Summary
Recent data indicate that low-birthweight adults are at a higher risk than their high-birthweight peers of developing ischaemic heart disease or a cluster of conditions known as the IRS, which includes dyslipidaemias, hypertension, unfavourable body fat distribution and NIDDM. Thus far these observations have been limited to Caucasians from the United Kingdom. We extended these observations to a broader segment of the general population by studying the association of birthweight and adult health outcomes in a biethnic population of the United States. We divided a group of 564 young adult Mexican-American and non-Hispanic white men and women participants of the San Antonio Heart Study into tertiles of birthweight and compared metabolic, anthropometric, haemodynamic, and demographic characteristics across these tertile categories. Additionally, we studied birthweight as a predictor of the clustering of diseases associated with the IRS, defined as any two or more of the following conditions: hypertension, NIDDM or impaired glucose tolerance, dyslipidaemia. Normotensive, non-diabetic individuals whose birthweight was in the lowest tertile had significantly higher levels of fasting serum insulin and a more truncal fat deposition pattern than individuals whose birthweight was in the highest tertile, independently of sex, ethnicity, and current socioeconomic status. Also, the odds of expressing the IRS increased 1.72 times (95% confidence interval: 1.16–2.55) for each tertile decrease in birthweight. These findings were independent of sex, ethnicity, and current levels of socioeconomic status or obesity. In conclusion, low birthweight could be a major independent risk factor for the development of adult chronic conditions commonly associated with insulin resistance in the general population.
Article PDF
Similar content being viewed by others
Abbreviations
- IRS:
-
insulin resistance syndrome
- NIDDM:
-
non-insulin dependent diabetes mellitus
- HDL:
-
high-density lipoprotein
- ANCOVA:
-
analysis of covariance
- SES:
-
socioeconomic status
- WHR:
-
waist-to-hip circumference ratio
- STR:
-
subscapular-to-triceps skinfold ratio
- BMI:
-
body mass index
- BP:
-
blood pressure
- FastI:
-
fasting insulin
- 2-h I:
-
2-h post-load insulin
- HDL:
-
high density lipoprotein cholesterol
- FastG:
-
fasting glucose
- 2-h G:
-
2-h post-load glucose
- Tg:
-
triglycerides
- LDL:
-
low density lipoprotein cholesterol
- TChol:
-
total cholesterol
References
Barker DJP, Winter PD, Osmond C, Margetts B, Simmonds SJ (1989) Weight in infancy and death from ischaemic heart disease. Lancet II: 577–580
Barker DJP, Bull AR, Osmond C, Simmonds SJ (1990) Fetal and placental size and risk of hypertension in adult life. BMJ 301: 259–262
Barker DJP, Hales CN, Fall CHD, Osmond C, Phipps K, Clark PMS (1993) Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 36: 62–67
Barker DJP (1992) The fetal origins of diseases of old age. Eur J Clin Nutrit 46:S3-S9
Barker DJP (1991) The intrauterine environment and adult cardiovascular disease. In: Bock GR, Whelan J (eds) The childhood environment and adult disease. Ciba Foundation Symposium 156. Chichester, John Wiley, pp 3–10
Barker DJP, Osmond C, Simmonds SJ, Wield GA (1993) The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. BMJ 306: 422–426
Hales CN, Barker DJP, Clark PMS et al. (1991) Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 303: 1019–1022
Seidman DS, Laor A, Gale R, Stevenson DK, Mashiach S, Danon YL (1991) Birth weight, current body weight, and blood pressure in late adolescence. BMJ 302: 1235–1237
Robinson S, Walton RJ, Clark PM, Barker DJP, Hales CN, Osmond C (1992) The relation of fetal growth to plasma glucose in young men. Diabetologia 35: 444–446
Reaven GM (1988) Banting Lecture 1988: Role of insulin resistance in human disease. Diabetes 37: 1595–1607
Björntorp P (1990) Abdominal obesity and risk. Clin Exp Hypertens A12: 783–794
Haffner SM, Hazuda HP, Mitchell BD, Patterson JK, Stern MP (1991) Increased incidence of type II diabetes mellitus in Mexican Americans. Diabetes Care 14: 102–108
Stern MP, Morales PA, Valdez RA et al. (1993) Predicting diabetes. Moving beyond impaired glucose tolerance. Diabetes 42: 706–714
Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ (1984) Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: the San Antonio Heart Study. Am J Epidemiol 120: 834–851
Hazuda HP, Comeaux PJ, Stern MP, Haffner SM, Eifler CW, Rosenthal M (1986) A comparison of three indicators for identifying Mexican Americans in epidemiologic research: methodological findings from the San Antonio Heart Study. Am J Epidemiol 123: 96–112
Haffner SM, Stern MP, Hazuda HP, Pugh JA, Patterson JK (1986) Hyperinsulinemia in a population at high risk for noninsulin-dependent diabetes mellitus. N Engl J Med 315: 220–224
World Health Organization Expert Committee (1980) Second Report on Diabetes Mellitus. World Health Organization Technical Report Series No 646, Geneva
Malina RM, Little BB, Stern MP, Gaskill SP, Hazuda HP (1983) Ethnic and social class differences in selected anthropometric characteristics of Mexican American and Anglo adults: the San Antonio Heart Study. Hum Biol 55: 867–883
Hypertension Detection and Follow-up Program Cooperative Group (1976) The Hypertension Detection and Follow-up Program. Prev Med 5: 207–215
Duncan OD (1961) A socioeconomic index for all occupations. In: Reiss AJ (ed) Occupations and social status. New York, The Free Press of Glencoe, New York
Featherman DL, Sobel M, Dickens D (1975) A manual for coding occupations and industries into detailed 1970 categories and a listing of 1970-basis Duncan socioeconomic and NORC prestige scores. Center for demography and ecology, University of Wisconsin, Madison
Haffner SM, Valdez R, Hazuda HP, Mitchell BD, Morales PA, Stern MP (1992) Prospective analysis of the insulin resistance syndrome (syndrome X). Diabetes 41: 715–722
SAS Institute Inc (1989) SAS/STAT user's guide, version 6, vols. 1–2. SAS Institute Inc, Cary, NC
Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett P (1988) The natural history of impaired glucose tolerance in the Pima Indians. New Engl J Med 319: 1500–1506
Zimmet PZ, Collins VR, Dowse GK, Knight LT (1992) Hyperinsulinaemia in youth is a predictor of type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 35: 534–541
Haffner SM, Fong DS, Hazuda HP, Pugh JA, Patterson JK (1988) Hyperinsulinemia, upper body adiposity, and cardiovascular risk factors in non-diabetics. Metabolism 37: 338–345
Cigolini M, Seidell JC, Charzewska J et al. (1991) Fasting serum insulin in relation to fat distribution, serum lipid profile, and blood pressure in European women: the European Fat Distribution Study. Metabolism 40: 781–787
Laws A, King AC, Haskell WL, Reaven GM (1991) Relation of fasting plasma insulin concentration to high density lipoprotein cholesterol and triglyceride concentrations in men. Arterioscler Thromb 11: 1636–1642
Mitchell BD, Haffner SM, Hazuda HP, Valdez R, Stern MP (1992) The relation between serum insulin levels and 8-year changes in lipid, lipoprotein, and blood pressure levels. Am J Epidemiol 136: 12–22
Haffner SM, Ferrannini E, Hazuda HP, Stern MP (1992) Clustering of cardiovascular risk factors in confirmed pre-hypertensive individuals. Hypertension 20: 38–45
Denker PS, Pollock VE (1992) Fasting serum insulin levels in essential hypertension. A meta-analysis. Arch Intern Med 152: 1649–1651
Ferrannini E, Haffner SM, Mitchell BD, Stern MP (1991) Hyperinsulinaemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia 34: 416–422
Haffner SM, Stern MP, Hazuda HP, Pugh J, Patterson JK (1987) Do upper body and centralized adiposity measure different aspects of regional fat distribution. Relationship to non-insulin dependent diabetes mellitus, lipids, and lipoproteins. Diabetes 36: 43–51
Neel JV (1962) Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”? Am J Hum Genet 14: 353–362
Neel JV (1982) The thrifty genotype revisited. In: Köbberling J, Tattersall J (eds) The genetics of diabetes mellitus. Academic Press, New York, pp 283–293
Weiss KM, Ferrell RE, Hanis CL (1984) A new world syndrome of metabolic diseases with a genetic and evolutionary basis. Yrbk Phys Anthropol 27: 153–178
Stern MP, Haffner SM (1990) Type II diabetes and its complications in Mexican Americans. Diabetes Metab Rev 6: 29–45
Bell GI (1991) Lilly Lecture 1990: Molecular defects in diabetes mellitus. Diabetes 40: 413–422
Zimmet PZ (1992) Kelly West Lecture 1991: Challenges in diabetes epidemiology -from West to the rest. Diabetes Care 15: 232–252
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Valdez, R., Athens, M.A., Thompson, G.H. et al. Birthweight and adult health outcomes in a biethnic population in the USA. Diabetologia 37, 624–631 (1994). https://doi.org/10.1007/BF00403383
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00403383