Utility of Childhood Glucose Homeostasis Variables in Predicting Adult Diabetes and Related Cardiometabolic Risk Factors

Nguyen, Quoc Manh; Srinivasan, Sathanur R.; Xu, Jihua; Chen, Wei; Kieltyka, Lyn; Berenson, Gerald S.

doi:10.2337/dc09-1635

Cited by 89 publications

(72 citation statements)

References 25 publications

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“…In addition, the Bogalusa Heart Study has recently confirmed that adiposity and HOMA-IR are interrelated. 21 Programs that include increased activity and behavior modification have traditionally resulted in more improvements in childhood obesity. 6 During the development of the program, the major goal was to provide the child and parent with tools to empower them to make better decisions that would promote a healthier lifestyle.…”

Section: Discussionmentioning

confidence: 99%

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Long-term pediatric weight management studies have been predominantly carried out with affluent, white populations. Thus, evidence on successful management of childhood obesity is limited, especially in innercity, ethnically diverse populations. WHAT THIS STUDY ADDS:This randomized controlled trial bridges the gap in the pediatric obesity treatment literature by revealing a sustained treatment effect on anthropometric and metabolic markers after a family-based lifestyle intervention versus traditional clinical care in inner-city, ethnically diverse populations.abstract OBJECTIVE: To determine if beneficial effects of a weight-management program could be sustained for up to 24 months in a randomized trial in an ethnically diverse obese population. PATIENTS AND METHODS: There were 209 obese children (BMI Ͼ 95th percentile), ages 8 to 16 of mixed ethnic backgrounds randomly assigned to the intensive lifestyle intervention or clinic control group. The control group received counseling every 6 months, and the intervention group received a family-based program, which included exercise, nutrition, and behavior modification. Lifestyle intervention sessions occurred twice weekly for the first 6 months, then twice monthly for the second 6 months; for the last 12 months there was no active intervention. There were 174 children who completed the 12 months of the randomized trial. Follow-up data were available for 76 of these children at 24 months. There were no statistical differences in dropout rates among ethnic groups or in any other aspects. RESULTS: Treatment effect was sustained at 24 months in the intervention versus control group for BMI z score (Ϫ0.16 [95% confidence interval: Ϫ0.23 to Ϫ0.09]), BMI (Ϫ2.8 kg/m 2 [95% confidence interval: Ϫ4.0 -1.6 kg/m 2 ]), percent body fat (Ϫ4.2% [95% confidence interval: Ϫ6.4% to Ϫ2.0%]), total body fat mass (Ϫ5.8 kg [95% confidence interval: Ϫ9.1 kg to Ϫ2.6 kg]), total cholesterol (Ϫ13.0 mg/dL [95% confidence interval: Ϫ21.7 mg/dL to Ϫ4.2 mg/dL]), low-density lipoprotein cholesterol (Ϫ10.4 mg/dL [95% confidence interval: Ϫ18.3 mg/dL to Ϫ2.4 mg/dL]), and homeostasis model assessment of insulin resistance (Ϫ2.05 [95% confidence interval: Ϫ2.48 to Ϫ1.75]). CONCLUSIONS: This study, unprecedented because of the high degree of obesity and ethnically diverse backgrounds of children, reveals that benefits of an intensive lifestyle program can be sustained 12 months after completing the active intervention phase.

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Section: Discussionmentioning

confidence: 99%

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population

et al. 2011

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“…140,141 In particular, severe obesity in childhood is strongly associated with future development of T2DM. 81,138,[142][143][144][145][146][147][148] In one study, severe obesity at baseline was an independent predictor of eventual development of T2DM. 81 Adiposity in childhood is also known to predict intermediate cardiovascular outcomes in adulthood, including noninvasive measures of target-organ damage.…”

Section: Long-term Risksmentioning

confidence: 99%

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Kelly¹,

Barlow

Rao³

et al. 2013

Circulation

887

804

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espite recent data suggesting that the rate of increase of obesity among children and adolescents has slowed and overall prevalence has possibly begun to plateau, 1,2 a worrisome trend has emerged in the form of severe pediatric obesity. As the fastest-growing subcategory of obesity in children and adolescents, 1,3,4 severe obesity afflicts between 4% and 6% of all youth in the United States 3-7 and has both immediate and long-term health consequences. Recent data further Abstract-Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing.Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behaviorbased treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks. (Circulation. 2013;128:1689-1712.)

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“…32 Three major studies have previously examined the association between insulin levels in childhood and later T2DM. Nguyen et al 33 showed that children in the top decile for insulin were .5 times more likely to develop T2DM than those with a lower insulin value in 1120 participants of the Bogalusa Heart Study, whereas Morrison et al 34 demonstrated among 556 North American schoolgirls that fasting insulin concentrations at age 10 predicted T2DM at a mean age of 24 years. However, both studies were biracial and had few participants with T2DM in adult life (n = 25 and 11, respectively).…”

Section: Discussionmentioning

confidence: 99%

Insulin and BMI as Predictors of Adult Type 2 Diabetes Mellitus

et al. 2015

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BACKGROUND AND OBJECTIVES: Fasting insulin concentrations are increasingly being used as a surrogate for insulin resistance and risk for type 2 diabetes (T2DM), although associations with adult outcomes are unclear. Our objective was to determine whether fasting insulin concentrations in childhood associate with later T2DM. METHODS:Fasting insulin values were available from 2478 participants in the longitudinal Cardiovascular Risk in Young Finns Study at baseline age 3 to 18 years, along with data on adult T2DM (N = 84, mean age = 39.6 years). RESULTS:Among 3-to 6-year-olds, a 1-SD increase in fasting insulin was associated with a relative risk (RR) of 2.04 (95% confidence interval [CI], 1.54-2.70) for later T2DM, which remained significant after we adjusted for BMI and parental history of T2DM. For those aged 9 to 18 years, a 1-SD increase in insulin was associated with an RR of 1.32 (95% CI, 1.06-1.65) for T2DM, but this became nonsignificant after we adjusted for BMI and parental history of T2DM. In the latter age group, a 1-SD increase in BMI was associated with an RR of 1.45 (95% CI, 1.21-1.73) for T2DM, with adjustment for insulin and parental history of T2DM not improving this association. BMI in younger children was not associated with later T2DM. In life course analyses, those with T2DM had higher fasting insulin levels in early childhood and later adulthood but not in peripubertal years.CONCLUSIONS: Elevated fasting insulin concentrations in early childhood, but not adolescence, are independently associated with an elevated risk of T2DM in adulthood. WHAT'S KNOWN ON THIS SUBJECT:Fasting insulin levels in childhood are increasingly being used as a surrogate for insulin resistance and risk of later type 2 diabetes, despite only a moderate correlation with whole-body insulin sensitivity and few data related to adult outcomes. WHAT THIS STUDY ADDS:Elevated insulin values between the ages of 3 and 6 years are associated with an elevated risk for later type 2 diabetes. In 9-to 18-year-olds, elevated BMI (but not insulin values) is associated with later type 2 diabetes. Drs Sabin and Magnussen contributed equally to the study. Dr Sabin conceptualized the study, analyzed the data, and drafted the initial manuscript; Drs Magnussen and Juonala analyzed the data and assisted in writing core aspects of the manuscript; Professor Shield provided critical analysis of the findings and interpretation; Drs Kähönen, Lehtimäki, Rönnemaa, Knip, and Hutri-Kähönen and Professor Viikari collected the study data; Dr Koskinen and Professor Dwyer provided critical analysis of the findings and interpretation; Dr Loo collected the study data and provided data related to the correction of insulin values over time; Professor Raitakari led the study and was involved in all aspects of the study including conceptualization, data collection, analysis, and interpretation; and all authors approved the final manuscript as submitted. With the high prevalence of childhood obesity, pediatricians are routinely encountering obese patie...

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Utility of Childhood Glucose Homeostasis Variables in Predicting Adult Diabetes and Related Cardiometabolic Risk Factors

Cited by 89 publications

References 25 publications

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Insulin and BMI as Predictors of Adult Type 2 Diabetes Mellitus

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