Impact of gestational diabetes mellitus on pubertal changes in adiposity and metabolic profiles in Latino offspring.

OBJECTIVE: To examine the impact of maternal gestational diabetes mellitus (GDM) status on longitudinal changes in adiposity and metabolic variables in overweight Latino offspring (from age 8-20 years) across puberty. STUDY DESIGN: This longitudinal cohort of 210 overweight Latino children was measured annually for a period of 3 ± 1 years for Tanner stage through physical examination, adiposity by dual-energy X-ray absorptiometry and magnetic resonance imaging, lipids, and glucose and insulin action via the oral glucose tolerance test and frequently sampled intravenous glucose tolerance test. Linear mixed-effects modeling estimated the impact of maternal GDM status on baseline and changes in adiposity and metabolic variables across puberty. RESULTS: In our cohort, 22% of offspring were from GDM pregnancies. At baseline, the GDM offspring were heavier at birth, more likely to have a family history of type 2 diabetes, and less likely to have been breastfed (for any duration). Compared with the non-GDM offspring, the GDM offspring had greater increases in total body fat (+6.5% vs +4.5%; P = .03) and steeper declines in acute insulin response (-39% vs -17%; P < .001) and disposition index (-57% vs -35%; P < .001) across Tanner stages, independent of ethnicity, sex, breastfeeding status, family history of diabetes, and baseline and changes in body composition. CONCLUSION: These findings confirm the elevated risk for excess adiposity and type 2 diabetes in GDM offspring, and further underscore the need for interventions targeting Latino GDM and their offspring.

Subclinical atherosclerosis in Latino youth: progression of carotid intima-media thickness and its relationship to cardiometabolic risk factors.

OBJECTIVE: To assess carotid artery intima-media thickness (CIMT) change over 2 years in overweight Latino adolescents and examine its relationship to cardiometabolic risk. STUDY DESIGN: Seventy-two healthy overweight male and female Latino adolescents (mean age, 14.5 ± 1.7 years; mean body mass index, 31.5 ± 6.9 kg/m(2)) were evaluated at baseline and 2 years later for CIMT by high-resolution B-mode ultrasound, the metabolic syndrome and its features, body composition by dual-energy x-ray absorptiometry and magnetic resonance imaging, glucose/insulin measures by fasting blood, and oral and intravenous glucose tolerance tests. RESULTS: Baseline CIMT did not differ from 2-year follow-up; however, 38 participants increased CIMT (0.017 ± 0.003 mm; +2.8%) and 34 decreased or remained the same (-0.019 ± 0.002 mm; -3.1%). ANCOVA analyses showed that participants with CIMT progression had higher baseline low-density lipoprotein (LDL)-cholesterol and total cholesterol (91.3 ± 3.4 and 150.3 ± 3.9 mg/dL) compared with those with CIMT non-progression (78.1 ± 3.6 and 135.6 ± 4.2 mg/dL, P < .05), independent of sex, baseline CIMT, age, and height. In multivariate regression, LDL-cholesterol was the sole predictor of CIMT progression, but the effect was small (odds of CIMT progression increased by 3% for each 1 mg/dL higher baseline LDL-cholesterol; 95% CI, 1.004 to 1.006, P = .03). CONCLUSIONS: These results indicate a high variability in the magnitude of CIMT change in growing overweight Latino youth and support the use of LDL-cholesterol to assess subclinical atherosclerosis risk in this population.

Persistence of the metabolic syndrome over 3 annual visits in overweight Hispanic children: association with progressive risk for type 2 diabetes.

OBJECTIVE: To examine an association between persistent metabolic syndrome (MetS) and the risk for type 2 diabetes in overweight Hispanic children. STUDY DESIGN: A total of 73 subjects (mean age, 11.0 +/- 1.7 years) from a longitudinal study were classified as Never (negative for MetS at all 3 annual visits), Intermittent (positive for MetS at 1 or 2 visits), or Persistent (positive for MetS at all 3 visits). Measures included dual-energy x-ray absorptiometry, magnetic resonance imaging, the 2-hour oral glucose tolerance test, and the frequently sampled intravenous glucose tolerance test. RESULTS: The Persistent group had a faster rate of fat mass gain than the Never group (20% vs 15% gain of baseline value; P < .05 for time *group interaction [time = visit]). Independent of body composition, the Persistent group increased by 70% in insulin incremental area under the curve, whereas the other groups decreased (P < .05 for time *group interaction). Despite no time *group interactions for insulin sensitivity, acute insulin response, or disposition index, the Persistent group maintained 43% lower insulin sensitivity (P < .01) and by visit 2 had a 25% lower disposition index (P < .05) compared with the Never group. CONCLUSIONS: Patients with persistent MetS had accelerated fat gain, increased insulin response to oral glucose, and decreased sensitivity and beta cell function, indicators of progressively greater risk for type 2 diabetes.