title: Insulin and BMI as predictors of adult type 2 diabetes mellitus.
abstract: OBJECTIVE
  Fasting insulin concentrations are increasingly being used as a surrogate for insulin resistance and risk for type 2 diabetes (T2DM), although associations with adult outcomes are unclear. Our objective was to determine whether fasting insulin concentrations in childhood associate with later T2DM.
  
  
  METHODS
  Fasting insulin values were available from 2478 participants in the longitudinal Cardiovascular Risk in Young Finns Study at baseline age 3 to 18 years, along with data on adult T2DM (N = 84, mean age = 39.6 years).
  
  
  RESULTS
  Among 3- to 6-year-olds, a 1-SD increase in fasting insulin was associated with a relative risk (RR) of 2.04 (95% confidence interval [CI], 1.54-2.70) for later T2DM, which remained significant after we adjusted for BMI and parental history of T2DM. For those aged 9 to 18 years, a 1-SD increase in insulin was associated with an RR of 1.32 (95% CI, 1.06-1.65) for T2DM, but this became nonsignificant after we adjusted for BMI and parental history of T2DM. In the latter age group, a 1-SD increase in BMI was associated with an RR of 1.45 (95% CI, 1.21-1.73) for T2DM, with adjustment for insulin and parental history of T2DM not improving this association. BMI in younger children was not associated with later T2DM. In life course analyses, those with T2DM had higher fasting insulin levels in early childhood and later adulthood but not in peripubertal years.
  
  
  CONCLUSIONS
  Elevated fasting insulin concentrations in early childhood, but not adolescence, are independently associated with an elevated risk of T2DM in adulthood.
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Melbourne, Australia; matthew.sabin@mcri.edu.au.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Sabin
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine, and Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia;
authors.forename: Costan G
authors.initials: CG
authors.lastname: Magnussen
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine, and Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland;
authors.forename: Markus
authors.initials: M
authors.lastname: Juonala
authors.affiliation: National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, University of Bristol and Royal Hospital for Children, Bristol, United Kingdom;
authors.forename: Julian P H
authors.initials: JP
authors.lastname: Shield
authors.affiliation: Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland;
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
authors.affiliation: Department of Clinical Chemistry, Finlab Laboratories, University of Tampere School of Medicine, Tampere, Finland;
authors.forename: Terho
authors.initials: T
authors.lastname: Lehtimäki
authors.affiliation: Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland;
authors.forename: Tapani
authors.initials: T
authors.lastname: Rönnemaa
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine, and.
authors.forename: Juha
authors.initials: J
authors.lastname: Koskinen
authors.affiliation: National Institute for Health and Welfare, Department of Chronic Disease Prevention, Population Studies Unit, Turku, Finland; and.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Loo
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Knip
authors.affiliation: Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland;
authors.forename: Nina
authors.initials: N
authors.lastname: Hutri-Kähönen
authors.affiliation: Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland;
authors.forename: Jorma S A
authors.initials: JS
authors.lastname: Viikari
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Melbourne, Australia;
authors.forename: Terence
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine, and Departments of Clinical Physiology and Nuclear Medicine, and.
authors.forename: Olli T
authors.initials: OT
authors.lastname: Raitakari
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D007328:Insulin
keywords: BMI; child; insulin; type 2 diabetes mellitus