Variability of BMI, HDL-C in Childhood May Predict Risk for Diabetes in Adulthood

Increased variations of body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) during childhood are independent risk factors for the development of diabetes, according to study results published in Diabetes Care.

Intraindividual variabilities in cardiovascular (CV) risk factors have emerged as potential markers for risk prediction for CV events, cognitive dysfunction, and mortality. To understand how variability in CV risk factors in childhood may predict diabetes in adulthood, researchers conducted a study of patients from the Bogalusa Heart Study who had ≥4 measures of BMI, systolic/diastolic blood pressure, total cholesterol, HDL-C, low-density lipoprotein cholesterol (LDL-C), and triglycerides during childhood (mean age at follow-up, 37.9 years; n=1718). Patients were also required to have ≥1 recorded measure for fasting plasma glucose.

The researchers calculated intraindividual CV risk factor variabilities during childhood using 4 indices: standard deviation (SD), coefficient of variation, deviation from age-predicted values, and residual SD. The primary outcome was a diagnosis of diabetes based on fasting plasma glucose ≥7.0 mmol/L or use of insulin or an antidiabetes medication. During 20.5 years of follow-up, 133 patients developed diabetes.

The results indicated that increased variability in BMI or HDL-C during childhood was significantly associated with later-life diabetes risk, independent of mean levels in childhood and other potential confounders.

For every standardized unit increase in BMI variability during childhood, the adjusted odds ratio for the development of diabetes in adulthood was 1.55 using SD (95% CI, 1.32-1.81), 1.50 using coefficient of variation (95% CI, 1.26-1.80), 1.42 using deviation from age-predicted value (95% CI, 1.24-1.63), and 1.43 using residual SD (95% CI, 1.24-1.63).

After performing combined analysis, the researchers found that high childhood BMI variability and high childhood HDL-C variability had similar magnitudes of association with diabetes risk.

The researchers also reported that variability in other CV risk factors including systolic/diastolic blood pressure, total cholesterol, triglycerides, and LDL-C was not significantly associated with diabetes risk after adjusting for potential confounding variables.

“These findings raise the possibility that variabilities in BMI and HDL-C would be useful for identifying future risk of diabetes,” the researchers wrote.

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Reference

Du T, Fernandez C, Barshop R, Fonseca V, Chen W, Bazzano LA. Variabilities in childhood cardiovascular risk factors and incident diabetes in adulthood: the Bogalusa Heart Study [published online July 18, 2019]. Diabetes Care. doi:10.2337/dc19-0430