Childhood predictors of adult acute insulin response and insulin action.
OBJECTIVE
Because declines in acute insulin response (AIR) and insulin action (M) predict development of type 2 diabetes, we sought to determine childhood factors that predict insulin action and AIR using longitudinal data from young Pima Indian adults with normal glucose regulation.


METHODS
Predictors of adult M, measured by the euglycemic-hyperinsulinemic clamp, and AIR, measured after a 25-g glucose bolus, were assessed in 76 individuals from a set of childhood data (BMI, systolic blood pressure [sBP] and diastolic blood pressure, cholesterol, fasting and 2-h insulin, and glucose levels during an oral glucose tolerance test).


RESULTS
After adjustment for sex, adult percent body fat, adult and childhood age, childhood BMI, and sBP were negative and independent predictors of adult M. A 5 kg/m(2) increase in childhood BMI was associated with a 7.4% decrease in adult insulin action (95% CI -12.7 to -1.8%, P = 0.01) and a 10-mmHg increase in childhood sBP with a 5.0% decrease in adult M (95% CI -8.4 to -1.4%, P = 0.007). After a similar adjustment with M as an additional covariate, childhood 2-h insulin was a positive predictor of adult AIR such that a 25% increase predicted a 7.3% increase in adult AIR (95% CI 1.5-13.5%, P = 0.014).


CONCLUSIONS
Childhood insulin response during an oral glucose challenge predicts adult AIR, indicating that beta-cell capacity may be set early in life. Childhood measures related to adiposity predict adult insulin action, which may reflect common underlying mechanisms that may be amenable to modification through programs targeting prevention or treatment of childhood obesity.
Thearle
Marie S
MS
Obesity and Diabetes Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA. thearlem@mail.nih.gov
Bunt
Joy C
JC
Knowler
William C
WC
Krakoff
Jonathan
J
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002648:Child; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003971:Diastole; D005215:Fasting; D005260:Female; D015309:Glucose Clamp Technique / Q000379:methods*; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D000078790:Insulin Secretion; D008297:Male; D011237:Predictive Value of Tests; D013599:Systole; D055815:Young Adult
D001786:Blood Glucose; D007328:Insulin; D002784:Cholesterol