title: Life course path analysis of total and central adiposity throughout adolescence on adult blood pressure and insulin resistance.
abstract: OBJECTIVE
  We aimed to study whether the effect of adolescent adiposity on adult blood pressure and insulin resistance was mediated by adult adiposity.
  
  
  RESULTS
  Data from the EPITeen cohort at 13, 17 and 21 years was used (n = 2211). Sex- and age-specific body mass index z-scores (BMIz) and waist-to-hip ratio (WHR) were used as indicators of total and central adiposity, respectively. Systolic blood pressure (SBP), glucose and insulin were assessed at 21 years and the homeostasis model assessment (HOMA-IR) was used as a marker of insulin resistance. Path analysis was applied to evaluate direct and indirect effects of adiposity (13, 17 and 21y) on adult SBP and HOMA-IR, separately for total and central adiposity and for each outcome. Results are presented as standardized regression coefficients [β (95%CI)]. The total effect of BMIz at 13 years on SBP at 21 years was 0.211 (0.178; 0.244), totally mediated by adult BMIz. Total effect of BMIz 13y on HOMA-IR was 0.248 (0.196; 0.299). Although this effect was mostly mediated by BMIz 21y, an additional direct effect from BMIz 17y was found [β = -0.240 (-0.315; -0.164)]. Central adiposity was also positively associated with SBP and HOMA-IR at 21 years, and the effect of adolescent WHR was totally mediated by adult WHR for both outcomes.
  
  
  CONCLUSIONS
  The effect of adolescent adiposity on adult SBP and HOMA-IR was mostly mediated by adult adiposity. However, for HOMA-IR an additional direct effect from total adiposity at 17 years was found.
authors.affiliation: EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal. Electronic address: joana.araujo@ispup.up.pt.
authors.forename: J
authors.initials: J
authors.lastname: Araújo
authors.affiliation: EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Severo
authors.affiliation: EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Santos
authors.affiliation: EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Ramos
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D063766:Pediatric Obesity / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011174:Portugal; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin
keywords: Adiposity; Adolescence; Blood pressure; Insulin resistance; Life course; Path analysis