英国南亚裔、非裔加勒比裔和白种欧洲裔儿童中肥胖对胰岛素抵抗和血糖标志物的影响：英国儿童心脏与健康研究。
Influence of adiposity on insulin resistance and glycemia markers among U.K. Children of South Asian, black African-Caribbean, and white European origin: child heart and health study in England.
机构信息
Division of Population Health Sciences and Education, St George’s, University of London, London, UK.
出版信息
Diabetes Care. 2013 Jun;36(6):1712-9. doi: 10.2337/dc12-1726. Epub 2013 Jan 11.
OBJECTIVE
Ethnic differences in type 2 diabetes risk between South Asians and white Europeans originate before adult life and are not fully explained by higher adiposity levels in South Asians. Although metabolic sensitivity to adiposity may differ between ethnic groups, this has been little studied in childhood. We have therefore examined the associations among adiposity, insulin resistance, and glycemia markers in children of different ethnic origins.
RESEARCH DESIGN AND METHODS
Cross-sectional study of 4,633 9- to 10-year-old children (response rate 68%) predominantly of South Asian, black African-Caribbean, and white European origin (n = 1,266, 1,176, and 1,109, respectively) who had homeostasis model assessments of insulin resistance (HOMA-IR), glycemia markers (HbA1c and fasting glucose), and adiposity (BMI, waist circumference, skinfold thicknesses, and bioimpedance [fat mass]).
RESULTS
All adiposity measures were positively associated with HOMA-IR in all ethnic groups, but associations were stronger among South Asians compared to black African-Caribbeans and white Europeans. For a 1-SD increase in fat mass percentage, percentage differences in HOMA-IR were 37.5% (95% CI 33.3-41.7), 29.7% (25.8-33.8), and 27.0% (22.9-31.2), respectively (P interaction < 0.001). All adiposity markers were positively associated with HbA1c in South Asians and black African-Caribbeans but not in white Europeans; for a 1-SD increase in fat mass percentage, percentage differences in HbA1c were 0.04% (95% CI 0.03-0.06), 0.04% (0.02-0.05), and 0.02% (-0.00 to 0.04), respectively (P interaction < 0.001). Patterns for fasting glucose were less consistent.
CONCLUSIONS
South Asian children are more metabolically sensitive to adiposity. Early prevention or treatment of childhood obesity may be critical for type 2 diabetes prevention, especially in South Asians.
目的
南亚人和白种欧洲人 2 型糖尿病风险的种族差异起源于成年之前，并且不能完全用南亚人的更高肥胖水平来解释。尽管不同种族之间的脂肪含量代谢敏感性可能有所不同，但这在儿童时期研究甚少。因此，我们研究了不同种族来源的儿童中肥胖、胰岛素抵抗和血糖标志物之间的关联。
研究设计和方法
对 4633 名 9-10 岁的儿童（回应率为 68%）进行了横断面研究，这些儿童主要来自南亚、非裔加勒比和白种欧洲血统（分别有 1266 名、1176 名和 1109 名），他们接受了胰岛素抵抗稳态模型评估（HOMA-IR）、血糖标志物（HbA1c 和空腹血糖）和肥胖（BMI、腰围、皮褶厚度和生物阻抗[体脂肪量]）的检测。
结果
在所有种族群体中，所有肥胖指标均与 HOMA-IR 呈正相关，但南亚人群的相关性强于非裔加勒比和白种欧洲人群。脂肪质量百分比每增加 1SD，HOMA-IR 的百分比差异分别为 37.5%（95%CI 33.3-41.7）、29.7%（25.8-33.8）和 27.0%（22.9-31.2）（P 交互<0.001）。在南亚人和非裔加勒比人群中，所有肥胖标志物均与 HbA1c 呈正相关，但在白种欧洲人群中则没有；脂肪质量百分比每增加 1SD，HbA1c 的百分比差异分别为 0.04%（95%CI 0.03-0.06）、0.04%（0.02-0.05）和 0.02%（-0.00 至 0.04）（P 交互<0.001）。空腹血糖的模式则不那么一致。
结论
南亚儿童对肥胖的代谢敏感性更高。儿童期肥胖的早期预防或治疗对 2 型糖尿病的预防可能至关重要，尤其是在南亚人群中。
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