title: Metabolic Risk Factors and Type 2 Diabetes Incidence in American Indian Children.
abstract: Data are lacking on how metabolic risk factors during childhood affect the long-term risk of type 2 diabetes.
  
  
  
  Assess four metabolic risk factors as predictors of type 2 diabetes and determine whether the risk differs between younger and older children.
  
  
  
  In a prospective cohort study conducted between 1965 and 2007, participants were followed for development of diabetes. Baseline measurements included body mass index (BMI), blood pressure, serum cholesterol, and 2-hour plasma glucose after an oral glucose tolerance test. Additional analyses divided subjects into two groups according to baseline age, 5–11 and 12–19 years.
  
  
  
  Gila River Indian Community in Arizona.
  
  
  
  A total of 5532 nondiabetic Pima Indian children 5–19 years old.
  
  
  
  A total of 1281 children developed diabetes (median follow-up, 12.4 years). Diabetes incidence was higher in overweight children (BMI ≥ 85th percentile) than in nonoverweight children. Nonoverweight children had the lowest risk of diabetes (20-year cumulative incidence, 9.5%), whereas overweight children with impaired glucose tolerance (2-hour glucose ≥ 140 mg/dL) had the highest (79.0%). The relative risk for children with metabolic abnormalities compared with their healthy counterparts was higher in younger children than in older children early in follow-up. BMI and 2-hour glucose were related to incident diabetes in multivariable models (predicted 15-year cumulative incidence for the highest vs lowest quartile was 3.9 and 1.8 times as high for BMI and 2-hour glucose, respectively; P < .001), whereas blood pressure and cholesterol were not.
  
  
  
  BMI and impaired glucose tolerance in children are strong predictors of type 2 diabetes. Other components of the “metabolic syndrome” are not.
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Wheelock
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
authors.forename: Madhumita
authors.initials: M
authors.lastname: Sinha
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
authors.forename: Gudeta D
authors.initials: GD
authors.lastname: Fufaa
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona 85014.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism* / Q000473:pathology; D050171:Dyslipidemias / Q000503:physiopathology*; D005260:Female; D018149:Glucose Intolerance / Q000503:physiopathology*; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D009765:Obesity / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose