Predicting adult metabolic syndrome from childhood body mass index: follow-up of the New Delhi birth cohort

• Published in: Archives of disease in childhood Vol. 94; no. 10; pp. 768 - 774
• Main Authors: Sachdev, H P S, Osmond, C, Fall, C H D, Lakshmy, R, Ramji, S, Dey Biswas, S K, Prabhakaran, D, Tandon, N, Reddy, K S, Barker, D J P, Bhargava, S K
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.10.2009; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adult; Adults; Age; Aging - physiology; Anthropometry - methods; Biological and medical sciences; Blood pressure; Body Composition; Body Mass Index; Data Analysis; Demographic aspects; Developing Countries; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Diabetes Mellitus, Type 2 - physiopathology; Disease control; Epidemiologic Methods; Families & family life; Fasting; Female; General aspects; Glucose Intolerance - epidemiology; Glucose Intolerance - etiology; Glucose Intolerance - physiopathology; Humans; Hypertension; India - epidemiology; Infant, Newborn; LDCs; Lifestyles; Male; Medical sciences; Metabolic diseases; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - epidemiology; Metabolic Syndrome - etiology; Metabolic Syndrome - physiopathology; Metabolic syndrome X; Miscellaneous; Obesity; Obesity - complications; Obesity - epidemiology; Obesity - physiopathology; Other metabolic disorders; Prevention and actions; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk factors; Studies; Weight Gain - physiology; Delhi; Asia; India; Endocrinopathy; Human; Pediatrics; Metabolic diseases; Cardiovascular disease; Metabolic syndrome; Body mass index; Surveillance; Follow up study; Cohort study; Adult; Birth cohort; Predictive factor; Child; Public health
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2008.140905

Objectives:To assess whether serial measurements of childhood body mass index (BMI) give clinically useful predictions of the risk of developing adult metabolic syndrome and impaired glucose tolerance or type 2 diabetes.Design/setting:Follow-up of a community-based birth cohort in Delhi, India.Participants:1492 men and women aged 26–32 years whose BMI was recorded 6-monthly throughout childhood.Main outcome measures:The predictive value of childhood BMI for adult metabolic syndrome and impaired glucose tolerance (IGT) and diabetes mellitus.Results:25% of subjects had metabolic syndrome and 15% had IGT/diabetes mellitus. Both outcomes were associated with greater childhood BMI gain (metabolic syndrome: OR 1.63 (95% CI 1.44 to 1.85); IGT/diabetes mellitus: 1.39 (1.20 to 1.60) per unit increase in within-cohort BMI SD score between 5 and 14 years). The best predictions of adult disease were obtained using a combined test comprising (i) any increase in BMI SD score between 5 and 14 years and (ii) a BMI SD score >0 at 14 years (metabolic syndrome: sensitivity 45%, specificity 78%; IGT/diabetes mellitus: 37%, 73%). Likelihood ratios were low (metabolic syndrome: 1.4–2.0; IGT/diabetes mellitus: 1.2–1.4). A single high BMI measurement at 14 years (overweight or obese, according to International Obesity Task Force criteria) was highly specific but insensitive (metabolic syndrome: sensitivity 7%, specificity 97%; IGT/diabetes mellitus: 8%, 97%). Charts for plotting BMI SD scores through childhood were produced.Conclusions:Serial measurements of childhood BMI give useful predictions of adult risk and could guide advice to children and parents on preventing later disease.