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Published on: July 5, 2022
Metabolic Risk Factors and Type 2 Diabetes Incidence in American Indian Children
Kevin M Wheelock1, Madhumita Sinha1, William C Knowler1
1Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
Insights
Childhood overweight and impaired glucose tolerance are key predictors of type 2 diabetes. These metabolic risk factors significantly increase long-term diabetes risk in children, especially younger ones.
Area of Science:
- Pediatric endocrinology
- Metabolic disease research
- Diabetes epidemiology
Background:
- Limited data exist on how childhood metabolic risk factors influence long-term type 2 diabetes risk.
- Understanding these early predictors is crucial for timely intervention and prevention strategies.
Purpose of the Study:
- To evaluate four key metabolic risk factors as predictors of type 2 diabetes in children.
- To determine if the predictive value of these factors differs between younger (5–11 years) and older (12–19 years) children.
Main Methods:
- Prospective cohort study of 5532 Pima Indian children (aged 5–19) from 1965–2007.
- Baseline measurements included body mass index (BMI), blood pressure, serum cholesterol, and 2-hour plasma glucose.
- Participants were followed for diabetes development, with analyses stratified by age group.
Main Results:
- Diabetes incidence was significantly higher in overweight children (BMI ≥ 85th percentile).
- Overweight children with impaired glucose tolerance (2-hour glucose ≥ 140 mg/dL) had the highest diabetes risk (79.0%).
- Body mass index and impaired 2-hour plasma glucose were significant predictors of type 2 diabetes; blood pressure and cholesterol were not.
Conclusions:
- Childhood body mass index (BMI) and impaired glucose tolerance are strong predictors of future type 2 diabetes.
- These specific metabolic factors, rather than other components of the metabolic syndrome, are most critical for identifying high-risk children.
Context:
Data are lacking on how metabolic risk factors during childhood affect the long-term risk of type 2 diabetes.
Objectives:
Assess four metabolic risk factors as predictors of type 2 diabetes and determine whether the risk differs between younger and older children.
Design:
In a prospective cohort study conducted between 1965 and 2007, participants were followed for development of diabetes. Baseline measurements included body mass index (BMI), blood pressure, serum cholesterol, and 2-hour plasma glucose after an oral glucose tolerance test. Additional analyses divided subjects into two groups according to baseline age, 5–11 and 12–19 years.
Setting:
Gila River Indian Community in Arizona.
Participants:
A total of 5532 nondiabetic Pima Indian children 5–19 years old.
Results:
A total of 1281 children developed diabetes (median follow-up, 12.4 years). Diabetes incidence was higher in overweight children (BMI ≥ 85th percentile) than in nonoverweight children. Nonoverweight children had the lowest risk of diabetes (20-year cumulative incidence, 9.5%), whereas overweight children with impaired glucose tolerance (2-hour glucose ≥ 140 mg/dL) had the highest (79.0%). The relative risk for children with metabolic abnormalities compared with their healthy counterparts was higher in younger children than in older children early in follow-up. BMI and 2-hour glucose were related to incident diabetes in multivariable models (predicted 15-year cumulative incidence for the highest vs lowest quartile was 3.9 and 1.8 times as high for BMI and 2-hour glucose, respectively; P < .001), whereas blood pressure and cholesterol were not.
Conclusions:
BMI and impaired glucose tolerance in children are strong predictors of type 2 diabetes. Other components of the “metabolic syndrome” are not.
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