Division of Community Health Sciences, St George's, University of London, London, United Kingdom.
PLoS Med. 2010 Apr 20;7(4):e1000263. doi: 10.1371/journal.pmed.1000263.
Adults of South Asian origin living in the United Kingdom have high risks of type 2 diabetes and central obesity; raised circulating insulin, triglyceride, and C-reactive protein concentrations; and low HDL-cholesterol when compared with white Europeans. Adults of African-Caribbean origin living in the UK have smaller increases in type 2 diabetes risk, raised circulating insulin and HDL-cholesterol, and low triglyceride and C-reactive protein concentrations. We examined whether corresponding ethnic differences were apparent in childhood.
We performed a cross-sectional survey of 4,796 children aged 9-10 y in three UK cities who had anthropometric measurements (68% response) and provided blood samples (58% response); ethnicity was based on parental definition. In age-adjusted comparisons with white Europeans (n = 1,153), South Asian children (n = 1,306) had higher glycated haemoglobin (HbA1c) (% difference: 2.1, 95% CI 1.6 to 2.7), fasting insulin (% difference 30.0, 95% CI 23.4 to 36.9), triglyceride (% difference 12.9, 95% CI 9.4 to 16.5), and C-reactive protein (% difference 43.3, 95% CI 28.6 to 59.7), and lower HDL-cholesterol (% difference -2.9, 95% CI -4.5 to -1.3). Higher adiposity levels among South Asians (based on skinfolds and bioimpedance) did not account for these patterns. Black African-Caribbean children (n = 1,215) had higher levels of HbA1c, insulin, and C-reactive protein than white Europeans, though the ethnic differences were not as marked as in South Asians. Black African-Caribbean children had higher HDL-cholesterol and lower triglyceride levels than white Europeans; adiposity markers were not increased.
Ethnic differences in type 2 diabetes precursors, mostly following adult patterns, are apparent in UK children in the first decade. Some key determinants operate before adult life and may provide scope for early prevention.
与白种欧洲人相比，居住在英国的南亚裔成年人患 2 型糖尿病和中心性肥胖的风险较高，循环胰岛素、甘油三酯和 C 反应蛋白浓度升高，高密度脂蛋白胆固醇水平较低。居住在英国的非裔加勒比成年人患 2 型糖尿病的风险增加幅度较小，循环胰岛素和高密度脂蛋白胆固醇水平升高，甘油三酯和 C 反应蛋白浓度较低。我们研究了这些差异在儿童期是否存在对应差异。
我们对三个英国城市的 4796 名 9-10 岁儿童进行了横断面调查，这些儿童进行了人体测量（应答率为 68%）并提供了血样（应答率为 58%）；种族是基于父母的定义。与白种欧洲人（n=1153）相比，南亚儿童（n=1306）的糖化血红蛋白（HbA1c）水平更高（差异百分比：2.1，95%置信区间：1.6 至 2.7），空腹胰岛素水平更高（差异百分比 30.0，95%置信区间：23.4 至 36.9），甘油三酯水平更高（差异百分比 12.9，95%置信区间：9.4 至 16.5），C 反应蛋白水平更高（差异百分比 43.3，95%置信区间：28.6 至 59.7），高密度脂蛋白胆固醇水平更低（差异百分比 -2.9，95%置信区间：-4.5 至 -1.3）。南亚人较高的体脂水平（基于皮褶厚度和生物阻抗）并不能解释这些模式。与白种欧洲人相比，非裔加勒比黑人儿童（n=1215）的 HbA1c、胰岛素和 C 反应蛋白水平更高，尽管差异没有南亚人那么明显。非裔加勒比黑人儿童的高密度脂蛋白胆固醇水平较高，甘油三酯水平较低；体脂标志物没有增加。
在英国儿童的第一个十年中，2 型糖尿病前期的种族差异明显，主要与成年人的模式一致。一些关键决定因素在成年前就已经存在，这为早期预防提供了可能。
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