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Hispanic children who are overweight and have a family history of diabetes may already be moving toward diabetes or heart disease, two studies published today suggest.
The findings suggest that tests for diabetes and abnormal cholesterol levels, which usually are done only on adults, should begin much earlier for all obese children, says Michael Goran, professor of preventive medicine, physiology and biophysics at the University of Southern California.
Goran and colleagues found that 28% of the 150 children who took part in a study had a condition that is a precursor to diabetes. In a second study, 90% of the 126 children examined had at least one of the medical markers that is a red flag for diabetes or heart disease, such as abdominal obesity, high blood pressure, low levels of good cholesterol and high triglycerides.
Participants in both studies were Hispanic, ages 8 to 13. All were overweight and had relatives with diabetes. The studies are published in the January issue of the Journal of Clinical Endocrinology & Metabolism.
Adults who are obese, have a family history of diabetes and are members of minority groups are known to be at higher risk for diabetes, but in this group of children, Goran says, ''the extent of the problems was much higher than anticipated. We need to try to do a better job of screening these children.''
Type 2 diabetes, which is caused by the inability to produce enough insulin or to use it properly to turn sugar in the blood into energy, affects 90% to 95% of the more than 18 million people in the USA with diabetes. Other forms of the disease include type 1, which results from the destruction of cells that produce insulin, and gestational diabetes, which causes high blood sugar levels during pregnancy.
Pre-diabetes, a condition in which blood sugar levels are higher than normal but not quite at the level of diabetes, was twice as high in children who had been exposed to gestational diabetes in utero, regardless of the degree of obesity, Goran said. The reasons are not clear and need more study, the researchers write.
Until recent years, type 2 diabetes occurred almost exclusively in middle age or older, but it is increasingly being diagnosed in overweight children and teens.
Goran said at least 40% of Hispanic children in the pre-teen to early-teen years are too heavy, about twice as many as a decade ago.
The causes are ''the interaction of genetic makeup with the environment we've created that promotes inactivity and high-calorie eating,'' he said.
Francine Kaufman, a pediatric endocrinologist at Children's Hospital in Los Angeles who was not involved in the studies, said the research is important and highlights the need for early detection and treatment.
Doctors and parents should be aware of these risk factors in obese children with a strong family history, she said. ''The hope is if we could identify them and get them into some kind of lifestyle intervention, we could reverse some of this.''
If that doesn't happen, Kaufman said, children may need to start taking medications to improve blood-fat profiles or insulin sensitivity.
''We have to find out when it is optimal to start treating some of these abnormalities before they become full-blown.''
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