August 22, 2018
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Metformin may be safe, effective option for children with obesity

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Among children with obesity, metformin may serve as a safe and effective adjunct to lifestyle therapy for weight loss, according to findings published in Childhood Obesity.

“The mainstay of management of childhood obesity is based on lifestyle modification,” Loretta S. Warnakulasuriya, MBBS, of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, and colleagues wrote in the study background. “Although dietary modification and increased physical activity are the main components, long-term compliance to them remains very poor. While some of these programs have shown to be effective in improving anthropometric parameters, their effectiveness in improving the body composition and reversing the insulin resistance and metabolic derangements remain unclear.”

In a triple-blind randomized controlled trial, researchers evaluated data from 150 children with obesity aged 8 to 16 years identified through a screening program conducted in schools in the Negombo educational zone of Sri Lanka. The researchers stratified participants by age groups (aged 8 to 10 years and aged 11 to 16 years) for purposes of dosing.

Researchers conducted a baseline evaluation after a 12-hour overnight fast, assessing height, weight, waist circumference and percent fat mass, expressed as a fraction of total body weight, as well as blood pressure, blood glucose, serum total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, insulin, alanine transaminase, aspartate transaminase, and high-sensitivity C-reactive protein. Children underwent an oral glucose tolerance test, and insulin resistance was measured using the homeostatic model assessment of insulin resistance.

Researchers randomly assigned participants in each age group to two parallel treatment arms, either metformin (500 mg twice daily for children aged 8 to 10 years; 1 g twice daily for children aged 11 to 16 years) or placebo. Caregivers were masked to the treatment assignments.

At 6 and 12 months, anthropometric measurements were taken again. The researchers used analysis of covariance to compare mean difference in outcome measures, adjusted for baseline values.

Within the cohort, 25 children (16.7%) had metabolic syndrome.

When compared with placebo, metformin was associated with a greater reduction in BMI per age standard deviation score (SDS) at 6 and 12 months, according to researchers. Mean BMI per age SDS fell from 2.58 to 2.39 in the metformin groups and from 2.54 to 2.42 in the placebo groups.

At 12 months, the reduction in BMI per age SDS persisted, with a mean of 2.21 in the metformin group vs. 2.32 in the placebo group.

At 6 months, Children in the metformin group experienced an adjusted mean reduction in percent fat mass per age SDS of –0.092 vs. –0.016 in the placebo group. The difference persisted at 12 months, but was no longer statistically significant, according to researchers.

The metformin groups also experienced greater reductions in systolic BP, total cholesterol, LDL cholesterol and high-sensitivity C-reactive protein at 6 months; however, only the reduction in systolic BP persisted for the metformin at 12 months, according to researchers.

No adverse events were reported.

“Metformin was shown to bring overall improvement as well as to be safe in use in obese children,” the researchers wrote. “Therefore, metformin would be a good adjunct to lifestyle modifications and would help in achieving some control in the management of childhood obesity.” – by Jennifer Byrne

Disclosures: The authors report no relevant financial disclosures.