Search

Background Observational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk. However, it remains uncertain whether this association is causal. Objective This study evaluated the feasibility of an intervention to increase cereal fiber intake in children using breakfast cereals. Methods The study was a 2-arm parallel group randomized controlled trial in 9–10-y-old children, who received free supplies of high-fiber breakfast cereals (g3.5 g/portion) or low-fiber breakfast cereals (l1.0 g/portion) to eat daily for 1 mo with behavioral support to promote adherence. Children provided baseline and 1-mo fasting blood samples, physical measurements, and 24-h dietary recalls. The primary outcome was the group difference in change in plasma total alkylresorcinol (AR) concentration; secondary outcomes were group differences in nutrient intakes and adiposity indices. Analyses (complete case and multiple imputation) were conducted by regressing the final AR concentration on baseline AR in models adjusted for sex, ethnicity, age, and school (random effect). Results Two-hundred seventy-two children were randomly assigned (137 receiving a low-fiber and 135 a high-fiber diet) and 193 (71%) provided fasting blood samples at baseline and follow-up. Among randomized participants, median (IQR) of baseline AR was 43.1 (24.6–85.5) nmol/L and of cereal fiber intake was 4.5 (2.7–6.4) g; 87% of participants reported consuming the cereal on most or all days. Compared with changes in the low-fiber group, the high-fiber group had greater increases in AR (40.7 nmol/L; 95% CI: 21.7, 59.8 nmol/L, P l 0.0001) and in reported cereal fiber intake (2.9g/d; 95% CI: 2.0, 3.7 g; P l 0.0001). There were no appreciable differences in other secondary outcomes. Conclusions We have developed a simple and acceptable nutritional intervention that increases markers of daily cereal fiber intake in children. This intervention could be used to test whether increases in cereal fiber intake in children might reduce insulin resistance. This trial was registered at www.isrctn.com as ISRCTN33260236. more...

BACKGROUND: Associations between sleep duration and type 2 diabetes (T2D) risk markers in childhood have been little studied. We examined associations between self-reported sleep duration and T2D risk markers in children. METHODS: Cross-sectional study of 4525 multiethnic UK children aged 9 to 10 years. Sleep time was calculated from self-reported usual time of going to bed and getting up on a school day, validated in a subset using accelerometers. Fasting blood samples provided levels of serum lipids and insulin, plasma glucose, and HbA1c. Physical measures included height, weight, bioimpedance, and blood pressure. Multilevel linear regression models of anthropometric, T2D, and cardiovascular risk markers with sleep duration were adjusted for sex, age, month, ethnicity, socioeconomic position, observer (physical measures only), and random effect of school. RESULTS: On average, children slept 10.5 hours per night (95% range 8.0–12.0 hours). There were strong inverse graded relationships between sleep duration, adiposity, and diabetes risk markers. In adjusted models, a 1-hour-longer sleep duration was associated with 0.19 lower BMI (95% confidence interval [CI] 0.09 to 0.28), 0.03 kg/m5 lower fat mass index (95% CI 0.00 to 0.05 kg/m5), 2.9% lower homeostasis model assessment insulin resistance (95% CI 1.2% to 4.4%), and 0.24% lower fasting glucose (95% CI 0.03% to 0.44%); there was no association with HbA1c or cardiovascular risk. Associations with insulin and glucose remained after an additional adjustment for adiposity markers. CONCLUSIONS: The finding of an inverse association between sleep duration and T2D risk markers in childhood is novel. Intervention studies are needed to establish the causality of these associations, which could provide a simple strategy for early T2D prevention. more...

Background The relationship between physical fitness and risk markers for type 2 diabetes (T2D) in children and the contribution to ethnic differences in these risk markers have been little studied. We examined associations between physical fitness and early risk markers for T2D and cardiovascular disease in 9‐ to 10‐year‐old UK children. Methods Cross‐sectional study of 1445 9‐ to 10‐year‐old UK children of South Asian, black African‐Caribbean and white European origin. A fasting blood sample was used for measurement of insulin, glucose (from which homeostasis model assessment [HOMA]‐insulin resistance [IR] was derived), glycated hemoglobin (HbA1c), urate, C‐reactive protein (CRP), and lipids. Measurements of blood pressure (BP) and fat mass index (FMI) were made; physical activity was measured by accelerometry. Estimated VO2 max was derived from a submaximal fitness step test. Associations were estimated using multilevel linear regression. Results Higher VO2 max was associated with lower FMI, insulin, HOMA‐IR, HbA1c, glucose, urate, CRP, triglycerides, LDL‐cholesterol, BP and higher HDL‐cholesterol. Associations were reduced by adjustment for FMI, but those for insulin, HOMA‐IR, glucose, urate, CRP, triglycerides and BP remained statistically significant. Higher levels of insulin and HOMA‐IR in South Asian children were partially explained by lower levels of VO2max compared to white Europeans, accounting for 11% of the difference. Conclusions Physical fitness is associated with risk markers for T2D and CVD in children, which persist after adjustment for adiposity. Higher levels of IR in South Asians are partially explained by lower physical fitness levels compared to white Europeans. Improving physical fitness may provide scope for reducing risks of T2D. more...

Diet and nutrition are strongly implicated in the aetiology of type 2 diabetes; low dietary fibre intake could be an important factor. Evidence from prospective observational studies has suggested that it may be low cereal fibre intake, rather than low fruit and vegetable fibre intake, which is particularly important. In this issue of Diabetologia (DOI 10.1007/s00125-015-3585-9 ) Kuijsten et al report on the prospective associations between different dietary fibre sources and type 2 diabetes risk in the European Prospective Investigation of Cancer and Nutrition (EPIC)-Interact study and set their findings in context with a meta-analysis of relevant published prospective studies. The results presented strengthen the evidence implicating cereal fibre as an important determinant of type 2 diabetes risk and suggest that randomised controlled trials examining the effect of cereal fibre supplementation on type 2 diabetes risk are now needed. more...

OBJECTIVE Energy intake, energy density, and nutrient intakes are implicated in type 2 diabetes risk in adults, but little is known about their influence on emerging type 2 diabetes risk in childhood. We examined these associations in a multiethnic population of children. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 2,017 children predominantly of white European, South Asian, and black African-Caribbean origin aged 9–10 years who had a detailed 24-h dietary recall and measurements of body composition and provided a fasting blood sample for measurements of plasma glucose, HbA1c, and serum insulin; homeostasis model assessment of insulin resistance was also derived. RESULTS Energy intake was positively associated with insulin resistance. After the removal of 176 participants with implausible energy intakes (unlikely to be representative of habitual intake), energy intake was more strongly associated with insulin resistance and was also associated with glucose and fat mass index. Energy density was also positively associated with insulin resistance and fat mass index. However, in mutually adjusted analyses, the associations for energy intake remained while those for energy density became nonsignificant. Individual nutrient intakes showed no associations with type 2 diabetes risk markers. CONCLUSIONS Higher total energy intake was strongly associated with high levels of insulin resistance and may help to explain emerging type 2 diabetes risk in childhood. Studies are needed to establish whether reducing energy intake produces sustained favorable changes in insulin resistance and circulating glucose levels. more...

Background Higher screen time is associated with type 2 diabetes (T2D) risk in adults, but the association with T2D risk markers in children is unclear. We examined associations between self-reported screen time and T2D risk markers in children. Methods Survey of 4495 children aged 9–10 years who had fasting cardiometabolic risk marker assessments, anthropometry measurements and reported daily screen time; objective physical activity was measured in a subset of 2031 children. Results Compared with an hour or less screen time daily, those reporting screen time over 3 hours had higher ponderal index (1.9%, 95% CI 0.5% to 3.4%), skinfold thickness (4.5%, 0.2% to 8.8%), fat mass index (3.3%, 0.0% to 6.7%), leptin (9.2%, 1.1% to 18.0%) and insulin resistance (10.5%, 4.9% to 16.4%); associations with glucose, HbA1c, physical activity and cardiovascular risk markers were weak or absent. Associations with insulin resistance remained after adjustment for adiposity, socioeconomic markers and physical activity. Conclusions Strong graded associations between screen time, adiposity and insulin resistance suggest that reducing screen time could facilitate early T2D prevention. While these observations are of considerable public health interest, evidence from randomised controlled trials is needed to suggest causality. more...

In the UK, South Asian adults have increased risks of CHD, type 2 diabetes and central obesity. Black African-Caribbeans, in contrast, have increased risks of type 2 diabetes and general obesity but lower CHD risk. There is growing evidence that these risk differences emerge in early life and that nutritional factors may be important. We have therefore examined the variations in nutritional composition of the diets of South Asian, black African-Caribbean and white European children, using 24 h recalls of dietary intake collected during a cross-sectional survey of cardiovascular health in eighty-five primary schools in London, Birmingham and Leicester. In all, 2209 children aged 9–10 years took part, including 558 of South Asian, 560 of black African-Caribbean and 543 of white European ethnicity. Compared with white Europeans, South Asian children reported higher mean total energy intake; their intakes of total fat, polyunsaturated fat and protein (both absolute and as proportions of total energy intake) were higher and their intakes of carbohydrate as a proportion of energy (particularly sugars), vitamin C and D, Ca and haem Fe were lower. These differences were especially marked for Bangladeshi children. Black African-Caribbean children had lower intakes of total and saturated fat (both absolute and as proportions of energy intake), NSP, vitamin D and Ca. The lower total and saturated fat intakes were particularly marked among black African children. Appreciable ethnic differences exist in the nutritional composition of children's diets, which may contribute to future differences in chronic disease risk. more...

Aim To examine whether low circulating vitamin C concentrations and low fruit and vegetable intakes were associated with insulin resistance and other Type 2 diabetes risk markers in childhood. Methods We conducted a cross‐sectional, school‐based study in 2025 UK children aged 9–10 years, predominantly of white European, South‐Asian and black African origin. A 24‐h dietary recall was used to assess fruit, vegetable and vitamin C intakes. Height, weight and fat mass were measured and a fasting blood sample collected to measure plasma vitamin C concentrations and Type 2 diabetes risk markers. Results In analyses adjusting for confounding variables (including socio‐economic status), a one interquartile range higher plasma vitamin C concentration (30.9 μmol/l) was associated with a 9.6% (95% CI 6.5, 12.6%) lower homeostatic model assessment of insulin resistance value, 0.8% (95% CI 0.4, 1.2%) lower fasting glucose, 4.5% (95% CI 3.2, 5.9%) lower urate and 2.2% (95% CI 0.9, 3.4%) higher HDL cholesterol. HbA1c concentration was 0.6% (95% CI 0.2, 1.0%) higher. Dietary fruit, vegetable and total vitamin C intakes were not associated with any Type 2 diabetes risk markers. Lower plasma vitamin C concentrations in South‐Asian and black African‐Caribbean children could partly explain their higher insulin resistance. Conclusions Lower plasma vitamin C concentrations are associated with insulin resistance and could partly explain ethnic differences in insulin resistance. Experimental studies are needed to establish whether increasing plasma vitamin C can help prevent Type 2 diabetes at an early stage., What's new? We examined the cross‐sectional associations between intakes of fruit, vegetables and vitamin C, circulating vitamin C concentrations and insulin resistance in UK children.Circulating vitamin C concentration was inversely associated with insulin resistance, while intakes of fruit, vegetable and vitamin C were unrelated to insulin resistance.Low levels of circulating vitamin C concentrations in UK South‐Asian children could contribute to their higher insulin resistance.Further studies (including trials) are needed to examine the association of vitamin C with insulin resistance and its potential implications for Type 2 diabetes prevention. more...

Background Excess childhood body fatness, overweightness, and obesity are a major public health challenge in the UK. Accurate assessments, usually based on body-mass index (BMI), are crucial. However, recent studies have demonstrated that BMI underestimates body fatness in South Asian children and overestimates it in black African children. These errors are a concern in these ethnic minority populations, particularly UK South Asians, who are at high risk of obesity, type 2 diabetes, and cardiovascular disease. We aimed to develop BMI adjustments for these children to ensure that BMI relates to body fatness in the same way as for white European children. Methods Four recent UK population-based studies, which used deuterium dilution assessments of fat mass as a reference method, were pooled to include 1725 children (52% girls) aged 4–12 years (mean 9·3, SD 1·6) of white European, South Asian, and black African origins. A height-standardised fat-mass index (FMI) was derived to represent body fatness. Linear regression models were fitted, separately by sex, to quantify ethnic differences in BMI–FMI associations and to provide ethnic-specific BMI adjustments. Findings The FMI derived for this study population and used in analyses was fat mass/height 5 , which was independent of height for the 4–12-year age-group. BMI consistently underestimated body fatness in South Asians, requiring a BMI adjustment of +1·12 kg/m 2 (95% CI 0·83–1·41) for boys and +1·07 (0·74–1·39) for girls, irrespective of age and FMI. BMI overestimated body fatness in black Africans. However, adjustments for black African children were more complex, with statistically significant interactions between black African ethnicity and FMI (p=0·004 boys, p=0·003 girls) and between FMI and age-group (p 2 for boys and between −0·22 and −2·86 kg/m 2 for girls for unadjusted BMI values of 13 kg/m 2 in 10–12 year-olds and 25 kg/m 2 in 4–6 year-olds, respectively. Interpretation BMI underestimated body fatness in South Asians and overestimated it in black Africans. Ethnic-specific adjustments—increasing BMI in South Asians and reducing BMI in black Africans—can improve the accuracy of body fatness assessment in these children. Funding This work was supported by the British Heart Foundation (grant ref PG/15/19/31336) and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London) (grant ref CLAHRC-2013-10022). Primary data collection was funded by the British Heart Foundation (PG/11/42/28895), BUPA Foundation (TBF-S09-019), Child Growth Foundation (GR 10/03), and Wellcome Trust (WT094129MA). MF is supported by Great Ormond Street Hospital Childrens' Charity. more...

BACKGROUND: Socio-economic position (SEP) and ethnicity influence type 2 diabetes mellitus (T2DM) risk in adults. However, the influence of SEP on emerging T2DM risks in different ethnic groups and the contribution of SEP to ethnic differences in T2DM risk in young people have been little studied. We examined the relationships between SEP and T2DM risk factors in UK children of South Asian, black African-Caribbean and white European origin, using the official UK National Statistics Socio-economic Classification (NS-SEC) and assessed the extent to which NS-SEC explained ethnic differences in T2DM risk factors.\ud \ud METHODS AND FINDINGS: Cross-sectional school-based study of 4,804 UK children aged 9-10 years, including anthropometry and fasting blood analytes (response rates 70%, 68% and 58% for schools, individuals and blood measurements). Assessment of SEP was based on parental occupation defined using NS-SEC and ethnicity on parental self-report. Associations between NS-SEC and adiposity, insulin resistance (IR) and triglyceride differed between ethnic groups. In white Europeans, lower NS-SEC status was related to higher ponderal index (PI), fat mass index, IR and triglyceride (increases per NS-SEC decrement [95%CI] were 1.71% [0.75, 2.68], 4.32% [1.24, 7.48], 5.69% [2.01, 9.51] and 3.17% [0.96, 5.42], respectively). In black African-Caribbeans, lower NS-SEC was associated with lower PI (-1.12%; [-2.01, -0.21]), IR and triglyceride, while in South Asians there were no consistent associations between NS-SEC and T2DM risk factors. Adjustment for NS-SEC did not appear to explain ethnic differences in T2DM risk factors, which were particularly marked in high NS-SEC groups. \ud \ud CONCLUSIONS: SEP is associated with T2DM risk factors in children but patterns of association differ by ethnic groups. Consequently, ethnic differences (which tend to be largest in affluent socio-economic groups) are not explained by NS-SEC. This suggests that strategies aimed at reducing social inequalities in T2DM risk are unlikely to reduce emerging ethnic differences in T2DM risk. more...

Background Shorter sleep duration has been associated with obesity, increased cardiovascular morbidity, and mortality in adults and with obesity in children. However, effects on childhood risk markers for cardiometabolic disease have been little studied. We examined associations between self-reported sleep duration and cardiometabolic risk markers in children and whether sleep duration might explain ethnic differences in insulin resistance. Methods This was a cross-sectional study of 4560 children aged 9–10 years, predominantly of white European, South Asian, and black African origin, from 200 UK primary schools. Children were asked to recall usual time of going to sleep and awakening on a school day. Fasting blood samples provided concentrations of serum insulin, plasma glucose, HbA 1c , and serum lipids. Physical measures included height, weight, bioimpedance, and blood pressures. Multilevel linear regression models examined the association of sleep duration (in hours) with blood markers and anthropometric measures, adjusted for sex, age quartiles, month, ethnicity, socioeconomic status, observer (physical measures only), and random effect for school; percentange changes are given for log transformed outcomes. Informed consent was obtained from parents or children, and ethics approval was given by the Multicentre Research Ethics Committee (Wales). Findings Median sleep duration was 10·5 h (95% central range 8–12). On average, white European children slept longer than South Asian and black African children (10·4 h/night, 10·2, and 10·1, respectively). There were strong inverse graded associations between sleep duration, adiposity, and diabetes risk markers. Per hour increase in sleep duration was associated with 0·8 kg/m 3 lower ponderal index (95% CI 1·2–0·3), 0·03 kg/m 5 lower fat-mass index (0·05–0·0), 1·73% lower HOMA (homoeostatis model assessment) insulin resistance (0·50–3·91), 2·43% lower fasting glucose (0·86–3·97), and 0·19% lower HbA 1c (0·0–0·39) after adjustment. Associations with diabetes risk markers remained after adjustment for adiposity and objective measures of physical activity. Sleep duration did not account for ethnic differences in insulin resistance, and was unrelated to blood pressure and serum lipids. Interpretation The inverse association between type 2 diabetes risk markers and sleep duration in childhood is novel. Intervention studies are needed to establish causal associations, especially since increased sleep duration might offer a strategy for early prevention of type 2 diabetes. Funding This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (South London) and by grants from Diabetes UK and the Wellcome Trust. more...

Background Frequent takeaway meal consumption has been associated with increased risks of coronary heart disease (CHD), type 2 diabetes (T2D) and obesity in adults. However, the associations between takeaway meal consumption and risk markers for CHD, T2D and obesity have been little studied in children. We set out to examine these associations in a study of 9–0 year-old children. Methods A cross-sectional study of UK primary school children aged 9–10 years from a sample of 85 primary schools in London, Birmingham and Leicester provided balanced numbers of white European, South Asian and black African origin. Children reported their frequency of takeaway meal consumption (never/hardly ever, 1/ week), completed a 24 h dietary recall, had physical measurements including bioelectrical impedance assessment of fat mass and provided a fasting blood sample for measurement of insulin, HbA1c and blood lipids. Standard multilevel linear regression models were used to examine associations between takeaway meal frequency and risk markers. Results 2529 children (response 69%) participated in the study, of whom 1948 had complete data; participants with and without complete data were similar. Among participants, 499 (26%) never/rarely ate a takeaway meal, 894 (46%) did so less than weekly and 545 (28%) did so at least weekly. In models adjusted for age, sex, month, school (random effect), ethnic group and socioeconomic status, higher reported takeaway meal frequency had graded positive associations with fat mass index, serum total and LDL-cholesterol (p trend = 0.03, 0.04, 0.01 respectively). Compared with children who never/hardly ever ate a takeaway meal, children who ate one at least weekly had a higher fat mass index (% difference 10.6% [95% CI 1.00, 20.9%]), a higher total cholesterol (mean difference 0.09 mmol/L [95% CI 0.01, 0.17 mmol/L]) and a higher LDL-cholesterol (mean difference 0.10mmol/L [95% CI 0.02, 0.18 mmol/L]); insulin resistance, HbA1c and blood pressure did not differ. Children with higher takeaway meal frequency had higher total energy, energy density, fat% energy (particularly saturated fat% energy) intakes (all p Conclusion More frequent takeaway meal consumption was associated with higher body fatness, total and LDL-cholesterol levels and with higher energy and fat intakes (particularly saturated fat). Frequent takeaway meal consumption may have adverse cardiometabolic effects but the takeaway effects need to be distinguished from those of other dietary differences in takeaway meal consumers. more...

Background Although high fruit and vegetable intakes and high vitamin C intake may protect against type 2 diabetes risk, recent evidence in adults has suggested that circulating vitamin C levels, rather than fruit and vegetable intake, could be particularly important. However, the influence of these factors on emerging type 2 diabetes risk in childhood (particularly insulin resistance) has not been reported. We therefore examined these associations in children, including their contributions to emerging ethnic differences in insulin resistance. Methods This investigation is based on a cross-sectional, school-based survey in UK children aged 9–10 years, predominantly of white European, South Asian and black African origin from London, Birmingham and Leicester. Children provided a detailed 24-hour dietary recall (collected by a trained nutritionist) providing intakes of fruit, vegetables and vitamin C, had detailed measurements of body composition and provided a fasting blood sample for measurements of plasma vitamin C, serum insulin, plasma glucose, HbA1c and other metabolic markers; homeostasis model assessment (HOMA) insulin resistance was also derived. Multilevel linear regression models were fitted to provide adjusted means and differences in risk factors. Results Among 2025 participants (68% response rate), intakes of fruit, vegetables and vitamin C showed no associations with markers of insulin resistance, though plasma vitamin C showed an inverse association. In age, gender, month, adiposity and school adjusted analyses, a 1 interquartile range increase in plasma vitamin C level was associated with 9.22% (95% CI 6.25, 12.11%) lower HOMA insulin resistance, 0.75% (95% CI 0.32, 1.18%) lower fasting glucose, a 4.11% (95% CI 2.78, 5.42%) lower urate and 2.26% (95% CI 1.03, 3.51%) higher HDL-cholesterol and (less consistently) a 0.62% (95% CI 0.24, 1.0%) higher HbA1c. Further adjustments for socio-economic status and physical activity did not substantially alter the results. Plasma vitamin C levels were markedly lower among South Asian children; higher levels of HOMA insulin resistance in South Asian children (particularly in Bangladeshis) could be at least partly accounted for (˜20%) by lower plasma vitamin C levels. Conclusion Plasma vitamin C levels (but not fruit, vegetable or vitamin C intakes) are independently associated with insulin resistance in childhood, a consistent pattern to what has been shown in adult studies. Further studies are needed to establish whether this association is causal and can provide a basis for type 2 diabetes prevention. more...

Introduction UK South Asian adults have high risks of coronary heart disease, stroke and type 2 diabetes (T2D) when compared with Europeans; UK African-Caribbeans have high risks of stroke and T2D and low coronary heart disease risks. With growing evidence that cardiovascular disease risks begin before adulthood, we compared risk factor patterns and vascular disease markers in UK children from these ethnic groups. Methods We conducted a school-based study of cardiovascular risk profiles in 4796 9–10 year-old UK children of South Asian, African-Caribbean and European origin, with substudies of carotid intimal-medial thickness (cIMT) and carotid-femoral pulse wave velocity (cfPWV) in 939 and 631 children respectively. Results Compared with Europeans, UK South Asian children had higher adiposity, diastolic BP, insulin resistance, HbA1c and triglyceride levels; their HDL-cholesterol was low. cfPWV was slightly higher in South Asians and cIMT similar. In contrast, African-Caribbean children had lower adiposity, LDL-cholesterol and triglyceride levels and higher diastolic BP, insulin resistance, HbA1c and HDL-cholesterol; both cfPWV and cIMT were higher in African-Caribbeans. cIMT was positively associated with systolic and diastolic BP, while cfPWV was positively associated with adiposity, diastolic BP and insulin resistance. However, adjustment for these risk factors had little effect on the ethnic differences in cfPWV and cIMT observed. Conclusion Appreciable ethnic differences both in cardiovascular risk factors and vascular disease markers are apparent in children before puberty, which are substantially consistent with adult cardiovascular disease patterns. There may be important opportunities for cardiovascular disease prevention before adult life in high-risk ethnic minority groups. more...

Peter Whincup and colleagues carry out a cross-sectional study examining ethnic differences in precursors of of type 2 diabetes among children aged 9–10 living in three UK cities., Background Adults of South Asian origin living in the United Kingdom have high risks of type 2 diabetes and central obesity; raised circulating insulin, triglyceride, and C-reactive protein concentrations; and low HDL-cholesterol when compared with white Europeans. Adults of African-Caribbean origin living in the UK have smaller increases in type 2 diabetes risk, raised circulating insulin and HDL-cholesterol, and low triglyceride and C-reactive protein concentrations. We examined whether corresponding ethnic differences were apparent in childhood. Methods and Findings We performed a cross-sectional survey of 4,796 children aged 9–10 y in three UK cities who had anthropometric measurements (68% response) and provided blood samples (58% response); ethnicity was based on parental definition. In age-adjusted comparisons with white Europeans (n = 1,153), South Asian children (n = 1,306) had higher glycated haemoglobin (HbA1c) (% difference: 2.1, 95% CI 1.6 to 2.7), fasting insulin (% difference 30.0, 95% CI 23.4 to 36.9), triglyceride (% difference 12.9, 95% CI 9.4 to 16.5), and C-reactive protein (% difference 43.3, 95% CI 28.6 to 59.7), and lower HDL-cholesterol (% difference −2.9, 95% CI −4.5 to −1.3). Higher adiposity levels among South Asians (based on skinfolds and bioimpedance) did not account for these patterns. Black African-Caribbean children (n = 1,215) had higher levels of HbA1c, insulin, and C-reactive protein than white Europeans, though the ethnic differences were not as marked as in South Asians. Black African-Caribbean children had higher HDL-cholesterol and lower triglyceride levels than white Europeans; adiposity markers were not increased. Conclusions Ethnic differences in type 2 diabetes precursors, mostly following adult patterns, are apparent in UK children in the first decade. Some key determinants operate before adult life and may provide scope for early prevention. Please see later in the article for the Editors' Summary, Editors' Summary Background Worldwide, nearly 250 million people have diabetes, and the number of people affected by this chronic disease is increasing rapidly. Diabetes is characterized by dangerous amounts of sugar (glucose) in the blood. Blood sugar levels are normally controlled by insulin, a hormone that the pancreas releases when blood sugar levels rise after eating (digestion of food produces glucose). In people with type 2 diabetes (the most common type of diabetes), blood sugar control fails because the fat and muscle cells that usually respond to insulin by removing sugar from the blood become less responsive to insulin (insulin resistant). Type 2 diabetes can be controlled with diet and exercise, and with drugs that help the pancreas make more insulin or that make cells more sensitive to insulin. Long-term complications of diabetes include kidney failure, blindness, nerve damage, and an increased risk of developing cardiovascular problems, including heart disease and stroke. Why Was This Study Done? South Asians and African-Caribbeans living in Western countries tend to have higher rates of type 2 diabetes than host populations. South Asian adults living in the UK, for example, have a 3-fold higher risk of developing type 2 diabetes than white Europeans. They also have higher fasting blood levels of glucose, insulin and triglycerides (a type of fat), higher blood levels of “glycated hemoglobin” (HbA1c; an indicator of average of blood-sugar levels over time), more body fat (increased adiposity), raised levels of a molecule called C-reactive protein, and lower levels of HDL-cholesterol (another type of fat) than white Europeans. Most of these “diabetes precursors” (risk factors) are also seen in black African-Caribbean adults living in the UK except that individuals in this ethnic group often have raised HDL-cholesterol levels and low triglyceride levels. Ethnic differences in type 2 diabetes precursors are also present in adolescents, but the extent to which they are present in childhood remains unclear. Knowing this information could have implications for diabetes prevention. In this population-based study, therefore, the researchers investigate patterns of diabetes precursors in 9- to 10-year-old UK children of white European, South Asian, and black African-Caribbean origin. What Did the Researchers Do and Find? The researchers enrolled nearly 5,000 children (including 1,153 white European, 1,306 South Asian and 1,215 black African-Caribbean children) from primary schools with high prevalences of ethnic minority pupils in London, Birmingham, and Leicester in the Child Heart and Health study in England (CHASE). They measured and weighed more than two-thirds of the enrolled children and determined their adiposity. They also took blood samples for measurement of diabetes precursors from nearly two-thirds of the children. The recorded ethnicity of each child was based on parental definition. The researchers' analysis of these data showed that, compared with white Europeans, South Asian children had higher levels of HbA1c, insulin, triglycerides, and C-reactive protein but lower HDL-cholesterol levels. In addition, they had higher adiposity levels than the white European children, but this did not account for the observed differences in the other diabetes precursors. Black African-Caribbean children also had higher levels of HbA1c, insulin, and C-reactive protein than white European children, although the differences were smaller than those between South Asians and white Europeans. Similar to black African-Caribbean adults, however, children of this ethnic origin had higher HDL-cholesterol and lower triglyceride levels than white Europeans. What Do These Findings Mean? These findings indicate that ethnic differences in diabetes precursors are already present in apparently healthy children before they are 10 years old. Furthermore, most of the ethnic differences in diabetes precursors seen among the children follow the pattern seen in adults. Although these findings need confirming in more children, they suggest that the ethnic differences in type 2 diabetes susceptibility first described in immigrants to the UK are persisting in UK-born South Asian and black African-Caribbean children. Most importantly, these findings suggest that some of the factors thought to be responsible for ethnic differences in type 2 diabetes—for example, varying levels of physical activity and dietary differences—are operating well before adult life. Interventions that target these factors early could, therefore, offer good opportunities for diabetes prevention in high-risk ethnic groups, provided such interventions are carefully tailored to the needs of these groups. Additional Information Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000263. The International Diabetes Federation provides information about all aspects of diabetes (in English, French and Spanish) The US National Diabetes Information Clearinghouse provides detailed information about diabetes for patients, health-care professionals and the general public, including information on diabetes in specific US populations (in English and Spanish) The UK National Health Service also provides information for patients and carers about type 2 diabetes (in several languages) MedlinePlus provides links to further resources and advice about diabetes (in English and Spanish) The US Agency for Healthcare Research and Quality has a fact sheet on diabetes disparities among racial and ethnic minorities more...

Aims/hypothesis Lower birthweight (a marker of fetal undernutrition) is associated with higher risks of type 2 diabetes and cardiovascular disease (CVD) and could explain ethnic differences in these diseases. We examined associations between birthweight and risk markers for diabetes and CVD in UK-resident white European, South Asian and black African-Caribbean children. Methods In a cross-sectional study of risk markers for diabetes and CVD in 9- to 10-year-old children of different ethnic origins, birthweight was obtained from health records and/or parental recall. Associations between birthweight and risk markers were estimated using multilevel linear regression to account for clustering in children from the same school. Results Key data were available for 3,744 (66%) singleton study participants. In analyses adjusted for age, sex and ethnicity, birthweight was inversely associated with serum urate and positively associated with systolic BP. After additional height adjustment, lower birthweight (per 100 g) was associated with higher serum urate (0.52%; 95% CI 0.38, 0.66), fasting serum insulin (0.41%; 95% CI 0.08, 0.74), HbA1c (0.04%; 95% CI 0.00, 0.08), plasma glucose (0.06%; 95% CI 0.02, 0.10) and serum triacylglycerol (0.30%; 95% CI 0.09, 0.51) but not with BP or blood cholesterol. Birthweight was lower among children of South Asian (231 g lower; 95% CI 183, 280) and black African-Caribbean origin (81 g lower; 95% CI 30, 132). However, adjustment for birthweight had no effect on ethnic differences in risk markers. Conclusions/interpretation Birthweight was inversely associated with urate and with insulin and glycaemia after adjustment for current height. Lower birthweight does not appear to explain emerging ethnic difference in risk markers for diabetes. Electronic supplementary material The online version of this article (doi:10.1007/s00125-014-3474-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users. more...