The role of insulin in clustering of serum lipids and blood pressure in children and adolescents The Cardiovascular Risk in Young Finns Study

Abstract

In adults hyperinsulinaemia is associated with an atherogenic risk profile including obesity, low levels of HDL-cholesterol, high levels of triglycerides and elevated blood pressure. To examine these associations in the young we studied the cross-sectional relationships of insulin with obesity indices (body mass index, subscapular skinfold thickness), serum lipids and blood pressure in 1,865 children, adolescents and young adults aged 6-24 years. We also used longitudinal data to study the value of a single insulin measurement to predict high risk factor levels and clustering of multiple risk factors after a 6-year follow-up. In cross-sectional analyses the levels of triglycerides, HDL-cholesterol, systolic blood pressure and obesity indices were usually significantly different across the quartiles of fasting insulin in both sexes among children, adolescents and young adults. In general, no associations were seen with total cholesterol or LDL-cholesterol. In prospective analysis elevated baseline insulin was related to the incidence of hypertriglyceridaemia (> or = 95th percentile) at the follow-up. This relationship persisted even after adjustments for baseline obesity or 6-year change in obesity status. Moreover, baseline insulin concentration was higher in subjects who subsequently showed clustering of high triglycerides, low HDL-cholesterol and high systolic blood pressure levels at the follow-up. We conclude that high fasting insulin levels measured in children and adolescents predict the development of hypertriglyceridaemia years later. In addition, high insulin levels seem to precede the development of a potentially atherogenic risk factor profile including low HDL-cholesterol, high triglycerides and high systolic blood pressure.

Metabolic Syndrome and Its Individual Components among Jordanian Children and Adolescents

“…While earlier studies in childhood had focused on the clustering of risk factors for cardiovascular diseases [7, 8], recent studies had reported the prevalence of MeS during childhood [9–11]. Several definitions have been proposed for MeS in children and some of these definitions followed the ATP III guidelines [9–14].…”

Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study

“…[10][11][12] Two 10,12 of the three common definitions include measures of insulin resistance, reflecting the proposed causal or mediating role insulin action plays in the development of MS. 13,14 In the paediatric literature there is no single definition of MS. [15][16][17] Barriers to a consistent, accepted definition for children and adolescents include use of adult cut points or a single set of cut points for all ages of childhood, the fact that disturbances seen in the metabolic indicators in most children are quantitatively moderate, lack of a normal range for insulin concentration across childhood, the insulin resistance of puberty, and lack of central obesity (waist) cut points linked to obesity morbidity or MS for children. If hyperinsulinaemia alone is used as a marker of MS in children, 18 it ignores the clustering of several metabolic indicators which is potentially of greater clinical significance.…”

Determination of the BMI threshold that predicts cardiovascular risk and insulin resistance in late childhood

“…Our observation indicates that children above BMI thresholds that predict cardiovascular risk at this stage also have elevated insulin resistance. Reaven proposed that insulin resistance is a fundamental cause of the clustering of cardiovascular risk factors [38] and several studies have reported that the risk factors become clustered with increased insulin resistance estimated by HOMA or the fasting insulin level not only in adults but also in children [17,[39][40][41][42]. However, to our knowledge, no studies have reported whether or how much more the children with cardiovascular risk are insulin resistant compared to those without the clustering who had the same BMI in late childhood.…”

“…the 75th percentile of fasting insulin and HOMA obtained from the study population [32][33][34]. These thresholds are similar to those used in the Cardiovascular Risk in Young Finns Study and Lambert's study [17,33].…”

“…Increased insulin resistance in childhood is associated with a constellation of cardiovascular risk factors and the development of type 2 diabetes mellitus during late childhood and adolescence [14][15][16][17][18][19][20]. Insulin sensitivity changes throughout growth.…”