Philip S. Zeitler - Insulin Resistance: Childhood Precursors of Adult Disease

Since the publication of the first edition of this book, there has been substantial progress in the understanding of insulin resistance and -cell function, as well as the contribution of these two factors to the pathophysiology of type 2 diabetes and other disorders associated with obesity. In particular, a deeper understanding of the unique pathophysiology of insulin resistance in childhood and the impact of insulin resistance across the lifespan is emerging. This understanding includes a greater appreciation of the impact of insulin action on development of body composition in the fetus, child, and adolescent; the unique impact of puberty and sex steroids; the role of insulin resistance in the fetus and early life in the programming of glucose metabolism and pancreatic function; the effect of insulin resistance on development of target organ abnormalities in the liver, kidney, and heart; and the now-established role of insulin resistance in the young as a risk for disease in adulthood. In the process, there has been increased recognition that, beyond risk for the future, disorders related to insulin resistance are also having serious metabolic and cardiorenal impacts resulting in life-altering diseases at a time when individuals should be reaching their prime years for education, work, and family. As a reflection that insulin resistance in the young is having both short-term and long-term effects, we have changed the name of this book to Insulin Resistance: Childhood Precursors of Adult Disease .

In this second edition, we have again brought together experts in the field to provide a comprehensive overview and update on a wide variety of topics related to insulin resistance in youth. In some cases, these contributions are updated and timely chapters from the first edition. In other cases, we have added new chapters to address areas not previously covered. The first part of the edition addresses the clinical presentation and assessment of insulin resistance in youth, as well as a new chapter on insulin resistance in chronic childhood disease, an increasing contributor to the clinical picture of insulin resistance in children. Part II reviews the pathophysiology of insulin resistance in youth, including mechanism of insulin resistance and impact on metabolism, contributions of the in utero and early childhood environments, the growing understanding of the relationship between puberty and insulin resistance, and current perspectives on the role of body composition and ectopic fat. It closes with reviews of the impact of insulin resistance on the heart, liver, and kidneys. Part III addresses unique clinical settings for insulin resistance in youth, including type 1 diabetes, intrauterine growth retardation, and adolescent polycystic ovary syndrome. Finally, Part IV focuses on treatment, with a discussion of whether insulin resistance itself should be considered a treatment target, as well as impact of exercise, weight loss medications, and bariatric surgery.