Determinants of persistent obesity and hyperinsulinemia in a biracial cohort: a 15-year prospective study of schoolgirls.
OBJECTIVE
To identify childhood-adolescent determinants of persistent hyperinsulinemia and obesity.


METHODS
We conducted a 15-year prospective study of 296 African-American and 260 Caucasian girls.


RESULTS
Childhood insulin level (partial R2=40.4%) and 14-year change in body mass index (BMI; partial R2=20.2%) were major predictors for average insulin Z score during the 15-year follow-up. Waist circumference at age 19 years, 10-year mean percentage of calories from carbohydrates, 15-year change in insulin Z score, the interaction of race with 8-year change in waist, and 14-year change in glucose level were major predictors of a 14-year change in BMI, explaining 66.7% of variability. In girls with all 9 insulin measurements in 15 years persistently in the top 25% versus girls with all measures in the bottom 75%, variables predicting the persistent insulin category included waist circumference at age 11 years (odds ratio [OR], 1.25; 95% CI, 1.11-1.40; P=.0003), 14-year change in BMI (OR, 1.26; 95% CI, 1.01-1.57; P=.037), and 8-year change in waist circumference (OR, 1.16; 95% CI, 1.01-1.32; P=.038).


CONCLUSIONS
Childhood interventions to reduce occurrence of hyperinsulinemia and obesity in early adulthood should focus on childhood-adolescent hyperinsulinemia, obesity, central adiposity, and adolescent increases in these factors.
Morrison
John A
JA
Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Glueck
Charles J
CJ
Daniels
Stephen
S
Wang
Ping
P
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004040:Dietary Carbohydrates / Q000378:metabolism; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis* / Q000208:ethnology* / Q000378:metabolism; D007328:Insulin / Q000097:blood; D008074:Lipoproteins / Q000378:metabolism; D009765:Obesity / Q000175:diagnosis* / Q000208:ethnology* / Q000378:metabolism; D011446:Prospective Studies; D044469:Racial Groups; D013334:Students / Q000706:statistics & numerical data*; D013997:Time Factors; D055105:Waist Circumference; D055815:Young Adult
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D008074:Lipoproteins