title: Temporal Relationship Between Childhood Body Mass Index and Insulin and Its Impact on Adult Hypertension: The Bogalusa Heart Study.
abstract: Although obesity and insulin resistance are closely correlated, their temporal sequences in early life and influence on adult hypertension are largely unknown. This study aims to delineate the temporal relationship patterns between body mass index (BMI) and insulin in childhood and their impact on adult hypertension. The longitudinal cohort consisted of 990 adults (630 whites and 360 blacks) who had BMI and fasting insulin measured twice 5.4 years apart in childhood (mean age, 10.5 years at baseline and 15.9 years at follow-up) and blood pressure measured 14.7 years later in adulthood (mean age, 30.5 years). Cross-lagged panel and mediation analysis models were used to examine the temporal relationship between childhood BMI and insulin and its impact on adult hypertension. After adjusting for age, race, sex, and follow-up years, the cross-lagged path coefficient (β=0.33; P<0.001) from baseline BMI to follow-up insulin was significantly greater than the path coefficient (β=-0.02; P>0.05) from baseline insulin to follow-up BMI in childhood with P<0.001 for the difference in βs. Blacks and whites showed similar patterns of the temporal relationship. The path coefficient (β=0.59; P<0.001) from BMI to insulin in the hypertensive group was significantly greater than that (β=0.24; P<0.001) in normotensive group, with P<0.001 for the difference in βs between these 2 groups. The mediation effect of childhood insulin on the childhood BMI-adult hypertension association was estimated at 21.1% (P<0.001). These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this 1-directional relation plays a role in the development of hypertension.
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Huijie
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Dianjianyi
authors.initials: D
authors.lastname: Sun
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Shengxu
authors.initials: S
authors.lastname: Li
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Camilo
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Lu
authors.initials: L
authors.lastname: Qi
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Emily
authors.initials: E
authors.lastname: Harville
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Lydia
authors.initials: L
authors.lastname: Bazzano
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.).
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.). wchen1@tulane.edu xuefzh@sdu.edu.cn.
authors.forename: Fuzhong
authors.initials: F
authors.lastname: Xue
authors.affiliation: From the Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (T.Z., F.X.); Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (T.Z., H.Z., Y.L., D.S., S.L., C.F., L.Q., E.H., L.B., J.H., W.C.); Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, China (H.Z.); and Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China (Y.L.). wchen1@tulane.edu xuefzh@sdu.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044383:Black People / Q000706:statistics & numerical data; D001795:Blood Pressure Determination; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000453:epidemiology / Q000503:physiopathology*; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology*; D015994:Incidence; D007333:Insulin Resistance / Q000502:physiology*; D008137:Longitudinal Studies; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D012737:Sex Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
keywords: blood pressure; body mass index; hyperinsulinism; hypertension; obesity