Source:Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (Syndrome X) in young adulthood: the Bogalusa Heart Study.
Diabetes.
2002
;
51
:
204
–209.

These Centers for Disease Control and Prevention (CDC) investigators studied Syndrome X, defined as the coexistence of 4 significant risk factors for adult coronary artery disease: dyslipidemia, hypertension, insulin resistance/hyperinsulinemia, and obesity. The Bogalusa Heart Study was a cohort study that enrolled all schoolchildren ages 8–17 and eligible young adults aged 19–38 living in Bogalusa, Louisiana. Participants were reexamined periodically into young adulthood, during the years 1978–1996. From 4,262 children and 2,324 adults who participated in the cross-sectional studies, 745 individuals who had complete laboratory data and clinical follow-up from childhood to adulthood were selected in order to determine if childhood adiposity could predict the onset of Syndrome X in young adulthood. Participants with reported pregnancy, diabetes, hypertension, dyslipidemia, or use of medications to treat these 3 diseases were excluded.

The primary variables chosen for evaluation in this study were body mass index (BMI), total insulin, systolic blood pressure (SBP), mean arterial pressure (MAP), ratio of total cholesterol to HDL (TC/HDL), and ratio of triglycerides to HDL (TG/HDL). Clustering, which would meet the criteria of Syndrome X, was defined as simultaneous values greater than 75% for BMI, total insulin, SBP or MAP, and TC/HDL or TG/HDL. Among the 745 subjects included in the study, 48 were found to have clustering as young adults. Mean values for all 6 primary variables were significantly higher among clustered individuals as compared with their non-clustered counterparts. When stratified by the number of Syndrome X criteria met in adulthood, subjects with a higher number of criteria met in young adulthood were significantly more likely to have a higher value for each variable.

When childhood values of each of the 6 primary variables were analyzed for relationships to clustering in adulthood, significant associations were discovered for childhood BMI and fasting insulin levels. Children with a BMI in the top quartile were more likely to have adult clustering than children in the bottom quartile (odds ratio 11.7; 95% CI, 3.4–39.7). Children with a fasting insulin in the top quartile were more likely to have clustering than those in the bottom quartile (odds ratio 3.6; 95% CI, 1.5–8.7). However, this difference became statistically insignificant when adjusted for childhood BMI. Finally, a stepwise logistic regression model was used to determine which of the primary variables had the most predictive impact on adult clustering. Only BMI and insulin were included in the best-fitting model. Comparing children with mean BMI to those with BMI 1 standard deviation above the mean, the odds of clustering as an adult were 2.03. Comparing children with mean insulin levels to those with insulin levels 1 standard deviation above mean, the odds of clustering as an adult were 1.33. The authors conclude that adiposity, as measured by childhood BMI, is a significant predictor of Syndrome X in young adulthood, and that children...

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