Metabolic syndrome during childhood led to type 2 diabetes later in life

Issue: March 2008

Family history of diabetes and pediatric metabolic syndrome were predictors of type 2 diabetes later in life, according to results of a new follow-up study.

Researchers from Cincinnati Children’s Hospital Medical Center, Cincinnati Jewish Hospital and the Maryland Medical Research Institute evaluated the relationship between childhood metabolic syndrome and adult metabolic syndrome and type 2 diabetes 25 to 30 years later.

Their findings showed that childhood metabolic syndrome was strongly associated with type 2 diabetes in adulthood when compared with children and adults who never had metabolic syndrome. The researchers used data from the National Heart, Lung, and Blood Institute Lipid Research Clinics Princeton Prevalence Study (children aged 5 to 19 years; 1973-1976) and the Princeton Follow-up Study (adults aged 30 to 48 years; 2000-2004).

Forty-four adults had type 2 diabetes in the Princeton Follow-up Study. The researchers reported a 15.6% incidence of adult type 2 diabetes in 32 cases of pediatric metabolic syndrome during the intervening years. However, the incidence was just 5% in patients who did not have childhood metabolic syndrome (P,.0001).

Age at follow-up, change in BMI percentile and black race were other major predictors of diabetes in adulthood. Black individuals had two times the risk for de-veloping diabetes compared with white individuals. Further, the risk for diabetes increased by 12% with each passing year.

Early identification and careful attention to these predictors could allow for primary prevention, the researchers suggested. – by Katie Kalvaitis

For more information:
Morrison J, Friedman LA, Wang P, et al. Metabolic Syndrome in Childhood Predicts Adult Metabolic Syndrome and Type 2 Diabetes Mellitus 25 to 30 Years Later. J Pediatr. 2008;152:201-206.

There is a growing body of evidence that metabolic abnormalities in childhood track into adulthood. This paper shows that metabolic syndrome in childhood is an independent predictor of both metabolic syndrome and type 2 diabetes in adults. The authors propose that children with the metabolic syndrome would be the ideal candidates for a prevention study of type 2 diabetes. While the study is well designed with excellent follow-up of subjects, questions remain. First among these is the definition of metabolic syndrome in childhood. Components of the metabolic syndrome change throughout childhood and adolescents. Therefore, age related norms must be used (as was done in this study) to define normal and abnormal. Secondly, while the odds ratio for type 2 diabetes in adulthood was 11.5 in subjects that had metabolic syndrome in childhood compared with those that did not, the majority of cases of type 2 diabetes in adulthood were found in the group that did not have metabolic syndrome at this one time assessment in childhood. Certainly risk develops over time and a one time measure may not be sufficient to identify all children who will eventually develop type 2 diabetes as adults. This may also suggest that other risk factors are more potent markers of children destined to develop type 2 diabetes as adults or it may suggest that a subset of subjects who develop type 2 diabetes as adults will not manifest metabolic abnormalities during childhood. Regardless, these data highlight the importance of identifying risk factors for type 2 diabetes in children and suggest that early intervention maybe the best for preventing type 2 diabetes. They also provide information that is useful for counseling patients to encourage life-style change to prevent future type 2 diabetes.

– Jennifer M. Barker, MD

Assistant professor of pediatrics, Barbara Davis Center for Childhood Diabetes