Utility of Childhood Glucose Homeostasis Variables in Predicting Adult Diabetes and Related Cardiometabolic Risk Factors: The Bogalusa Heart Study

The Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
Diabetes care (Impact Factor: 8.42). 12/2009; 33(3):670-5. DOI: 10.2337/dc09-1635
Source: PubMed


This study examines the usefulness of childhood glucose homeostasis variables (glucose, insulin, and insulin resistance index [homeostasis model assessment of insulin resistance {HOMA-IR}]) in predicting pre-diabetes and type 2 diabetes and related cardiometabolic risk factors in adulthood.

This retrospective cohort study consisted of normoglycemic (n = 1,058), pre-diabetic (n = 37), and type 2 diabetic (n = 25) adults aged 19–39 years who were followed on average for 17 years since childhood.

At least 50% of the individuals who ranked highest (top quintile) in childhood for glucose homeostasis variables maintained their high rank by being above the 60th percentile in adulthood. In a multivariate model, the best predictors of adulthood glucose homeostasis variables were the change in BMI Z score from childhood to adulthood and childhood BMI Z score, followed by the corresponding childhood levels of glucose, insulin, and HOMA-IR. Further, children in the top decile versus the rest for insulin and HOMA-IR were 2.85 and 2.55 times, respectively, more likely to develop pre-diabetes; children in the top decile versus the rest for glucose, insulin, and HOMA-IR were 3.28, 5.54, and 5.84 times, respectively, more likely to develop diabetes, independent of change in BMI Z score, baseline BMI Z score, and total-to-HDL cholesterol ratio. In addition, children with adverse levels (top quintile versus the rest) of glucose homeostasis variables displayed significantly higher prevalences of, among others, hyperglycemia, hypertriglyceridemia, and metabolic syndrome.

Adverse levels of glucose homeostasis variables in childhood not only persist into adulthood but also predict adult pre-diabetes and type 2 diabetes and relate to cardiometabolic risk factors.

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Available from: Gerald S Berenson, Jan 17, 2015
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    • "It is widely reported that the natural history of rheumatic heart disease (RHD) is more aggressive in developing countries, manifesting symptoms and requiring interventions at a younger age than in industrialized nations [1] [2] [3] [4] [5]. As the demographics in urban America shift with growing immigrant minorities from Latin America and other developing countries, it is possible that the demographics and natural history of RHD in the U.S. are changing as well. "
    International Journal of Cardiology 04/2014; 175(1). DOI:10.1016/j.ijcard.2014.04.105 · 4.04 Impact Factor
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    • "Lots of studies have shown that maternal hyperglycemia during pregnancy is associated with increased risk of specific maternal-fetal complications, including pregnancy induced hypertension (PIH), preeclampsia, cesarean section, stillbirth, congenital defects, neonatal hypoglycemia and neonatal hyperbilirubinemia [3-5]. In the long term, for the mothers, there is an increased risk for developing Type 2 diabetes mellitus (T2DM) after pregnancy [2,6]; for the offspring, studies have provided substantial evidences that intrauterine exposure to maternal hyperglycemia has lifelong effects, including increased risk of obesity [7,8], T2DM [9,10], metabolic [11-14] and cardiovascular disease [15,16] and even cancer [17]. These hyperglycemia-related short or long term dysfunctions are not only confined to women with Type 1 diabetes mellitus (T1DM) or T2DM diagnosed before gestation, but are also observed in women with GDM. "
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    ABSTRACT: The purposes of this study were to explore whether the maternal-fetal outcomes differed among various types of hyperglycemia during pregnancy and whether the values of glycemic screening in the middle phase of pregnancy could predict maternal-fetal outcomes. A retrospective study was conducted to study the incidence of maternal-fetal outcomes in 383 singleton pregnant women with diabetes or gestational diabetes admitted to our hospital from November 2007 to March 2013. Patients were divided into three groups: DM (Type 1 and Type 2 diabetes mellitus) group, mGDM (mild gestational diabetes mellitus) group and sGDM (severe gestational diabetes mellitus) group. Maternal basic characteristics, results of oral glucose tolerance test (OGTT), antenatal random glycemia and maternal-fetal outcomes were collected. Binary logistic regression was used to estimate the association of blood glucose with the maternal-fetal outcomes. Predictive accuracy was assessed by calculating the areas under the receiver operating characteristic curves. The maternal basic characteristics, maternal complications and neonatal complications did not differ significantly between DM group and sGDM group, except neonatal intensive care units admission (NICU). Incidences of preterm, NICU and preeclampsia were significantly lower in the mGDM group than in the DM and sGDM groups (P < 0.05). After adjusted by confounding factors, the value of OGTT 0 h could predict pregnancy induced hypertension (PIH) (OR = 1.24, 95%CI [1.04 to 1.46], P = 0.015), preterm birth (OR = 1.23, 95%CI [1.03 to 1.47], P = 0.025) and stillbirth (OR = 1.55, 95%CI [1.14 to 2.10], P = 0.005); antenatal random glycemia could predict preterm birth (OR = 1.19, 95%CI [1.08 to 1.31], P < 0.001) and stillbirth (OR = 1.41, 95%CI [1.17 to 1.71], P < 0.001). Pregnant women in the mGDM group have better outcomes than those in the DM and sGDM groups. The values of OGTT in the middle phase of pregnancy and antenatal random glycemia could predict PIH, preterm birth or stillbirth to some extent.
    BMC Pregnancy and Childbirth 01/2014; 14(1):34. DOI:10.1186/1471-2393-14-34 · 2.19 Impact Factor
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    • "There is growing interest in the identification of cardiovascular risk factors at an early stage of life because increased BMI (1), altered glucose homeostasis (2), and high blood pressure (3) in childhood are associated with a high risk of developing obesity, diabetes, hypertension, and coronary artery disease in adulthood. Few prospective studies have analyzed the abnormalities of the lipid profile from childhood to adulthood. "
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    ABSTRACT: To evaluate whether the high triglyceride-to-HDL cholesterol (TG-to-HDL-C) ratio is associated with cardiometabolic risk (CMR) factors and preclinical signs of organ damage in an outpatient population of white children and adolescents. The study population included 884 subjects (aged 6-16 years), of whom 206 (23%) were normal weight, 135 (15%) were overweight, and 543 (61%) were obese. Biochemical variables were analyzed in the whole sample, whereas homocysteine and left ventricular (LV) geometry and function were evaluated in 536 and 258 children, respectively. The percentage of pubertal children (P < 0.001), as well as measurements of BMI, waist circumference, homeostasis model assessment of insulin resistance, white blood cell count, alanine aminotransferase (ALT), systolic blood pressure (P < 0.0001, for all), creatinine (P < 0.001), and diastolic blood pressure (P < 0.02), increased from the lowest to the highest tertile of the TG-to-HDL-C ratio. Age, sex, homocysteine, and glomerular filtration rate did not change. Moreover, interventricular septum thickness, relative wall thickness, and LV mass index (P = 0.01 to P < 0.0001) increased across tertiles of the TG-to-HDL-C ratio. Children with a TG-to-HDL-C ratio ≥2.0 showed a two- to threefold higher risk of elevated ALT levels and concentric LV hypertrophy than those with a TG-to-HDL-C ratio <2.0, independent of confounding factors. The high TG-to-HDL-C ratio is associated with several CMR factors and preclinical signs of liver and cardiac abnormalities in the outpatient, white pediatric population. Thus, a TG-to-HDL-C ratio ≥2.0 may be useful in clinical practice to detect children with a worsened CMR profile who need monitoring to prevent cardiovascular disease in adulthood.
    Diabetes care 01/2012; 35(1):158-62. DOI:10.2337/dc11-1456 · 8.42 Impact Factor
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