Abstract 1240: Changes in Risk Variables of Metabolic Syndrome ince Childhood in Prediabetic and Type 2 Diabetic Subjects: The Bogalusa Heart Study
That type 2 diabetes mellitus is associated with metabolic syndrome is known. However, information is lacking regarding the course of development of adverse levels of measures of glucose homeostasis and other risk variables of the metabolic syndrome from childhood to adulthood in subjects at risk of developing type 2 diabetes. This aspect was studied, retrospectively, in a community-based cohort of normoglycemic (n=1838), prediabetic (n=90), and type 2 diabetic (n=60) subjects examined serially for cardiovascular risk factors during childhood (4 – 11 years), adolescence (12 – 18 years), and adulthood (19 – 44 years). Prediabetic subjects versus normoglycemic subjects had significantly higher levels of subscapular skinfold and glucose beginning in childhood; higher levels of low-density lipoprotein cholesterol (LDL-C), insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in adolescence and adulthood; and higher body mass index (BMI), mean arterial pressure (MAP), and triglycerides in adulthood. Diabetic subjects versus normoglycemic subjects had significantly higher levels of subscapular skinfold, BMI, triglycerides, glucose, insulin, and HOMA-IR, and lower levels of high-density lipoprotein cholesterol (HDL-C) beginning in childhood; and higher levels of MAP in adolescence and adulthood. Many of these variables changed adversely at an increased rate in both prediabetic and diabetic groups. In a multivariate model that included BMI, MAP, HDL-C, 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; BMI, glucose, and HDL-C with diabetic subjects. As young adults, prediabetic and diabetic groups displayed significantly higher prevalence of obesity, hypertension, dyslipidemia, and hyperinsulinemia. These findings indicate that adverse levels of risk variables of metabolic syndrome, adiposity and measures of glucose homeostasis in particular, and their accelerated rates of change 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.