BMJ  2005;331:183 (23 July), doi:10.1136/bmj.331.7510.183

Paper

Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study

Debbie A Lawlor, senior lecturer in epidemiology and public health medicine1, Maarike Harro, director general3, Niels Wedderkopp, consultant orthopaedic surgeon and senior public health researcher4, Lars Bo Andersen, professor5, Luis B Sardinha, professor of exercise prescription6, Chris J Riddoch, professor of exercise science and head of institute7, Angie S Page, lecturer in exercise and health sciences2, Sigmund A Anderssen, associate professor of physical activity and health5, Karsten Froberg, associate professor4, David Stansbie, consultant in clinical biochemistry8, George Davey Smith, professor of clinical epidemiology1

1 Department of Social Medicine, University of Bristol, Bristol BS8 2PR, 2 Department of Exercise and Health Sciences, University of Bristol, 3 Estonian National Institute for Health Development, Tallin, Estonia, 4 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark, 5 Department of Sports Medicine, Norwegian University of Sport and Physical Education, Oslo, Norway, 6 Faculty of Human Movement, Technical University of Lisbon, Portugal, 7 London Sport Institute, Middlesex University, London, 8 Department of Clinical Biochemistry, United Bristol Healthcare NHS Trust, Bristol

Correspondence to: D A Lawlor d.a.lawlor{at}bristol.ac.uk

Objectives To examine the association between socioeconomic position and insulin resistance in children from three countries in northern Europe (Denmark), eastern Europe (Estonia), and southern Europe (Portugal) that have different physical, economic, and cultural environments.

Design Cross sectional study.

Participants 3189 randomly selected schoolchildren aged 9 and 15 years from Denmark (n = 933), Estonia (n = 1103), and Portugal (n = 1153).

Main outcome measure Insulin resistance (homoeostasis model assessment).

Results Family income and parental education were inversely associated with insulin resistance in Danish children but were positively associated with insulin resistance in Estonian and Portuguese children. Among Danish children, insulin resistance was 24% lower (95% confidence interval -38% to -10%) in those whose fathers had the most education compared with those with the least education. The equivalent results were 15% (2% to 28%) higher for Estonia and 19% (2% to 36%) higher for Portugal. These associations remained after adjustment for a range of covariates: -20% (-36% to -5%) for Denmark, 10% (-4% to 24%) for Estonia, and 18% (-1% to 31%) for Portugal. Strong statistical evidence supported differences between the associations in Denmark and those in the other two countries in both unadjusted and adjusted models (all P < 0.03).

Conclusions Among Danish children, those with the most educated and highest earning parents had least insulin resistance, whereas the opposite was true for children from Estonia and Portugal.


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