Abstract
This study aims to delineate the temporal relations between body mass index (BMI) and insulin in childhood and their impact on adult metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM).The longitudinal cohort consisted of 609 whites and 339 blacks who had BMI and fasting insulin measured twice in childhood (mean age = 10.5 years at baseline and 15.9 years at follow-up). Incident MetS and T2DM were identified in adulthood (mean age = 30.5 years). Cross-lagged panel and mediation analysis models were used. After adjusting for age, race, gender, and follow-up years, the cross-lagged path coefficient of BMI → insulin (β = 0.326, p < 0.001) was significantly greater than that of insulin → BMI (β = −0.023, p = 0.207) in childhood, with p < 0.001 for the difference in βs. The path coefficient for BMI → insulin was significantly greater in MetS than in non-MetS groups (0.510 vs 0.190, p < 0.001), and greater in hyperglycemia than in normoglycemia groups (0.503 vs 0.285, p = 0.026). The mediation effect of childhood insulin on the BMI-MetS and BMI-hyperglycemia associations was estimated at 19.2% (p < 0.001) and 18.3% (p < 0.001), respectively. These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this one-directional relation plays a significant role in the development of MetS and T2DM in adult life.
Highlights
The notion of “childhood origins” of metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) is supported by numerous publications from population-based cohorts followed since childhood, including the Bogalusa Heart Study[6,9,13,14,15]
Utilizing a longitudinal cohort from the Bogalusa Heart Study, the present study aims to examine the temporal sequence between childhood body mass index (BMI) and insulin using cross-lagged panel analysis and explore the impact of their temporal relationship patterns on adult MetS and T2DM using mediation analysis models
The present study examined the temporal relationship between BMI and insulin levels in a longitudinal cohort of black and white children using a cross-lagged path analysis model, a statistical approach to dissecting a causal relationship between inter-correlated variables[19,20]
Summary
The notion of “childhood origins” of MetS and T2DM is supported by numerous publications from population-based cohorts followed since childhood, including the Bogalusa Heart Study[6,9,13,14,15]. Our previous studies have demonstrated that long-term impact of obesity on MetS and T2DM is modified by insulin resistance in the longitudinal cohort of children and young adults[15,16,17]. We delineated the temporal sequence from obesity to insulin resistance by providing evidence that higher body mass index (BMI) levels precede hyperinsulinemia during childhood[18]. The cross-lagged analysis model is typically to dissect the temporal sequences of inter-correlated variables measured at two time points in a longitudinal study and help construct the mediation analysis model. Utilizing a longitudinal cohort from the Bogalusa Heart Study, the present study aims to examine the temporal sequence between childhood BMI and insulin using cross-lagged panel analysis and explore the impact of their temporal relationship patterns on adult MetS and T2DM using mediation analysis models
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