Materiais e Métodos: Busca nas bases PubMed e MEDLINE, utilizando palavras-chave obesity, metformin, pediatric. Ensaios clínicos randomizados com mais de 3 no escore Jadad foram inclusos.

Resultados: Entre os 5 estudos, a dose máxima foi 2000 mg/dia, de 3 a 6 meses. A diminuição do IMC foi de 1,07 a 1,4 kg/m2 comparado ao controle. Um estudo demonstrou diminuição significativa da resistência à insulina.

Conclusão: A metformina reduz IMC em pacientes obesos, porém não reduz resistência à insulina. Maiores estudos são necessários para identificar candidatos à metformina.


Texto completo:

PDF

Referências


Rogovik AL, Chanoine JP, Goldman RD. Pharmacotherapy and weight-loss supplements for treatment of paediatric obesity. Drugs. 2010 Feb 12; 70(3):335-46.

Fleischman A, Rhodes ET. Management of obesity, insulin resistance and type 2 diabetes in children: consensus and controversy. Diabetes Metab Syndr Obes. 2009; 2:185–202.

World Health Organization. World Health Statistics 2009. Disponível em: . Acesso em 7 agost 2009.

Acosta MC, Manubay J, Levin FR. Pediatric obesity: parallels with addiction and treatment recommendations. Harv Rev Psychiatry. 2008; 16(2):80-96.

Glaser Pediatric Research Network Obesity Study Group. Intraperitoneal fat and insulin resistance in obese adolescents. Obesity (Silver Spring). 2010 Feb; 18(2):402-9.

Nammi S. et al. Obesity: an overview on its current perspectives and treatment options. Nutr J. 2004; 3:3.

Marshall SJ. et al. Relationships between media use, body fatness and physical activity in children and youth: a meta-analysis. Int J Obes Relat Metab Disord. 2004; 28(10):1238–46.

Baur LA, Hazelton B, Shrewsbury VA. Assessment and management of obesity in childhood and adolescence. Nat Rev Gastroenterol Hepatol. 2011 Oct 4; 8(11):635-45.

US Preventive Services Task Force. Screening and interventions for overweight in children and adolescents: recommendation statement. Pediatrics. 2005; 116 (1):205-9.

McDonagh MS. et al. Systematic review of the benefits and risks of metformin in treating obesity in children aged 18 years and younger. JAMA Pediatr. 2014 Feb; 168(2):178-84.

Burgert TS. et al. Short-term metabolic and cardiovascular effects of metformin in markedly obese adolescents with normal glucose tolerance. Pediatr Diabetes. 2008 Dec; 9(6):567-76.

Weiss R. et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004; 350:2362–2374.

Mauras N. et al. Metformin use in children with obesity and normal glucose tolerance--effects on cardiovascular markers and intrahepatic fat. J Pediatr Endocrinol Metab. 2012; 25(1-2):33-40.

Matson KL, PharmD, Fallon RM. Treatment of Obesity in Children and Adolescents. J Pediatr Pharmacol Ther. 2012; 17(1):45–57.

Centers for Disease Control and Prevention US Department of Health and Human Services. Overweight and Obesity. Disponível em: . Acesso em: 19 nov. 2011.

Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatric Endocrinol Metab. 2008 Apr; 21(4):339-48.

Freemark M. Pharmacologic approaches to the prevention of type 2 diabetes in high risk pediatric patients. J Clin Endocrinol Metab. 2003; 88:3-13.

Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004; 89:2526-2539.

Decsi T, Molnar D. Insulin resistance syndrome in children: pathophysiology and potential management strategies. Pediatr Drugs. 2003; 5:291-299.

Brufani C. et al. Systematic review of metformin use in obese non diabetic children and adolescents. Horm Res Paediatr. 2013; 80(2):78-85.

US Food and Drug Administration. Orlistat Update Pediatric Advisory Committee Meeting. March 22, 2010. Disponível em: . Acesso em: 25 nov. 2011.

Dolinsky DH, Armstrong SC, Kinra S. The clinical treatment of childhood obesity. Indian J Pediatr. 2013 Mar; 80 Suppl 1:S48-54.

Iughetti L. et al. Pharmacological treatment of obesity in children and adolescents: present and future. J Obes. 2011; 2011:928165.

Wald AB, Uli NK. Pharmacotherapy in pediatric obesity: current agents and future directions. Rev Endocr Metab Disord. 2009 Sep; 10(3):205-14.

Kay JP. et al Beneficial effects of metformin in normoglycemic morbidly obese adolescents. Metabolism. 2001 Dec; 50(12):1457-61.

Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med. 2002; 137:25 – 33.

Prager R, Schernthaner G, Graf H: Effect of metformin on

peripheral insulin sensitivity in non-insulin-dependent mellitus. Diabet Med. 1988; 5:315-319.

Groop L. et al: Different effects of insulin and oral ant-diabetic agents on glucose and energy metabolism in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1989; 32:599-605.

August GP. et al; Endocrine Society. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008; 93:4576–99.

Penildon S. Farmacologia – Rio de Janeiro: Editora Guanabara Koogan, 2010; 8. ed., p.818.

Catoira N. et al. Pharmacological treatment of obesity in children and adolescents: current status and perspectives. Expert Opin Pharmacother. 2010; 11:2973–2983.

Quinn SM. et al. Treatment of clinical insulin resistance in children: a systematic review. Obesity Rev. 2010; 11:722–730.

Freemark M, Bursey D. The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics. 2001 Apr; 107(4):E55.

Srinivasan S. et al. Randomized, controlled trial of metformin for obesity and insulin resistance in children and adolescents: improvement in body composition and fasting insulin. J Clin Endocrinol Metab. 2006 Jun; 91(6):2074-80.

Wilson DM. et al. Glaser Pediatric Research Network Obesity Study Group. Metformin extended release treatment of adolescent obesity: a 48-week randomized, double-blind, placebo-controlled trial with 48-week follow-up. Arch Pediatr Adolesc Med. 2010 Feb; 164(2):116-23.

Kendall D. et al. Metformin in obese children and adolescents: the MOCA trial. J Clin Endocrinol Metab. 2013 Jan; 98(1):322-9.

Evia-Viscarra ML. et al. The effects of metformin on inflammatory mediators in obese adolescents with insulin resistance: controlled randomized clinical trial. J Pediatr Endocrinol Metab. 2012; 25(1-2):41-9.

Sociedade Brasileira de Pediatria, Departamento de Nutrologia. Obesidade na infância e adolescência – Manual de Orientação. São Paulo, 2008.

Pereira PF. et al. Circunferência da cintura e relação cintura/estatura: úteis para identificar risco metabólico em adolescentes do sexo feminino? Rev Paul Pediatr. set 2011; 29(3):372-377.

Weiss R. et al. The “obese insulin sensitive” adolescent: importance of adiponectin and lipid partitioning. J Clin Endocrinol Metab. 2005; 90:3731–3737.

Rodriguez G. et al Body composition in adolescents: measurements and metabolic aspects. Int J Obes Relat Metab Disord. 2004; 28(Suppl 3):S54–S58.

Park HS, Lee K. Greater beneficial effects of visceral fat reduction compared with subcutaneous fat reduction on parameters of the metabolic syndrome: a study of weight reduction programmes in subjects with visceral and subcutaneous obesity. Diabet Med. 2005; 22:266–272.

Vasques ACJ. et al. Análise crítica do uso dos índices do Homeostasis Model Assessment (HOMA) na avaliaçõa da resistência à insulina e capacidade funcional das células-beta pancreáticas. Arq bras endocrinol metab. fev 2008; 52(1):32-39.

Geloneze B, Tambascia MA. Avaliação laboratorial e diagnóstico da resistência insulínica. Arq bras endocrinol metab. abr 2006; 50(2): 208-215.


Apontamentos

  • Não há apontamentos.


Direitos autorais 2016 Revista UNILUS Ensino e Pesquisa - RUEP

ISSN (impresso): 1807-8850
ISSN (eletrônico): 2318-2083

Periodicidade: Trimestral

Primeiro trimestre, jan./mar., limite para publicar a edição - 31 de maio
Segundo trimestre, abr./jun., limite para publicar a edição - 31 de agosto
Terceiro trimestre, jul./set., limite para publicar a edição - 30 de novembro
Quarto trimestre, out./dez., limite para publicar a edição - 31 de março

Licença Creative Commons
Este obra está licenciado com uma Licença Creative Commons Atribuição-NãoComercial-SemDerivações 4.0 Internacional.

 

Indexadores

 

Estatística de Acesso à RUEP

Monitorado desde 22 de novembro de 2016.