Childhood predictors of young-onset type 2 diabetes
Childhood predictors of young-onset type 2 diabetes
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DOI：
10.2337/db06-1639
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发表时间：
2007-12-01
期刊：
影响因子：
7.7
通讯作者：
Looker, Helen C.
中科院分区：
文献类型：
--
作者：
Franks, Paul W.;Hanson, Robert L.;Looker, Helen C.
预防-最佳的预防2型糖尿病需要确定生命早期可改变的危险因素。研究设计和方法--对于2型糖尿病预测，我们推导出一个最佳加权的、连续分布的、标准化的多变量评分（zMS），包括通常测量的代谢、人体测量和血管特征（即，空腹和2小时葡萄糖、A1 C、BMI、腰围、空腹胰岛素、HDL胆固醇、甘油三酯和血压），并将每个特征的预测能力与zMS进行比较。在单独的考克斯比例风险模型中，调整年龄、性别和种族，zMS及其每个组成风险因素与2型糖尿病的发生相关。逐步比例风险模型选择空腹血糖、2小时血糖、HDL胆固醇和BMI作为独立的糖尿病预测因子;单独来看，这些预测因子比zMS弱（P < 0.01）。然而，仅结合这些变量的简约汇总评分具有与zMS相似的预测能力（P = 0.33）。虽然宫内糖尿病暴露或父母的糖尿病发病史增加了孩子的绝对风险发展为糖尿病，糖尿病风险关系的大小zMS和吝啬的分数是相似的，无论家族危险factors. CONCLUSIONS，我们已经确定了相对价值的功能，在儿童期的代谢综合征的预测随后的2型糖尿病。我们的研究结果表明，针对儿童和青少年时期的肥胖、葡萄糖稳态失调和低HDL胆固醇的策略可能在预防糖尿病方面最成功。
OBJECTIVE-Optimal prevention of young-onset type 2 diabetes requires identification of the early-life modifiable risk factors. We aimed to do this using longitudinal data in 1,604 5- to 19-year-old initially nondiabetic American Indians.RESEARCH DESIGN AND METHODS-For type 2 diabetes prediction, we derived an optimally weighted, continuously distributed, standardized multivariate score (zMS) comprising commonly measured metabolic, anthropometric, and vascular traits (i.e., fasting and 2-h glucose, A1C, BMI, waist circumference, fasting insulin, HDL cholesterol, triglycerides, and blood pressures) and compared the predictive power for each feature against zMS.RESULTS-In separate Cox proportional hazard models, adjusted for age, sex, and ethnicity, zMS and each of its component risk factors were associated with incident type 2 diabetes. Stepwise proportional hazards models selected fasting glucose, 2-h glucose, HDL cholesterol, and BMI as independent diabetes predictors; individually, these were weaker predictors than zMS (P < 0.01). However, a parsimonious summary score combining only these variables had predictive power similar to that of zMS (P = 0.33). Although intrauterine diabetes exposure or parental history of young-onset diabetes increased a child's absolute risk of developing diabetes, the magnitude of the diabetes-risk relationships for zMS and the parsimonious score were similar irrespective of familial risk factors.CONCLUSIONS-We have determined the relative value of the features of the metabolic syndrome in childhood for the prediction of subsequent type 2 diabetes. Our findings suggest that strategies targeting obesity, dysregulated glucose homeostasis, and low HDL cholesterol during childhood and adolescence may have the most success in preventing diabetes.