160-OR: Increased Adiposity and Low Height-for-Age in Early Childhood Is Associated with Later Metabolic Risk in American Indian Children and Adolescents

Background: Growth abnormalities in early childhood have been related to later metabolic risk, but little is known about these associations in populations at high risk of diabetes.

Methods: We linked anthropometric data collected at ages 0-<5 y from 2928 routine clinical examinations conducted 1990-2000 to metabolic data from a longitudinal study in a southwestern American Indian population at high risk of diabetes. A total of 701 participants with ≥1 follow-up examination at ages 5-16 y were included. We derived age and sex-specific z-scores (from WHO Child Growth Standards) of weight-for-height (WHZ) and height-for-age (HAZ) at ages 0-<5 y. We selected the highest observed WHZ and the lowest HAZ and analyzed associations of categories of WHZ and HAZ with metabolic data at ages 5-9 y and 10-16 y. Linear mixed effects models were used to account for repeated measures.

Results: In age and sex-adjusted models, overweight and obesity (WHZ > 2) at ages 0-<5 y was significantly associated with higher BMI and with greater height at ages 5-16 y relative to normal weight (WHZ ≤ 1). It was also associated with increased fasting glucose, 2-h glucose, fasting insulin, 2-hr insulin, total cholesterol, triglycerides, SBP, DPB and decreased HDL. For example, at ages 5-9 y 2-h glucose was 10.4 mg/dl higher (95% CI: 5.6, 15.3) and fasting insulin was 1.88 times higher (95% CI: 1.58, 2.24). Associations were attenuated and no longer significant when adjusted for BMI. Low height-for-age (HAZ< -2) at ages 0-<5 y was associated with lower BMI and lower height at ages 5-16 y relative to normal height (HAZ ≥ 0). With adjustment for BMI, low height-for-age was associated with 1.40 times higher 2-h insulin (95% CI: 1.05, 1.87) and 5.47 mg/dL lower HDL (95% CI: 2.68, 8.62) at ages 10-16 y.

Conclusion: These analyses suggest that both overweight/obesity and low height-for-age in early childhood can influence subsequent metabolic risk in American Indian children and adolescents.