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Diabetologia. 2015 Dec;58(12):2745-52. doi: 10.1007/s00125-015-3759-5. Epub 2015 Sep 17.

Severity of the metabolic syndrome as a predictor of type 2 diabetes between childhood and adulthood: the Princeton Lipid Research Cohort Study.

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Division of Pediatric Endocrinology, University of Virginia, P.O. Box 800386, Charlottesville, VA, 22908, USA.
Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Division of Cardiology, University of Cincinnati, Cincinnati, OH, USA.



The aim of this study was to determine the long-term associations of a sex- and race/ethnicity-specific metabolic syndrome (MetS) severity z score from childhood and adulthood with a future diagnosis of type 2 diabetes mellitus.


We performed a prospective cohort study with evaluations from the Cincinnati Clinic of the National Heart Lung and Blood Institute Lipids Research Clinic (LRC) 1973-1976 and Princeton Follow-up Study (PFS) 1998-2003, and further disease status from the Princeton Health Update (PHU) 2010-2014. We assessed MetS severity as a predictor of incident type 2 diabetes among 629 cohort participants assessed at both the LRC and PFS and 354 participants at the PHU.


Cohort participants had a mean age of 12.9 years at baseline (LRC), 38.4 years at the PFS and 49.6 years at the most recent follow-up. Childhood MetS z scores were associated with adult MetS z scores (p < 0.01). Compared with individuals who were disease-free at all time-points, those who developed type 2 diabetes by 1998-2003 and 2010-2014 had higher MetS severity z scores in childhood (p < 0.05). For every one-unit elevation in childhood MetS z score, the OR of developing future type 2 diabetes was 2.7 for incident disease by a mean age of 38.5 years (p < 0.01) and 2.8 for incident disease by a mean age of 49.6 years (p < 0.05). Regarding associations with the change in z score from childhood to adulthood, for every one-unit increase in MetS z score over time the OR of developing incident type 2 diabetes by a mean age of 49.6 years was 7.3 (p < 0.01).


The severity of MetS in childhood was associated with the incidence of adult type 2 diabetes and the degree of increase in this severity predicted future disease. These findings provide evidence of potential clinical utility in assessing MetS severity to detect risk and follow clinical progress over time.


Insulin resistance; Metabolic syndrome; Risk; Type 2 diabetes mellitus

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