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Pre-teen insulin resistance predicts weight gain, impaired fasting glucose, and type 2 diabetes at age 18–19 y: a 10-y prospective study of black and white girls^1,2,3

¹ From the Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (JAM); the Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH (CJG and PW); the Department of Mathematics, University of Cincinnati, Cincinnati, OH (PSH); and Westat Inc, Rockville, MD (GBS)

Background: Identifying early pre-teen predictors of adolescent weight gain and the development of impaired fasting glucose (IFG) and type 2 diabetes (T2DM) at age 18–19 y could provide avenues for prevention.

Objective: We evaluated possible pre-teen predictors for development of IFG, T2DM, and changes in body mass index at age 18–19 y in black and white girls.

Design: In a prospective cohort study, body habitus and fasting insulin and glucose were measured at ages 9–10 and 18–19 y, and multiple 3-d diet records were collected. Factors predicting 10-y change in body mass index and development of IFG and T2DM together were assessed.

Results: In multivariate analyses, 10-y change in homeostatic model assessment of insulin resistance (HOMA-IR) and the age 9–10 y HOMA-IR x percentage of calories from fat interaction were positive predictors of 10-y changes in body mass index. At age 18–19 y, there were 5 incident cases of T2DM, 37 cases of IFG, and 597 noncases. Age 9–10 y IFG and HOMA-IR (or insulin), 10-y change in HOMA-IR (or insulin), and the age 9–10 y insulin x total caloric intake interaction predicted IFG and T2DM at age 18–19 y.

Conclusions: Pre-teen IFG, insulin resistance (and insulin), and rapidly increasing insulin resistance during adolescence identifies girls who are at greater risk of future IFG and T2DM. In addition, insulin resistance, interacting with high-fat diets, identifies girls who are at risk of greater weight gain. These findings could open avenues to primary prevention of obesity, IFG, and T2DM in children.