Srinivasan Sathanur R, Myers Leann, Berenson Gerald S
Tulane Center for Cardiovascular Health, Departments of Epidemiology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
Diabetes. 2002 Jan;51(1):204-9. doi: 10.2337/diabetes.51.1.204.
The occurrence of insulin resistance syndrome (syndrome X) is common in the general population. However, information is scant on the childhood predictors of syndrome X. This study examined the relative contribution of childhood adiposity and insulin to the adulthood risk of developing syndrome X in a biracial (black-white) community-based longitudinal cohort (n = 745; baseline age, 8-17 years; mean +/- SD follow-up period, 11.6 +/- 3.4 years). The four criterion risk variables considered were the highest quartile (specific for age, race, sex, and study year) of 1) BMI, 2) fasting insulin, 3) systolic or mean arterial blood pressure, and 4) total cholesterol to HDL cholesterol ratio or triglycerides to HDL cholesterol ratio. Clustering was defined as the combination of all four risk variables. In addition to the criterion risk variables, clustered adults had adverse levels of total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, diastolic blood pressure, and glucose compared with those who did not cluster (P < 0.001). Childhood variables, except glucose, showed adverse trends with increasing number of criterion risk variables present in adulthood (P for trend, 0.01-0.0001). The proportion of individuals who developed clustering as adults increased across childhood BMI (P for trend <0.0001) and insulin (P for trend <0.01) quartiles. The relationship to childhood BMI remained significant even after adjusting for childhood insulin. In contrast, corresponding association with childhood insulin disappeared after adjusting for childhood BMI. In a logistic regression model, childhood BMI and insulin were significant predictors of adulthood clustering, with BMI being the strongest and showing a curvilinear relationship. Using an insulin resistance index instead of insulin did not change the above findings. These results indicate that childhood obesity is a powerful predictor of development of syndrome X and underscore the importance of weight control early in life.
胰岛素抵抗综合征（X综合征）在普通人群中很常见。然而，关于X综合征儿童期预测因素的信息却很少。本研究在一个基于社区的双种族（黑人和白人）纵向队列（n = 745；基线年龄8 - 17岁；平均±标准差随访期为11.6±3.4年）中，考察了儿童期肥胖和胰岛素对成年后患X综合征风险的相对贡献。所考虑的四个标准风险变量为：1）体重指数（BMI）、2）空腹胰岛素、3）收缩压或平均动脉压、4）总胆固醇与高密度脂蛋白胆固醇比值或甘油三酯与高密度脂蛋白胆固醇比值的最高四分位数（根据年龄、种族、性别和研究年份进行特定划分）。聚类定义为所有四个风险变量的组合。与未聚类者相比，除了标准风险变量外，聚类的成年人在总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、舒张压和血糖水平方面也存在不良情况（P < 0.001）。除血糖外，儿童期变量随着成年期出现的标准风险变量数量增加呈不良趋势（趋势P值为0.01 - 0.0001）。成年后出现聚类的个体比例随着儿童期BMI（趋势P值<0.0001）和胰岛素（趋势P值<0.01）四分位数的增加而升高。即使在对儿童期胰岛素进行校正后，与儿童期BMI的关系仍然显著。相反，在对儿童期BMI进行校正后，与儿童期胰岛素的相应关联消失。在逻辑回归模型中，儿童期BMI和胰岛素是成年期聚类的显著预测因素，其中BMI的预测作用最强且呈曲线关系。使用胰岛素抵抗指数而非胰岛素并未改变上述结果。这些结果表明，儿童期肥胖是X综合征发生的有力预测因素，并强调了生命早期体重控制的重要性。
