Early evidence of ethnic differences in cardiovascular risk: cross sectional comparison of British South Asian and white children

doi:10.1136/bmj.324.7338.635

BMJ 2002;324:635 ( 16 March )

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Early evidence of ethnic differences in cardiovascular risk: cross sectional comparison of British South Asian and white children

Peter H Whincup, professor of cardiovascular epidemiology, ^a Julie A Gilg, medical statistician, ^a Olia Papacosta, medical statistician, ^b Carol Seymour, professor of clinical biochemistry and metabolic medicine, ^c George J Miller, professor of epidemiology, ^d K G M M Alberti, professor of medicine, ^e Derek G Cook, professor of epidemiology. ^a

^a Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE, ^b Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University of London, London NW3 2PF, ^c Division of Cardiological Sciences (Metabolic Medicine), St George's Hospital Medical School, London, ^d MRC Epidemiology and Medical Care Unit, Wolfson Institute, London EC1M 6BQ, ^e Human Diabetes and Metabolism Research Centre, Department of Diabetes, University of Newcastle upon Tyne, Newcastle NE2 4HH

Correspondence to: P Whincup p.whincup{at}sghms.ac.uk

Objectives: To examine whether British South Asian childrendiffer in insulin resistance, adiposity, and cardiovascular riskprofile from whitechildren.
Design: Cross sectionalstudy.
Setting: Primary schools in 10 Britishtowns.
Participants: British children aged 8 to 11 years (227 SouthAsian and 3415 white); 73 South Asian and 1287 white childrenaged 10 and 11 years provided blood samples (half fasting, halfafter glucoseload).
Main outcome measures: Insulin concentrations, anthropometric measures,established cardiovascular riskfactors.
Results: Mean ponderal index was lower in South Asianchildren than in white children (mean difference $-$ 0.43 kg/m³, 95% confidence interval $-$ 0.13 kg/m³ to $-$ 0.73 kg/m³). Mean waist circumferences and waist:hip ratios were similar.Mean insulin concentrations were higher in South Asian children(percentage difference was 53%, 14% to 106%, after fasting and54%, 19% to 99%, after glucose load), though glucose concentrationswere similar. Mean heart rate and triglyceride and fibrinogenconcentrations were higher among South Asian children; serum total,low density lipoprotein, and high density lipoprotein cholesterolconcentrations were similar in the two groups. Differences ininsulin concentrations remained after adjustment for adiposityand other potential confounders. However, the relations betweenadiposity and insulin concentrations (particularly fasting insulin)were much stronger among South Asian children than among whitechildren.
Conclusions: The tendency to insulin resistance observedin British South Asian adults is apparent in children, in whomit may reflect an increased sensitivity to adiposity. Action toprevent non-insulin dependent diabetes in South Asian adults mayneed to begin duringchildhood.

What is already known on this topic
Compared with white people British South Asians are at increased risk of coronary heart disease, stroke, and non-insulin dependent diabetes

There is evidence that these conditions originate in early life

What this study adds
British South Asian children show higher average levels of insulin and insulin resistance than white children

These ethnic differences in insulin resistance in childhood are not associated with corresponding differences in adiposity, particularly central adiposity

Insulin metabolism seems to be more sensitive to a given degree of adiposity among the South Asian children compared with white children

The prevention of insulin resistance and its consequences may need to begin during childhood, particularly in South Asians

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