Type 2 Diabetes Can Be Predicted in Childhood, According to New Cincinnati Children's Study
Wednesday, November 07, 2007
CINCINNATI -- New data from a study now in its 34th year shows that the development of type 2 diabetes in adults can be predicted in childhood.
The Cincinnati Children's Hospital Medical Center study, which has followed a group of children and adults since 1973, demonstrates that metabolic syndrome in childhood is strongly associated with type 2 diabetes in adulthood, particularly for African-American men and women. Metabolic syndrome is a constellation of any three of the following factors: high blood pressure, high triglycerides, high body mass, high blood glucose and low HDL cholesterol – often referred to as "good" cholesterol.
The study is published in the online edition of the Journal of Pediatrics and will appear in a future print issue of the journal.
"Pediatricians and family physicians should evaluate children and adolescents for metabolic syndrome and whether there is a family history of diabetes," says John Morrison, Ph.D., a researcher at Cincinnati Children's and the study's lead author. "We need to identify in childhood those who are at risk of adult metabolic syndrome and type 2 diabetes to prevent these outcomes."
The study is a follow-up of former student participants in the National Heart, Lung and Blood Institute Lipid Research Clinics Princeton Prevalence Study (LRC), which began in 1973, and in the Princeton Follow-up Study (PFS), which took place between 2000 and 2004. The PFS was a 25-30 year follow-up of students and parents who participated in the Cincinnati clinic of the LRC. The LRC in Cincinnati was a multi-stage survey of lipids and other cardiovascular disease risk factors.
Between 1973 and 1976, the LRC enrolled students in grades one-12 in public and parochial schools in the Princeton School District. The LRC also included a random sample of the students' parents. The PFS was conducted to prospectively assess changes in cardiovascular disease risk factors from childhood into the fourth and fifth decades of life, and to assess changes in families' lipid correlations from the period in which students lived in the same house as their parents to the period in which they lived in separate households.
There were 814 individuals in the Cincinnati Children's study, with a mean follow-up age of 38.4 years. Adult body mass index (BMI) was strongly associated with BMI in childhood and adolescence, according to Dr. Morrison. "Sixty-three percent of participants at risk of being overweight in the earlier LRC evaluation were obese at the PFS phase 25 to 30 years later," he says. "A positive parental history of diabetes was also strongly associated with overweight status in both childhood and adulthood."
Of the 32 LRC participants who had metabolic syndrome, 22 had metabolic syndrome at the PFS follow-up. In addition, adult metabolic syndrome was strongly associated with BMI at follow-up: Of the 217 adults with metabolic syndrome, 155 (72 percent) were obese.
There were 44 cases of type 2 diabetes in the PFS sample. Of the 32 cases of pediatric metabolic syndrome, 15.6 percent had adult metabolic syndrome at follow-up, compared to 5 percent of adults who did not have pediatric metabolic syndrome when they were younger.
Pediatric metabolic syndrome and a positive parental history of type 2 diabetes were major predictors of adult diabetes, according to Dr. Morrison. In addition, African-American men and women had twice the risk of developing type 2 diabetes as adults compared to white men and women. And for each one-year increase in age, the risk of diabetes increased 12 percent in African-Americans.
"Our 25-year follow-up evaluation should serve as a clarion call for primary prevention of adult metabolic syndrome and type 2 diabetes," says Dr. Morrison. "In addition, the significant changes in risk of metabolic syndrome in middle age associated with changes in body mass between the two LRC and PFS studies underscore the central importance of weight management in early and middle adult years."
The study was funded by the National Heart, Lung and Blood Institute of the National Institutes of Health. The follow-up study was funded in part by a grant from the American Heart Association.
Cincinnati Children's Hospital Medical Center, one of the leading pediatric research institutions in the nation, is dedicated to changing the outcome for children throughout the world. Cincinnati Children's ranks second among all pediatric institutions in the United States in grants from the National Institutes of Health. It has an established tradition of research excellence, with discoveries including the Sabin oral polio vaccine, the surfactant preparation that saves the lives of thousands of premature infants each year, and a rotavirus vaccine that saves the lives of hundreds of thousands of infants around the world each year. Current strategic directions include the translation of basic laboratory research into the development of novel therapeutics for the treatment of disease, and furthering the development of personalized and predictive medicine.