青少年持续性高血糖与胰岛素抵抗及心脏损伤恶化风险：阿冯纵向研究父母与儿童队列（ALSPAC）的7年纵向研究

Persistent Hyperglycemia and Insulin Resistance With the Risk of Worsening Cardiac Damage in Adolescents: A 7-Year Longitudinal Study of the ALSPAC Birth Cohort.

作者信息

Agbaje Andrew O, Zachariah Justin P, Barker Alan R, Williams Craig A, Vlachopoulos Dimitris, Saner Christoph, Tuomainen Tomi-Pekka

机构信息

Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.

Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, U.K.

出版信息

Diabetes Care. 2025 Jun 1;48(6):896-904. doi: 10.2337/dc24-2459.

DOI:10.2337/dc24-2459

PMID:40294628

Abstract

OBJECTIVE

Insulin resistance (IR) and dysglycemia can induce cardiac remodeling in adulthood, but little evidence exists with respect to cardiac remodeling in youth with and without evidence of new-onset glucose metabolic alterations. This study investigated whether changes in metabolic status from adolescence to young adulthood are associated with the risk of progressive cardiac remodeling and examined potential mechanistic pathways.

RESEARCH DESIGN AND METHODS

From the Avon Longitudinal Study of Parents and Children (ALSPAC), U.K. cohort, 1,595 adolescents, mean (SD) age 17.7 (0.4) years, who had data on fasting plasma glucose and insulin levels, and echocardiography left ventricular (LV) mass indexed for height raised to the power of 2.7 (LVMI2.7) and in whom these factors repeatedly were measured at a clinic visit when they were aged 24 years were included. HOMA-IR was computed, hyperglycemia was defined as glucose concentration of ≥5.6 mmol/L and ≥6.1 mmol/L, and LV hypertrophy was defined as LVMI2.7 ≥51g/m2.7.

RESULTS

The prevalence of LV hypertrophy increased from 2.4% at baseline to 7.1% at follow-up. Each unit increase of glucose (β = 0.37 g/m2.7 [95% CI 0.23-0.52]; P < 0.001) and HOMA-IR (1.10 g/m2.7 [0.63-1.57]; P < 0.001) was independently associated with increased LVMI2.7 over 7 years. Persistent hyperglycemia of 5.6 mmol/L and 6.1 mmol/L was associated with higher odds (odds ratio [OR] 1.46 [95% CI 1.35-1.47], P < 0.001; and 3.10 [95% CI 1.19-8.08], P = 0.021, respectively) of worsening LV hypertrophy over 7 years. Increased fat mass (62% mediation) significantly mediated the association of increased HOMA-IR with increased LVMI2.7.

CONCLUSIONS

Persistent adolescent hyperglycemia and worsening IR were associated with the risk of worsening structural and functional cardiac damage, and these were largely explained by increased fat mass.

摘要

目的

胰岛素抵抗（IR）和血糖异常可在成年期诱发心脏重塑，但关于有或无新发糖代谢改变证据的青年人心脏重塑的证据较少。本研究调查了从青春期到青年期代谢状态的变化是否与进行性心脏重塑风险相关，并研究了潜在的机制途径。

研究设计与方法

来自英国阿冯父母与儿童纵向研究（ALSPAC）队列，纳入1595名青少年，平均（标准差）年龄17.7（0.4）岁，他们有空腹血糖和胰岛素水平数据，以及根据身高校正的超声心动图左心室（LV）质量指数（LVMI2.7），并且在24岁门诊就诊时对这些因素进行了重复测量。计算稳态模型评估的胰岛素抵抗（HOMA-IR），高血糖定义为血糖浓度≥5.6 mmol/L和≥6.1 mmol/L，左心室肥厚定义为LVMI2.7≥51g/m2.7。

结果

左心室肥厚的患病率从基线时的2.4%增加到随访时的7.1%。血糖每升高一个单位（β = 0.37 g/m2.7 [95%置信区间0.23 - 0.52]；P < 0.001）和HOMA-IR每升高一个单位（1.10 g/m2.7 [0.63 - 1.57]；P < 0.001）与7年内LVMI2.7增加独立相关。持续血糖≥5.6 mmol/L和≥6.1 mmol/L与7年内左心室肥厚恶化的较高比值（比值比[OR]分别为1.46 [95%置信区间1.35 - 1.47]，P < 0.001；以及3.10 [95%置信区间1.19 - 8.08]，P = 0.021）相关。脂肪量增加（62%的中介作用）显著介导了HOMA-IR增加与LVMI2.7增加之间的关联。