Wheelock Kevin M, Sinha Madhumita, Knowler William C, Nelson Robert G, Fufaa Gudeta D, Hanson Robert L
Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
J Clin Endocrinol Metab. 2016 Apr;101(4):1437-44. doi: 10.1210/jc.2015-4309. Epub 2016 Feb 25.
Data are lacking on how metabolic risk factors during childhood affect the long-term risk of type 2 diabetes.
Assess four metabolic risk factors as predictors of type 2 diabetes and determine whether the risk differs between younger and older children.
In a prospective cohort study conducted between 1965 and 2007, participants were followed for development of diabetes. Baseline measurements included body mass index (BMI), blood pressure, serum cholesterol, and 2-hour plasma glucose after an oral glucose tolerance test. Additional analyses divided subjects into two groups according to baseline age, 5–11 and 12–19 years.
Gila River Indian Community in Arizona.
A total of 5532 nondiabetic Pima Indian children 5–19 years old.
A total of 1281 children developed diabetes (median follow-up, 12.4 years). Diabetes incidence was higher in overweight children (BMI ≥ 85th percentile) than in nonoverweight children. Nonoverweight children had the lowest risk of diabetes (20-year cumulative incidence, 9.5%), whereas overweight children with impaired glucose tolerance (2-hour glucose ≥ 140 mg/dL) had the highest (79.0%). The relative risk for children with metabolic abnormalities compared with their healthy counterparts was higher in younger children than in older children early in follow-up. BMI and 2-hour glucose were related to incident diabetes in multivariable models (predicted 15-year cumulative incidence for the highest vs lowest quartile was 3.9 and 1.8 times as high for BMI and 2-hour glucose, respectively; P < .001), whereas blood pressure and cholesterol were not.
BMI and impaired glucose tolerance in children are strong predictors of type 2 diabetes. Other components of the “metabolic syndrome” are not.
关于儿童期代谢风险因素如何影响2型糖尿病的长期风险，目前尚缺乏相关数据。
评估四种代谢风险因素作为2型糖尿病的预测指标，并确定不同年龄段儿童的风险是否存在差异。
在1965年至2007年进行的一项前瞻性队列研究中，对参与者进行随访以观察糖尿病的发生情况。基线测量包括体重指数（BMI）、血压、血清胆固醇以及口服葡萄糖耐量试验后的2小时血浆葡萄糖。根据基线年龄将受试者分为两组，5 - 11岁组和12 - 19岁组，并进行额外分析。
亚利桑那州的吉拉河印第安社区。
共有5532名5 - 19岁的非糖尿病皮马印第安儿童。
共有1281名儿童患糖尿病（中位随访时间为12.4年）。超重儿童（BMI≥第85百分位数）的糖尿病发病率高于非超重儿童。非超重儿童患糖尿病的风险最低（20年累积发病率为9.5%），而葡萄糖耐量受损（2小时血糖≥'140 mg/dL'）的超重儿童风险最高（79.0%）。在随访早期，与健康儿童相比，代谢异常儿童的相对风险在年幼儿童中高于年长儿童。在多变量模型中，BMI和2小时血糖与糖尿病发病相关（最高四分位数与最低四分位数相比，预测的15年累积发病率，BMI为3.9倍，2小时血糖为1.8倍；P <.001），而血压和胆固醇则无关。
儿童期的BMI和葡萄糖耐量受损是2型糖尿病的有力预测指标。“代谢综合征”的其他组成部分则不是。
