RESUMO
OBJECTIVE: To assess adolescent and young adult determinants of visceral adipose tissue (VAT) at ages 26-28 years. STUDY DESIGN: Prospective study (ages 9-28 years) of cardiometabolic measures, menarche age, menses irregularities, metabolic syndrome, impaired fasting glucose-type 2 diabetes mellitus, and VAT in 400 girls (248 black, 152 white). RESULTS: Adolescent (age 14-19) independent variables for greater VAT at ages 26-28 included larger mean waist circumference (partial R(2) = 30.8%), earlier age at menarche (0.9%), and white race (1.8%). Young adult (ages 20-28 years) independent variables for greater VAT included larger mean waist circumference (partial R(2) = 61.7%), greater triglyceride levels (3.3%), lower high-density lipoprotein cholesterol (1.0%), and greater insulin resistance (homeostasis model assessment-estimated insulin resistance; 0.4%). Independent variables for greater VAT when both adolescent and young adult variables were used included waist (tertile rank change from adolescence to young adulthood, partial R(2) = 58.3%), greater young adult triglyceride levels (4.4%), white race (1.8%), greater young adult homeostasis model assessment-estimated insulin resistance (age 20-28, 2.4%), and earlier menarche age (0.7%). Menses irregularities were not independently associated with young adult VAT. CONCLUSIONS: Adolescent girls with early menarche and larger waist circumference should be targets for primary prevention of accretion of VAT. In young adulthood, VAT is associated with dysregulated cardiometabolic profiles, which is greater for those with waist circumference increases from adolescence to adulthood. Waist circumference during young adulthood, and to a lesser degree during adolescence, is an inexpensive surrogate for VAT at ages 26-28 years.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Resistência à Insulina , Gordura Intra-Abdominal/patologia , Síndrome Metabólica/diagnóstico , Obesidade/complicações , Medição de Risco/métodos , Adolescente , Adulto , Índice de Massa Corporal , Criança , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Feminino , Seguimentos , Humanos , Incidência , Menarca , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Ohio/epidemiologia , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: To evaluate children's cardiovascular disease (CVD) risk factors as predictors of parents' subsequent CVD, type 2 diabetes mellitus (T2DM), and high blood pressure (HBP). STUDY DESIGN: We conducted a 26-year prospective follow-up of 852 5- to 19-year-old black and white schoolchildren (mean age, 12 years; Lipid Research Clinics, 1973-8), and parents (mean age, 40 years) from 519 families in Princeton Schools, Cincinnati, Ohio. Schoolchildren were reassessed in the Princeton Follow-up study 1999-2003 at mean age 39 years; CVD, T2DM, and HBP history of their 1038 parents were reassessed by mean age 66 years. We assessed relationships of childhood risk factors with parental CVD, T2DM, and HBP. Child-probands identified with triglyceride (TG) levels, blood pressure, low-density lipoprotein cholesterol levels, body mass index (BMI), and glucose level greater than and high-density lipoprotein cholesterol levels less than established cutoff points. RESULTS: Pediatric HBP (P=.006) and low high-density lipoprotein cholesterol (P=.018) were predictive of parental CVD at age ≤50 years. Pediatric HBP (P=.02) and high TG (P=.03) were predictive of parental CVD at age ≤60 years. Pediatric high TG (P=.009) and high low-density lipoprotein cholesterol (P=.04) were predictive of parental CVD by age 66 years. Pediatric high BMI (P=.0006) were predictive of parental T2DM. Pediatric high BMI (P=.003) and black race (P=.004) were predictive of parental HBP. CONCLUSIONS: Pediatric risk factors identify families with parents at increased risk for CVD, T2DM, and HBP, emphasizing the usefulness of the child as proband.
Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Saúde da Família , Hipertensão/epidemiologia , Pais , Adolescente , Adulto , Doenças Cardiovasculares/diagnóstico , Criança , Pré-Escolar , Diabetes Mellitus Tipo 2/diagnóstico , Seguimentos , Humanos , Hipertensão/diagnóstico , Ohio , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: We hypothesized that oligomenorrhea (menstrual cyclicity ≥42 days), hyperandrogenism, low levels of sex hormone-binding globulin (SHBG), childhood insulin, and metabolic syndrome (MetS) at age 14 years would predict MetS and class III obesity (body mass index ≥40 kg/m(2)) at age 24 years. STUDY DESIGN: In this prospective study of schoolgirls, at age 14 years, the girls were categorized as regularly cycling (n = 375), oligomenorrheic (n = 18), or oligomenorrhea plus biochemical hyperandrogenism (polycystic ovary syndrome [PCOS]; n = 12), together designated PCOS. RESULTS: Significant explanatory variables for MetS at age 24 years included childhood insulin, MetS, and PCOS category (all positive) and SHBG (negative) at age 14 years. Using categorical data, top decile of childhood insulin, MetS at age 14, bottom decile of SHBG, and PCOS category were significant positive predictors for MetS at age 24. SHBG (negative), black race (positive), and oligomenorrhea (positive) were significant explanatory variables for class III obesity at age 24. Using categorical data, black race, MetS at age 14, bottom decile of SHBG, PCOS category, and top decile of childhood insulin were positive explanatory variables for class III obesity at age 24 years. CONCLUSIONS: Oligomenorrhea, PCOS (a subcohort of oligomenorrhea), hyperandrogenism, low SHBG, MetS, and childhood insulin at age 14 years may represent a critical, reversible pathway for the development of MetS and class III obesity in young adulthood.
Assuntos
Resistência à Insulina , Insulina/sangue , Síndrome Metabólica/etiologia , Obesidade Mórbida/etiologia , Oligomenorreia/complicações , Síndrome do Ovário Policístico/complicações , Globulina de Ligação a Hormônio Sexual/metabolismo , Adolescente , Biomarcadores/sangue , Índice de Massa Corporal , Criança , Progressão da Doença , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Incidência , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Obesidade Mórbida/sangue , Obesidade Mórbida/epidemiologia , Oligomenorreia/sangue , Oligomenorreia/epidemiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/epidemiologia , Estudos Prospectivos , Curva ROC , Radioimunoensaio , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To evaluate the relationships of adiponectin levels at age 16 years in obese schoolgirls to metabolic syndrome and its components at age 23 years. STUDY DESIGN: Seven-year prospective study of 381 females. RESULTS: In 144 white and 129 black non-obese 16-year old girls (body mass index < 24.6 kg/m(2)), race-specific median adiponectin levels (white 12 mg/L, black 11) was used to identify paradoxically high adiponectin levels in obese girls. Of 34 white and 74 black obese girls, 12 (35%) and 19 (26%) had paradoxically high adiponectin levels. In these 108 obese girls, adiponectin levels at age 16 years independently predicted high-density lipoprotein cholesterol (positive) and waist (negative), insulin (negative), and glucose (negative) at age 23 years; paradoxically high adiponectin levels at age 16 years was a negative independent predictor for waist, homeostatic model assessment-insulin resistance, and for the number of abnormal components of the metabolic syndrome at age 23 years. In 31 pairs of obese girls with and without paradoxically high adiponectin levels, matched by race and age 16 body mass index, adiponectin levels at age 16 years was a negative predictor for the number of abnormal metabolic syndrome components at age 23 years. CONCLUSION: Paradoxically high adiponectin levels in obese 16 year old girls protects against metabolic syndrome and its components at age 23 years.
Assuntos
Adiponectina/sangue , Síndrome Metabólica/sangue , Síndrome Metabólica/prevenção & controle , Obesidade/sangue , Adolescente , Biomarcadores/sangue , População Negra/estatística & dados numéricos , Composição Corporal , Índice de Massa Corporal , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Incidência , Síndrome Metabólica/etnologia , Obesidade/diagnóstico , Obesidade/etnologia , Razão de Chances , Estudos Prospectivos , Valores de Referência , Medição de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Adulto JovemAssuntos
LDL-Colesterol/análise , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Síndrome Metabólica/epidemiologia , Adolescente , Fatores Etários , Criança , Proteção da Criança , HDL-Colesterol/análise , HDL-Colesterol/sangue , LDL-Colesterol/sangue , VLDL-Colesterol/análise , VLDL-Colesterol/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Dislipidemias/diagnóstico , Feminino , Inquéritos Epidemiológicos , Humanos , Resistência à Insulina , Masculino , Síndrome Metabólica/diagnóstico , Avaliação das Necessidades , Pediatria , Prevalência , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To identify childhood-adolescent determinants of persistent hyperinsulinemia and obesity. STUDY DESIGN: We conducted a 15-year prospective study of 296 African-American and 260 Caucasian girls. RESULTS: Childhood insulin level (partial R2=40.4%) and 14-year change in body mass index (BMI; partial R2=20.2%) were major predictors for average insulin Z score during the 15-year follow-up. Waist circumference at age 19 years, 10-year mean percentage of calories from carbohydrates, 15-year change in insulin Z score, the interaction of race with 8-year change in waist, and 14-year change in glucose level were major predictors of a 14-year change in BMI, explaining 66.7% of variability. In girls with all 9 insulin measurements in 15 years persistently in the top 25% versus girls with all measures in the bottom 75%, variables predicting the persistent insulin category included waist circumference at age 11 years (odds ratio [OR], 1.25; 95% CI, 1.11-1.40; P=.0003), 14-year change in BMI (OR, 1.26; 95% CI, 1.01-1.57; P=.037), and 8-year change in waist circumference (OR, 1.16; 95% CI, 1.01-1.32; P=.038). CONCLUSIONS: Childhood interventions to reduce occurrence of hyperinsulinemia and obesity in early adulthood should focus on childhood-adolescent hyperinsulinemia, obesity, central adiposity, and adolescent increases in these factors.
Assuntos
Hiperinsulinismo/diagnóstico , Hiperinsulinismo/etnologia , Obesidade/diagnóstico , Obesidade/etnologia , Grupos Raciais , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Glicemia/análise , Índice de Massa Corporal , Criança , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Carboidratos da Dieta/metabolismo , Ingestão de Energia , Feminino , Seguimentos , Humanos , Hiperinsulinismo/metabolismo , Insulina/sangue , Lipoproteínas/metabolismo , Obesidade/metabolismo , Estudos Prospectivos , Fatores de Tempo , Circunferência da Cintura , Adulto JovemRESUMO
OBJECTIVE: To prospectively assess the association of the metabolic syndrome in childhood with adult metabolic syndrome and type 2 diabetes mellitus (T2DM) 25 to 30 years later. STUDY DESIGN: Data from the National Heart Lung and Blood Institute Lipid Research Clinics (LRC) Princeton Prevalence Study (1973-1976) and the Princeton Follow-up Study (PFS, 2000-2004) were used. Body mass index (BMI = kg/m(2)) was used as the obesity measure in childhood because waist circumference was not measured at the LRC. The adult T2DM status of participants and their parents was obtained by participant report or fasting blood glucose >/=126 mg/dL. A logistic analysis for clustered samples was used to predict adult metabolic syndrome and T2DM, taking into account sibling correlations in the cohort. Pediatric metabolic syndrome, age at PFS, sex, race, change in BMI percentile, parental history of diabetes, and the interaction of pediatric metabolic syndrome and parental diabetes were explanatory variables. RESULTS: Ages ranged from 5 to 19 years in the LRC and from 30 to 48 years in the PFS. Pediatric metabolic syndrome, parental diabetes, age at follow-up, and change in age-specific BMI percentile were significant predictors of metabolic syndrome in adulthood, and pediatric metabolic syndrome, age at follow-up, black race, and parental diabetes were significant predictors of T2DM. CONCLUSIONS: Evaluating 5- to 19-year-old children for metabolic syndrome and family history of diabetes could identify children at increased risk of adult metabolic syndrome and T2DM, allowing prospective primary prevention of these outcomes.
Assuntos
Diabetes Mellitus Tipo 2/etiologia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/patologia , Adolescente , Adulto , Índice de Massa Corporal , Criança , Estudos de Coortes , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Modelos Estatísticos , Prevalência , Resultado do TratamentoRESUMO
OBJECTIVES: To test the hypothesis that metformin during lactation versus formula feeding would have no adverse effects on infants' growth, motor-social development, or intercurrent illness. STUDY DESIGN: Growth, motor-social development, and illness requiring a pediatrician visit were assessed in 61 nursing infants (21 male, 40 female) and 50 formula-fed infants (19 male, 31 female) born to 92 mothers with polycystic ovary syndrome (PCOS) taking a median of 2.55 g metformin per day throughout pregnancy and lactation. RESULTS: Within sex, at 3 and 6 months of age, weight, height, and motor-social development did not differ (p > or = .06) between breast- and formula-fed infants. No infants had retardation of growth, motor, or social development. Intercurrent illnesses did not differ. CONCLUSIONS: Metformin during lactation appears to be safe and effective in the first 6 months of infancy.