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Obesity and the Development of Insulin Resistance and Impaired Fasting Glucose in Black and White Adolescent Girls

A longitudinal study

¹ Division of Endocrinology and Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
² Maryland Medical Research Institute, Baltimore, Maryland
³ National Institute of Mental Health, Bethesda, Maryland
⁴ Westat, Rockville, Maryland
⁵ Division of Endocrinology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
⁶ National Cancer Institute, Bethesda, Maryland
⁷ Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

Address correspondence and reprint requests to John A. Morrison, OSB 4, Division of Cardiology, Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229. E-mail: john.morrison{at}cchmc.org

OBJECTIVE—Age at onset of type 2 diabetes has decreased during the past 20 years, especially in black women. Studies of factors associated with insulin resistance and hyperglycemia in preadolescent and adolescent populations are essential to understanding diabetes development.

RESEARCH DESIGN AND METHODS—The National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study (NGHS) is a 10-year cohort study of the development of obesity in black and white girls. Two NGHS centers examined the associations of obesity, puberty, and race with fasting insulin, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR; a calculated index of insulin resistance) measures at 9–10 years of age (baseline) and 10 years later.

RESULTS—Black girls had greater baseline and year-10 BMI than white girls, with a greater 10-year incidence of obesity. BMI-insulin correlations were positive in both black and white girls at both visits, but insulin remained higher in black girls after controlling for BMI. In black girls, insulin and HOMA-IR were higher in the prepubertal period (before the emergence of racial differences in BMI), increased more during puberty, and decreased less with its completion. Baseline BMI predicted year-10 glucose and the development of impaired fasting glucose (IFG) in black girls. In white girls, the rate of BMI increase during follow-up predicted these outcomes. The 10-year incidence of diabetes in black girls was 1.4%.

CONCLUSIONS—Black-white differences in insulin resistance are not just a consequence of obesity, but precede the pubertal divergence in BMI. The development of IFG appears to be a function of the rate of increase of BMI in white girls and early obesity in black girls.

Abbreviations: HOMA-IR, homeostasis model assessment of insulin resistance • IFG, impaired fasting glucose • NGHS, NHLBI Growth and Health Study • NHLBI, National Heart, Lung, and Blood Institute

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