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Body Mass Index Changes and Insulin Resistance at Age 4: A Prospective Cohort Study
Hye Jin Lee1, Youn-Hee Lim2, Yun-Chul Hong3,4,5
1Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea.
Insights
Maintaining a high body mass index (BMI) percentile from ages 2 to 4 is linked to elevated fasting glucose and insulin resistance in early childhood. This highlights the importance of monitoring childhood BMI for metabolic health.
Area of Science:
- Pediatrics
- Metabolic Health
- Child Development
Background:
- Childhood obesity is a growing concern with potential long-term health implications.
- Early identification of metabolic risk factors in children is crucial for timely intervention.
Purpose of the Study:
- To examine the association between changes in body mass index (BMI) Z-score and metabolic markers like fasting glucose and insulin resistance (IR) in early childhood.
- To determine if sustained high BMI Z-scores from ages 2 to 4 impact glucose metabolism and insulin sensitivity.
Main Methods:
- Analysis of data from 334 children in the Environment and Development of Children (EDC) cohort, assessed at ages 2 and 4.
- Measurement of height and weight to calculate BMI Z-scores; assessment of fasting glucose and insulin at age 4.
- Calculation of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and comparison across BMI Z-score change categories.
Main Results:
- Children in the highest BMI Z-score quartile (Q4) at both ages 2 and 4 exhibited significantly higher fasting glucose, insulin levels, and HOMA-IR compared to those in lower quartiles.
- Sustained high BMI Z-scores (Q4 at both ages) were associated with higher fasting glucose than in children whose BMI Z-score increased to Q4 from lower categories.
- Initial BMI Z-score at age 2 did not influence glucose or IR at age 4 if children were in the mid-range (Q2-3) at age 4.
Conclusions:
- Sustained high BMI Z-scores throughout early childhood are a significant risk factor for elevated fasting glucose and insulin resistance.
- These findings underscore the importance of monitoring BMI trajectories in young children to identify those at risk for metabolic dysfunction.
Objectives:
The objective of this study is to investigate whether body mass index (BMI) changes are associated with fasting glucose and insulin resistance (IR) in early childhood.
Methods:
From the Environment and Development of Children (EDC) cohort, 334 children who visited at ages 2 and 4 were included in this study. Height and weight were measured at ages 2 and 4, and fasting glucose and insulin were assessed at age 4. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated as insulin (μIU/ml) × glucose (mg/dl)/405. The BMI Z-score [BMI (Z)] quartiles for each age group were defined as Q4, ≥75th percentile; Q2-3, 25th to 75th percentile; and Q1, <25th percentile. Glucose, insulin, and the HOMA-IR were compared between groups according to the change in BMI (Z) from age 2 to 4.
Results:
Children who stayed in Q4 at both ages had higher fasting glucose (92.2 vs. 88.0 and 87.1 mg/dl), insulin (3.2 vs. 2.5 and 2.3 μIU/ml), and HOMA-IR (0.68 vs. 0.54 and 0.52) than children who stayed in Q1 or Q2-3 (all P<0.01). Children in Q4 at both ages had higher fasting glucose than children whose BMI (Z) increased from Q1 or Q2-3 to Q4 (92.2 vs. 87.3, P<0.001). The BMI (Z) category at age 2 of children who were in Q2-3 at age 4 did not affect glucose or IR at 4 years.
Conclusion:
The group of children within the highest BMI (Z) quartile at both 2 and 4 years of age had higher fasting glucose and IR at age 4 than any other BMI (Z) change group.
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