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

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7510.183 (Published 21 July 2005) Cite this as: BMJ 2005;331:183
  1. Debbie A Lawlor, senior lecturer in epidemiology and public health medicine (d.a.lawlor{at}bristol.ac.uk)1,
  2. Maarike Harro, director general3,
  3. Niels Wedderkopp, consultant orthopaedic surgeon and senior public health researcher4,
  4. Lars Bo Andersen, professor5,
  5. Luis B Sardinha, professor of exercise prescription6,
  6. Chris J Riddoch, professor of exercise science and head of institute7,
  7. Angie S Page, lecturer in exercise and health sciences2,
  8. Sigmund A Anderssen, associate professor of physical activity and health5,
  9. Karsten Froberg, associate professor4,
  10. David Stansbie, consultant in clinical biochemistry8,
  11. George Davey Smith, professor of clinical epidemiology1
  1. 1 Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. 2 Department of Exercise and Health Sciences, University of Bristol
  3. 3 Estonian National Institute for Health Development, Tallin, Estonia
  4. 4 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  5. 5 Department of Sports Medicine, Norwegian University of Sport and Physical Education, Oslo, Norway
  6. 6 Faculty of Human Movement, Technical University of Lisbon, Portugal
  7. 7 London Sport Institute, Middlesex University, London
  8. 8 Department of Clinical Biochemistry, United Bristol Healthcare NHS Trust, Bristol
  1. Correspondence to: D A Lawlor
  • Accepted 31 March 2005

Abstract

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.

Footnotes

  • We thank the participants and their families who gave their time to the study. We also acknowledge all members of the European Youth Heart Study Group not listed as coauthors of this paper.

  • Contributors DAL and GDS developed the aim and analytical approach for this paper. SAA, LBA, KF, MH, ASP, CJR, LBS, and NW were responsible for the overall European youth heart study design, obtained funding, and coordinated and performed data collection. DS did the biochemical assays for Denmark and Estonia and obtained funding for the Estonian insulin assays. DAL did the statistical analyses and wrote the first draft of the paper. All authors contributed to the final version. DAL, CJR, and LBA act as guarantors.

  • Funding This study was supported by the following grants. Denmark: Danish Heart Foundation, Danish Medical Research Council, Health Foundation, Danish Council for Sports Research, Foundation of 17-12-1981, Foundation in Memory of Asta Florida Bolding nee Andersen, and Faculty of Health Sciences, University of Southern Denmark. Estonia: Estonian Science Foundation grant numbers 3277 and 5209. Portugal: FEDER funding from the Government of Madeira. DAL is funded by a UK Department of Health career scientist award. The views expressed in this paper are those of the authors and not necessarily any funding body.

  • Competing interests None declared.

  • Ethical approval All study protocols conformed to the international guidelines on biomedical research and each research team complied with the ethical procedures of that country.

  • Accepted 31 March 2005
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