Short Stature and the Risk of Adiposity, Insulin Resistance, and Type 2 Diabetes in Middle Age

Abstract

OBJECTIVE -To investigate the association between stature-related measurements (height, leg length, and leg length-to-height ratio) and adiposity, insulin resistance, and glucose intolerance.RESEARCH DESIGN AND METHODS -We conducted a cross-sectional analysis of a nationally representative sample of 7,424 adults aged 40 -74 years, from the Third National Health and Nutrition Examination Survey (1988Survey ( -1994. The main outcome measures were percent body fat, homeostasis model assessment of insulin resistance (HOMA-IR), and glucose intolerance based on the World Health Organization's 1985 criteria for an oral glucose tolerance test.RESULTS -Shorter height and leg length, and lower leg length-to-height ratio, were associated with higher percent body fat, especially in women. Lower leg length-to-height ratio was associated with greater insulin resistance estimated by HOMA-IR. In multinomial regression models adjusting for potential confounders, including percent body fat, the relative prevalence of type 2 diabetes per 1-SD lower values in height, leg length, and leg length-to-height ratio were 1.10 (95% CI 0.94 -0.29), 1.17 (0.98 -1.39), and 1.19 (1.02-1.39), respectively. CONCLUSIONS -Our study supports the hypothesis that adult markers of prepubertal growth, especially leg length-to-height ratio, are associated with adiposity, insulin resistance, and type 2 diabetes in the general U.S. population. Diabetes Care 29:1632-1637, 2006B arker et al. (1) have hypothesized an association between impaired nutrition in utero and later development of chronic diseases, such as cardiovascular disease, hypertension, and diabetes. Children who are born small and then display "catch-up growth" are thought to be at highest risk (2,3). To facilitate the epidemiologic study of these hypotheses, it is helpful to focus on adult traits that are indicators of childhood development. Stature is one such trait.Adult stature and its components reflect childhood growth patterns: leg length is an indicator of prepubertal growth (4), evidence of which is usually hard to obtain directly in adulthood. Normal growth curves show that leg lengthening slows at about 13 years of age for girls and 16 years of age for boys (4). The ratio of sitting height to leg length falls rapidly between birth and 4 years of age (5,6). A recent study showed that attained leg length was positively associated with having been breast-fed (7,8) and with energy intake at 4 years of age (8).Several studies have established an association between short stature in adulthood and the risk of obesity (9 -11), insulin resistance (11,12), and glucose intolerance (10,13-22). Furthermore, some studies have suggested an association with leg length in particular (9,10,12,22). However, previous studies of anthropometry and glucose metabolism focused only on gestational diabetes (17-19,22) or used samples of only men (12) or only women (10,11). None used samples of the general U.S. population (9 -22), and many studies did not account for the potentially confounding effects of so...

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