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

The Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994

¹ Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
² Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
³ Department of Medicine, Johns Hopkins University, Baltimore, Maryland

Address correspondence and reprint requests to Dr. Frederick L. Brancati, Division of General Internal Medicine, Johns Hopkins University, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205. E-mail: fbrancat{at}jhmi.edu

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 (1988–1994). 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.

Abbreviations: HOMA-IR, homeostasis model assessment of insulin resistance • IGT, impaired glucose tolerance • NHANES III, Third National Health and Nutrition Examination Survey • OGTT, oral glucose tolerance test

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