Changes in risk variables of metabolic syndrome since childhood in prediabetic and type 2 diabetic subjects: the Bogalusa Heart Study

Abstract

Objective: That type 2 diabetes mellitus is associated with the metabolic syndrome is known. However, information is lacking regarding the long-term and adverse changes of metabolic syndrome variables in the development of type 2 diabetes from childhood to adulthood.

Research Design and Methods: Observations were examined, retrospectively, in a community-based cohort of normoglycemic (n=1838), prediabetic (n=90), and type 2 diabetic (n=60) subjects followed serially for cardiovascular risk factors during childhood (4–11 years), adolescence (12–18 years), and adulthood (19–44 years).

Results: Diabetic subjects versus normoglycemic subjects had significantly higher levels of subscapular skinfold, body mass index (BMI), triglycerides, glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR), and lower levels of high-density lipoprotein cholesterol (HDL-C) beginning in childhood; and higher levels of mean arterial pressure (MAP) in adolescence and adulthood. In a multivariate model including BMI, MAP, HDL-C, low-density lipoprotein cholesterol (LDL-C), triglycerides, glucose, and insulin, adjusted for age, age², race, sex, and race by sex interaction, adverse changes in glucose and LDL-C were independently associated with prediabetic subjects while adverse changes in BMI, glucose, and HDL-C with diabetic subjects. As young adults, prediabetic and diabetic groups displayed significantly higher prevalence of obesity, hypertension, dyslipidemia, hyperinsulinemia, and metabolic syndrome.

Conclusions: These findings indicate that adverse levels of risk variables of metabolic syndrome, adiposity and measures of glucose homeostasis accelerating since childhood characterize the early natural history of type 2 diabetes, and underscore the importance of early prevention and intervention on risk factors beginning in childhood.