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Cadario F. Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture. Nutrients 2022; 14:nu14224887. [PMID: 36432570 PMCID: PMC9699239 DOI: 10.3390/nu14224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, University of Piemonte Orientale, 28100 Novara, Italy;
- Diabetes Research Institute Federation, Miami, FL 33163, USA
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2
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Stevens P, Hunter J, Molodysky E. The role of hyperinsulinaemia in screening for prediabetes in the adolescent population: A systematic literature review. Diabetes Metab Syndr 2022; 16:102445. [PMID: 35305511 DOI: 10.1016/j.dsx.2022.102445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Present screening methods for Type 2 diabetes (T2DM) fall short of detecting prediabetes. This paper summarises the literature on the utility of insulin measurements (hyperinsulinemia) in detecting prediabetes in adolescents. METHODS A systematic literature review was conducted using EMBASE and Medline. Relevant data on hyperinsulinemia in the adolescent population is narrated. RESULTS The database search identified 174 potential articles; 106 underwent a full-paper review, and 36 were included. CONCLUSION Elevated fasting insulin is a marker of impaired insulin resistance and pending beta-cell dysfunction in at-risk adolescents and can be an early indicator of prediabetes.
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Yajnik CS, Bandopadhyay S, Bhalerao A, Bhat DS, Phatak SB, Wagh RH, Yajnik PC, Pandit A, Bhave S, Coyaji K, Kumaran K, Osmond C, Fall CHD. Poor In Utero Growth, and Reduced β-Cell Compensation and High Fasting Glucose From Childhood, Are Harbingers of Glucose Intolerance in Young Indians. Diabetes Care 2021; 44:2747-2757. [PMID: 34610922 DOI: 10.2337/dc20-3026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE India is a double world capital of early-life undernutrition and type 2 diabetes. We aimed to characterize life course growth and metabolic trajectories in those developing glucose intolerance as young adults in the Pune Maternal Nutrition Study (PMNS). RESEARCH DESIGN AND METHODS PMNS is a community-based intergenerational birth cohort established in 1993, with serial information on parents and children through pregnancy, childhood, and adolescence. We compared normal glucose-tolerant and glucose-intolerant participants for serial growth, estimates of insulin sensitivity and secretion (HOMA and dynamic indices), and β-cell compensation accounting for prevailing insulin sensitivity. RESULTS At 18 years (N = 619), 37% of men and 20% of women were glucose intolerant (prediabetes n = 184; diabetes n = 1) despite 48% being underweight (BMI <18.5 kg/m2). Glucose-intolerant participants had higher fasting glucose from childhood. Mothers of glucose-intolerant participants had higher glycemia in pregnancy. Glucose-intolerant participants were shorter at birth. Insulin sensitivity decreased with age in all participants, and those with glucose intolerance had consistently lower compensatory insulin secretion from childhood. Participants in the highest quintile of fasting glucose at 6 and 12 years had 2.5- and 4.0-fold higher risks, respectively, of 18-year glucose intolerance; this finding was replicated in two other cohorts. CONCLUSIONS Inadequate compensatory insulin secretory response to decreasing insulin sensitivity in early life is the major pathophysiology underlying glucose intolerance in thin rural Indians. Smaller birth size, maternal pregnancy hyperglycemia, and higher glycemia from childhood herald future glucose intolerance, mandating a strategy for diabetes prevention from early life, preferably intergenerationally.
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Affiliation(s)
| | | | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Dattatray S Bhat
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Sanat B Phatak
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Rucha H Wagh
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Pallavi C Yajnik
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Anand Pandit
- Department of Paediatrics, KEM Hospital Research Centre, Pune, India
| | - Sheila Bhave
- Department of Paediatrics, KEM Hospital Research Centre, Pune, India
| | - Kurus Coyaji
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Kalyanaraman Kumaran
- Holdsworth Memorial Hospital, Mysore, India.,Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, U.K
| | - Clive Osmond
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, U.K
| | - Caroline H D Fall
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, U.K
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Bilinski WJ, Szternel L, Siodmiak J, Krintus M, Paradowski PT, Domagalski K, Sypniewska G. Effect of fasting hyperglycemia and insulin resistance on bone turnover markers in children aged 9-11 years. J Diabetes Complications 2021; 35:108000. [PMID: 34384707 DOI: 10.1016/j.jdiacomp.2021.108000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/07/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
AIM Impaired regulation of glucose metabolism in childhood adversely affects bone health. We assessed the effect of fasting hyperglycemia and insulin resistance on bone turnover markers in prepubertal children with normal glycemia (<100 mg/dL) and fasting hyperglycemia (100-125 mg/dL). METHODS Glucose, hemoglobin A1c, IGF-I (insulin-like growth factor I), iP1NP (N-terminal propeptide of type I procollagen), CTX-1 (C-terminal telopeptide of type I collagen) and insulin were measured. Bone turnover index (BTI) and HOMA-IR (homeostasis model assessment) were calculated. RESULTS Bone resorption marker (CTX) levels were decreased by 26.5% in boys with hyperglycemia, though only 7% in girls. Hyperglycemia had no effect on the bone formation marker iP1NP. IGF-1, the best predictor of bone marker variance accounted for 25% of iP1NP and 5% of CTX variance. Girls presented significantly higher BTI indicating the predominance of bone formation over resorption. Insulin resistance significantly decreased CTX. In girls, HOMA-IR and IGF-1 predicted 15% of CTX variance. CONSLUSIONS Fasting hyperglycemia and insulin resistance in children impact bone turnover suppressing bone resorption. Hyperglycemia decreased resorption, particularly in boys, while suppression of resorption by insulin resistance was more pronounced in girls. We suggest that the progression of disturbances accompanying prediabetes, may interfere with bone modelling and be deleterious to bone quality in later life.
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Affiliation(s)
- Wojciech J Bilinski
- Department of Orthopaedics and Traumatology, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; Department of Orthopaedics, KoMed, Poddebickie Health Center, Poddebice, Poland.
| | - Lukasz Szternel
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Joanna Siodmiak
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Magdalena Krintus
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Przemyslaw T Paradowski
- Department of Orthopaedics and Traumatology, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; Department of Surgical and Perioperative Sciences, Division of Orthopedics, Sunderby Research Unit, Umeå University, Umeå, Sweden; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Krzysztof Domagalski
- Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun, Poland
| | - Grazyna Sypniewska
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
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Esser N, Utzschneider KM, Kahn SE. Early beta cell dysfunction vs insulin hypersecretion as the primary event in the pathogenesis of dysglycaemia. Diabetologia 2020; 63:2007-2021. [PMID: 32894311 DOI: 10.1007/s00125-020-05245-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
Obesity and insulin resistance are associated with the development of type 2 diabetes. It is well accepted that beta cell dysfunction is required for hyperglycaemia to occur. The prevailing view is that, in the presence of insulin resistance, beta cell dysfunction that occurs early in the course of the disease process is the critical abnormality. An alternative model has been proposed in which primary beta cell overstimulation results in insulin hypersecretion that then leads to the development of obesity and insulin resistance, and ultimately to beta cell exhaustion. In this review, data from preclinical and clinical studies, including intervention studies, are discussed in the context of these models. The preponderance of the data supports the view that an early beta cell functional defect is the more likely mechanism underlying the pathogenesis of hyperglycaemia in the majority of individuals who develop type 2 diabetes. Graphical abstract.
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Affiliation(s)
- Nathalie Esser
- Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (151), Seattle, WA, 98108, USA
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kristina M Utzschneider
- Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (151), Seattle, WA, 98108, USA
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Steven E Kahn
- Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (151), Seattle, WA, 98108, USA.
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA.
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Cominetti O, Hosking J, Jeffery A, Pinkney J, Martin FP. Contributions of Fat and Carbohydrate Metabolism to Glucose Homeostasis in Childhood Change With Age and Puberty: A 12-Years Cohort Study (EARLYBIRD 77). Front Nutr 2020; 7:139. [PMID: 32984398 PMCID: PMC7483556 DOI: 10.3389/fnut.2020.00139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022] Open
Abstract
Puberty-a period when susceptibility to the onset of Type 2 diabetes (T2D) increases-is marked with profound physiological and metabolic changes. In the EarlyBird cohort, children who developed impaired fasting glycemia in adolescence already exhibited higher fasting blood glucose at 5 years of age, independent of their body mass index (BMI), suggesting that pubertal factors may modify existing predisposition. Understanding how the physiological changes during childhood influence glucose homeostasis and how the central energy metabolism may help deciphering the mechanisms that underlie the risk of developing T2D in children and adults. We investigated these associations by analyzing glycemic variations with molecular markers of central energy metabolism, substrate oxidation status and pubertal stages in the EarlyBird cohort. The EarlyBird study is a non-interventional, prospective cohort study, that recruited 307 healthy UK children at age 5, and followed them annually throughout childhood for 12 years. Longitudinal data on blood biochemistry, respiratory exchange ratio, and anthropometry, available from 150 children were integrated with fasting glycemia. The gradual rise in blood glucose during childhood associates with age-dependent changes in molecular processes and substrate oxidation status, namely (i) greater pre-pubertal fat utilization, ketogenesis, and fatty acid oxidation, and (ii) greater pubertal carbohydrate oxidation and glycolytic metabolism (Cori and Cahill Cycles) associated with different amino acid exchanges between muscle and other tissues (proline, glutamine, alanine). Since children's metabolic and nutritional requirements evolve during childhood, this study has potential clinical implications for the development of nutritional strategies for disease prevention in children.
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Affiliation(s)
- Ornella Cominetti
- Nestlé Institute of Food Safety & Analytical Sciences, Nestlé Research, Lausanne, Switzerland
| | - Joanne Hosking
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, United Kingdom
| | - Alison Jeffery
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, United Kingdom
| | - Jonathan Pinkney
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, United Kingdom
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Carayol J, Hosking J, Pinkney J, Marquis J, Charpagne A, Metairon S, Jeffery A, Hager J, Martin FP. Genetic Susceptibility Determines β-Cell Function and Fasting Glycemia Trajectories Throughout Childhood: A 12-Year Cohort Study (EarlyBird 76). Diabetes Care 2020; 43:653-660. [PMID: 31915205 DOI: 10.2337/dc19-0806] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies suggested that childhood prediabetes may develop prior to obesity and be associated with relative insulin deficiency. We proposed that the insulin-deficient phenotype is genetically determined and tested this hypothesis by longitudinal modeling of insulin and glucose traits with diabetes risk genotypes in the EarlyBird cohort. RESEARCH DESIGN AND METHODS EarlyBird is a nonintervention prospective cohort study that recruited 307 healthy U.K. children at 5 years of age and followed them throughout childhood. We genotyped 121 single nucleotide polymorphisms (SNPs) previously associated with diabetes risk, identified in the adult population. Association of SNPs with fasting insulin and glucose and HOMA indices of insulin resistance and β-cell function, available from 5 to 16 years of age, were tested. Association analysis with hormones was performed on selected SNPs. RESULTS Several candidate loci influenced the course of glycemic and insulin traits, including rs780094 (GCKR), rs4457053 (ZBED3), rs11257655 (CDC123), rs12779790 (CDC123 and CAMK1D), rs1111875 (HHEX), rs7178572 (HMG20A), rs9787485 (NRG3), and rs1535500 (KCNK16). Some of these SNPs interacted with age, the growth hormone-IGF-1 axis, and adrenal and sex steroid activity. CONCLUSIONS The findings that genetic markers influence both elevated and average courses of glycemic traits and β-cell function in children during puberty independently of BMI are a significant step toward early identification of children at risk for diabetes. These findings build on our previous observations that pancreatic β-cell defects predate insulin resistance in the onset of prediabetes. Understanding the mechanisms of interactions among genetic factors, puberty, and weight gain would allow the development of new and earlier disease-management strategies in children.
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Affiliation(s)
- Jerome Carayol
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Joanne Hosking
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, U.K
| | - Jonathan Pinkney
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, U.K
| | - Julien Marquis
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Aline Charpagne
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Sylviane Metairon
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Alison Jeffery
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, U.K
| | - Jörg Hager
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
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Hosking J, Pinkney J, Jeffery A, Cominetti O, Da Silva L, Collino S, Kussmann M, Hager J, Martin FP. Insulin Resistance during normal child growth and development is associated with a distinct blood metabolic phenotype (Earlybird 72). Pediatr Diabetes 2019; 20:832-841. [PMID: 31254470 DOI: 10.1111/pedi.12884] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND While insulin resistance (IR) is associated with specific metabolite signatures in adults, there have been few truly longitudinal studies in healthy children, either to confirm which abnormalities are present, or to determine whether they precede or result from IR. Therefore, we investigated the association of serum metabolites with IR in childhood in the Earlybird cohort. METHODS The Earlybird cohort is a well-characterized cohort of healthy children with annual measurements from age 5 to 16 years. For the first time, longitudinal association analyses between individual serum metabolites and homeostatic model assessment (HOMA) of insulin resistance (HOMA-IR) have been performed taking into account the effects of age, growth, puberty, adiposity, and physical activity. RESULTS IR was higher in girls than in boys and was associated with increasing body mass index (BMI). In longitudinal analysis IR was associated with reduced concentrations of branched-chain amino acids (BCAA), 2-ketobutyrate, citrate and 3-hydroxybutyrate, and higher concentrations of lactate and alanine. These findings demonstrate the widespread biochemical consequences of IR for intermediary metabolism, ketogenesis, and pyruvate oxidation during normal child growth and development. CONCLUSIONS Longitudinal analysis can differentiate metabolite signatures that precede or follow the development of greater levels of IR. In healthy normal weight children, higher levels of IR are associated with reduced levels of BCAA, ketogenesis, and fuel oxidation. In contrast, elevated lactate concentrations preceded the rise in IR. These changes reveal the metabolite signature of insulin action during normal growth, and they contrast with previous findings in obese children and adults that represent the consequences of IR and obesity.
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Affiliation(s)
- Joanne Hosking
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Jonathan Pinkney
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Alison Jeffery
- Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Ornella Cominetti
- Department of Analytical Sciences, Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Laeticia Da Silva
- Department of Analytical Sciences, Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Sebastiano Collino
- Department of Analytical Sciences, Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Martin Kussmann
- Department of Analytical Sciences, Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Jorg Hager
- Department of Nutrition and Dietary recommendations, Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
| | - Francois-Pierre Martin
- Department of Metabolic Health, Société des Produits Nestlé SA, Nestlé Research, Lausanne, Switzerland
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Mostazir M, Jeffery A, Voss L, Wilkin T. Generational change in fasting glucose and insulin among children at ages 5-16y: Modelled on the EarlyBird study (2015) and UK growth standards (1990) (EarlyBird 69). Diabetes Res Clin Pract 2017; 123:18-23. [PMID: 27918974 DOI: 10.1016/j.diabres.2016.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/21/2016] [Indexed: 01/09/2023]
Abstract
AIM Pre-diabetes is a state of beta-cell stress caused by excess demand for insulin. Body mass is an important determinant of insulin demand, and BMI has risen substantially over recent time. We sought to model changes in the parameters of glucose control against rising BMI over the past 25years. METHODS Using random coefficient mixed models, we established the correlations between HbA1C, fasting glucose, fasting insulin, HOMA2-IR and BMI in contemporary (2015) children (N=307) at ages 5-16y from the EarlyBird study, and modelled their corresponding values 25years ago according to the distribution of BMI in the UK Growth Standards (1990). RESULTS There was little change in HbA1C or fasting glucose over the 25y period at any age or in either gender. On the other hand, the estimates for fasting insulin and HOMA2-IR were substantially higher in both genders in 2015 compared with 1990. CONCLUSION Insofar as it is determined by body mass, there has been a substantial rise in beta cell demand among children over the past 25years. The change could be detected by fasting insulin and HOMA2-IR, but not by fasting glucose or HbA1C.
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Affiliation(s)
- Mohammod Mostazir
- Institute of Health Research, University of Exeter Medical School, Exeter, UK; College of Life and Environmental Sciences (CLES), University of Exeter, Exeter, UK.
| | - Alison Jeffery
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - Linda Voss
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Terence Wilkin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Metcalf BS, Hosking J, Henley WE, Jeffery AN, Mostazir M, Voss LD, Wilkin TJ. Physical activity attenuates the mid-adolescent peak in insulin resistance but by late adolescence the effect is lost: a longitudinal study with annual measures from 9-16 years (EarlyBird 66). Diabetologia 2015; 58:2699-708. [PMID: 26264061 DOI: 10.1007/s00125-015-3714-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/10/2015] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to test whether the mid-adolescent peak in insulin resistance (IR) and trends in other metabolic markers are influenced by long-term exposure to physical activity. METHODS Physical activity (7 day ActiGraph accelerometry), HOMA-IR and other metabolic markers (glucose, fasting insulin, HbA1c, lipids and BP) were measured annually from age 9 years to 16 years in 300 children (151 boys) from the EarlyBird study in Plymouth, UK. The activity level of each child was characterised, with 95% reliability, by averaging their eight annual physical activity measures. Age-related trends in IR and metabolic health were analysed by multi-level modelling, with physical activity as the exposure measure (categorical and continuous) and body fat percentage (assessed by dual-energy X-ray absorptiometry) and pubertal status (according to age at peak height velocity and Tanner stage) as covariates. RESULTS The peak in IR at age 12-13 years was 17% lower (p < 0.001) in the more active adolescents independently of body fat percentage and pubertal status. However, this difference diminished progressively over the next 3 years and had disappeared completely by the age of 16 years (e.g. difference was -14% at 14 years, -8% at 15 years and +1% at 16 years; 'physical activity × age(2), interaction, p < 0.01). Triacylglycerol levels in girls (-9.7%, p = 0.05) and diastolic blood pressure in boys (-1.20 mmHg, p = 0.03) tended to be lower throughout adolescence in the more active group. CONCLUSIONS/INTERPRETATION Our finding that physical activity attenuates IR during mid-adolescence may be clinically important. It remains to be established whether the temporary attenuation in IR during this period has implications for the development of diabetes in adolescence and for future metabolic health generally.
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Affiliation(s)
- Brad S Metcalf
- Institute of Health Research, University of Exeter Medical School, Exeter, UK.
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Joanne Hosking
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - William E Henley
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Alison N Jeffery
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Mohammod Mostazir
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Linda D Voss
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Terence J Wilkin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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