Overweight Hispanic children shown to have vascular inflammation

February 27, 2008 – Overweight Hispanic children with normal blood glucose (sugar) levels showed elevated markers for blood vessel inflammation that may predispose them to developing both type 2 diabetes and cardiovascular disease, says a new study led by researchers from the Joslin Diabetes Center.

The study, published in the March issue of Diabetes Care, is the first to focus on Hispanic children, already known to be at high risk for developing type 2 diabetes as a result of both genetic and lifestyle factors.

“Our findings suggest that these children are not only at risk for type 2 diabetes, but also for cardiovascular disease,” said Dr. A. Enrique Caballero, lead investigator.

The study looked at 38 Hispanic children and adolescents, ages 10 through 18. Twenty-one were obese but with normal blood glucose levels, so they had not yet developed diabetes. The rest were considered lean. As a group, the obese subjects had significantly higher percentages of body fat than the lean group and were already showing signs of insulin resistance, meaning the insulin that their bodies produce is not working well and as a consequence their pancreases were being forced to work harder to produce more insulin to maintain normal blood sugar levels.

Overall, the obese group exhibited increased blood markers for subclinical or asymptomatic inflammation of the inner layer of blood vessels. “They are already exhibiting problems with circulation,” said Caballero, Director of the Latino Diabetes Initiative, Clinical Investigator, Staff Endocrinologist and Director, Medical Affairs, Professional Education at Joslin Diabetes Center, as well as an Assistant Professor of Medicine at Harvard Medical School. “There is an inflammatory process going on in the vessels.”

Such problems suggest these children may be at increased risk of developing cardiovascular problems at a young age, he said.

Subclinical vascular inflammation is a key element in the development of cardiovascular disease and is closely associated with insulin resistance. It also predicts the development of type 2 diabetes.

Earlier studies in overweight or obese children and adolescents showed similar vascular abnormalities, but were conducted primarily in non-Hispanic children.

Caballero wanted to study Hispanic children because they had not previously been studied and because they are a high-risk population for type 2 diabetes.

“We have found that overweight Hispanic children and adolescents have elevated markers of endothelial dysfunction and vascular inflammation closely related to excess body fat and increased insulin resistance,” the paper concluded. “This. . . may increase their risk of developing type 2 diabetes and cardiovascular disease, further emphasizing the need for obesity prevention strategies.”

Caballero said such strategies must be culturally appropriate.

“Even if these abnormalities may not be that different than those in Caucasian children, the strategies to prevent heart disease and diabetes need to be culturally oriented,’’ he said. “They need to be tailored to the population.”

Caballero stressed that the findings do not mean that such children will definitely develop type 2 diabetes or cardiovascular problems, but said the idea is to step in early to make sure they don’t.

“The problem is serious enough to warrant attention and a prevention strategy,” he said.

The research was funded by a grant from Sanofi Aventis and a National Institutes of Health grant for general clinical research at Beth Israel Deaconess Medical Center.

In addition to Dr. Caballero, other researchers participating in the study included: Dr. Ludivina Robles-Osorio, Valeria Montagnani, RN, Dr. Geetha Soodini, Dr. Sriurai Porramatikul, Dr. Osama Hamdy and Dr. Edward S. Horton from the Joslin and Kelb Bousquet-Santos and Dr. Antonio C.L. Nobrega from Fluminense Federal University in Brazil.

The Latino Diabetes Initiative at Joslin Diabetes Center, directed by Dr. Caballero, is a comprehensive effort to improve the lives of Latinos who have or are at risk of developing diabetes. This initiative integrates a culturally oriented clinical care and patient education program, community outreach activities, professional education programs and a clinical research program.

Joslin Diabetes Center is the world’s largest diabetes clinic, diabetes research center and provider of diabetes education. Joslin is dedicated to ensuring people with diabetes live long, healthy lives and offers real hope and progress toward diabetes prevention and a cure for the disease. Founded in 1898 by Elliott P. Joslin, M.D., Joslin is an independent nonprofit institution affiliated with Harvard Medical School. For more information on Joslin, call 1-800-JOSLIN-1 or visit www.joslin.org.