Childhood Predictors of Adult Type 2 Diabetes at 9- and 26-Year Follow-ups

Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
JAMA Pediatrics (Impact Factor: 5.73). 01/2010; 164(1):53-60. DOI: 10.1001/archpediatrics.2009.228
Source: PubMed


To determine whether pediatric office measures (waist circumference, body mass index [BMI], systolic [SBP] and diastolic [DBP] blood pressure, and parental diabetes) and laboratory measures (glucose, triglyceride, high-density lipoprotein cholesterol, and insulin) predict risk of type 2 diabetes mellitus (T2DM) at ages 19 and 39 years.
Nine- and 26-year prospective follow-ups of schoolchildren.
Urban and suburban schools.
One thousand sixty-seven girls starting at age 10 years in the National Growth and Health Study and 822 schoolchildren aged 6 to 18 years at entry from the Princeton Follow-up Study. Outcome Measure Development of T2DM.
In the Princeton Follow-up Study, childhood SBP and BMI in the top fifth percentile and black race predicted T2DM at age 39 years (area under the receiver-operator curve [AUC] = 0.698). Adding a childhood glucose level of 100 mg/dL or higher, and high-density lipoprotein cholesterol in the bottom fifth percentile and triglyceride concentration in the top fifth percentile as explanatory variables increased AUC to 0.717 and 0.709, respectively. If childhood BMI, SBP, and DBP were all lower than the 75th percentile, likelihood of T2DM at age 39 years was 2%; the likelihood was 1% if the parents had no DM. In the National Growth and Heath Study, SBP in the top fifth percentile and parental diabetes predicted T2DM at age 19 years (AUC = 0.699). Adding insulin in the top fifth percentile increased AUC to 0.764, with insulin being a significant variable. If childhood BMI, SBP, and DBP were all lower than the 75th percentile, the likelihood of T2DM at age 19 years was 0.2%, 0.2% if the parents were also free of DM, and 0.3% if childhood insulin was also less than the 75th percentile.
Office-based childhood measures predict the presence and absence of future T2DM 9 and 26 years after baseline. Childhood insulin measurement improves prediction, facilitating approaches to primary prevention of T2DM.

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    • "A key finding was that Infrequently Active children and youth – children and youth who accumulated 60 minutes of MVPA on average per day but who met this 60 minute target <5 days per week – were more insulin resistant than Frequently Active children and youth. This is an important observation given the strong, independent effects that insulin resistance has on the development of type 2 diabetes [36,37] and coronary heart disease [38,39]. The differences in insulin resistance between Infrequently Active and Frequently Active children and youth appeared to be attributable to differences in the weekly frequency of meeting the daily target of 60 minutes of MVPA rather than to differences in the weekly volume of MVPA. "
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    ABSTRACT: Background The influence of the fractionalization of moderate- to vigorous- intensity physical activity (MVPA) throughout the week on the health of children is unknown. We compared cardiometabolic risk factors in physically active children who accumulated their weekly MVPA in different patterns. Methods We studied 745 participants aged 6–19 years. MVPA was measured using accelerometers over 7 days. Three groups were created: Insufficiently Active, <60 minutes/day of MVPA on average; Infrequently Active, ≥60 minutes/day of MVPA on average but exceeding the 60 minute target <5 days; and Frequently Active, ≥60 minutes/day MVPA on average and exceeding the 60 minute target ≥5 days. Percentile scores for 8 cardiometabolic risk factors were determined. Results The least favorable cardiometabolic risk factor profile was observed in the Insufficiently Active group. The Frequently Active group had more favorable (5–6 percentile unit difference) diastolic blood pressure, HDL-cholesterol, insulin resistance, and metabolic syndrome scores than the Infrequently Active group, although only the difference for insulin resistance was statistically significant (P < 0.05). These differences remained after controlling for the weekly volume of MVPA. Conclusion The fractionalization of MVPA throughout the week was associated with insulin resistance.
    BMC Public Health 06/2013; 13(1):554. DOI:10.1186/1471-2458-13-554 · 2.26 Impact Factor
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    • "It is now known that overweight and obesity in childhood are associated with an increased risk of hypertension, diabetes, dyslipidemia and obesity in adulthood [9,10]. A number of studies from the USA (including the Bogalusa Heart Study) [11,12] and Finland [13,14] have shown that diseases that appear during older age may have their origin in earlier stages of life. "
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    ABSTRACT: Background This paper describes a methodology for comparing the effects of an eduentertainment strategy involving a music concert, and a participatory class experience involving the description and making of a healthy breakfast, as educational vehicles for delivering obesity-preventing/cardiovascular health messages to children aged 7–8 years. Methods/design This study will involve a cluster-randomised trial with blinded assessment. The study subjects will be children aged 7–8 years of both sexes attending public primary schools in the Madrid Region. The participating schools (n=30) will be randomly assigned to one of two groups: 1) Group MC, in which the children will attend a music concert that delivers obesity-preventing/cardiovascular health messages, or 2) Group HB, in which the children will attend a participatory class providing the same information but involving the description and making of a healthy breakfast. The main outcome measured will be the increase in the number of correct answers scored on a knowledge questionnaire and in an attitudes test administered before and after the above interventions. The secondary outcome recorded will be the reduction in BMI percentile among children deemed overweight/obese prior to the interventions. The required sample size (number of children) was calculated for a comparison of proportions with an α of 0.05 and a β of 0.20, assuming that the Group MC subjects would show values for the measured variables at least 10% higher than those recorded for the subjects of Group HB. Corrections were made for the design effect and assuming a loss to follow-up of 10%. The maximum sample size required will be 2107 children. Data will be analysed using summary measurements for each cluster, both for making estimates and for hypothesis testing. All analyses will be made on an intention-to-treat basis. Discussion The intervention providing the best results could be recommended as part of health education for young schoolchildren. Trial registration NCT01418872
    BMC Public Health 11/2012; 12(1):1024. DOI:10.1186/1471-2458-12-1024 · 2.26 Impact Factor
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    • "This difference might be explained by the lower average age in this overall cohort (1,9–11) and ethnic difference of our cohort, especially when compared with that in the study of Pima Indians (8). Nonetheless, the observed incidence rate of type 2 diabetes at ages 18–29 (1,16,17), 30–39 (17), and 40–50 years (5) did not differ from other previous findings. In the Bogalusa sample (4), as parents of a children’s study, they were younger and blacks were about twice more than whites. "
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    ABSTRACT: The risk factors for middle-age onset of type 2 diabetes are well known. However, information is scant regarding the age onset of type 2 diabetes and its correlates in community-based black and white relatively young adults. This prospective cohort study consisted of normoglycemic (n = 2,459) and type 2 diabetic (n = 144) adults aged 18-50 years who were followed for an average of 16 years. The incidence rate of the onset of type 2 diabetes was 1.6, 4.3, 3.9, and 3.4 per 1,000 person-years for age-groups 18-29, 30-39, and 40-50 and total sample, respectively. Incidences of diabetes increased with age by race and sex groups (P for trend ≤ 0.01); higher in black females versus white females and blacks versus whites in total sample (P < 0.05). In a multivariable Cox model, baseline parental diabetes (hazard ratio [HR] 5.24) and plasma insulin were significantly associated with diabetes incidence at the youngest age (18-29 years); black race, BMI, and glucose at age 30-39 years; female sex, parental diabetes (HR 2.44), BMI, ratio of triglycerides and HDL cholesterol (TG/HDL-C ratio), and glucose at age 40-50 years; and black race, parental diabetes (HR 2.44), BMI, TG/HDL-C ratio, and glucose in whole cohort. Further, patients with diabetes, regardless of age onset, displayed a significantly higher prevalence of maternal history of diabetes at baseline (P < 0.01). In relatively young adults, predictability of baseline cardiometabolic risk factors along with race, sex, and parental history of diabetes for the onset of type 2 diabetes varied by age-group. These findings have implications for early prevention and intervention in relatively young adults.
    Diabetes care 03/2012; 35(6):1341-6. DOI:10.2337/dc11-1818 · 8.42 Impact Factor
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