Relationship of carbohydrate intolerance to serum lipoprotein profiles in childhood. The Bogalusa Heart Study

Three hundred-eighty-eight children were selected from a total community and biracial (black-white) population for a special in-depth study related to serum lipoproteins and carbohydrate metabolism. Based on two previous serum lipoprotein determinations of high and/or low beta and pre-beta-lipoprotein cholesterol, they were stratified into four groups. A glucose tolerance test was performed for fasting, 30-minute, and one-hour glucose, insulin, free fatty acids, calcium, and magnesium. Observations of height, weight, and triceps skinfold were also obtained on the children. Children in the high beta-lipoprotein cholesterol groups tended to have higher glucose levels and were more obese than the other groups, while children in the high pre-beta-lipoprotein cholesterol group tended to have high insulin levels following the glucose load. Fasting blood levels were not appreciably different in the various groups, but after the glucose load an unusually high insulin secretory response occurred in black children, especially black girls. Black girls also demonstrated somewhat lower blood sugars than the other race-sex groups. The insulin/glucose ratios were dramatically different in the black children, especially black girls. These differences were particularly noted in the groups with the high pre-beta-lipoprotein. Black children also tended to have higher insulin/free fatty acid ratios during the glucose tolerance test. These differences persisted even after adjusting for obesity. Although not significant, calcium levels consistently decreased in all groups following a glucose load. The observation of racial contrasts in glucose and insulin responses are interesting. While black girls appear to show low glucose and high insulin responses to a glucose load, low and delayed insulin response along with high glucose response occur in whites, especially white girls. Since white children have greater body fat content, these observations suggest more insulin resistance in white children. Even at low levels of obesity, subtle carbohydrate lipid metabolic aberrations are found in children having high levels of serum lipoproteins. A persistence of these conditions could contribute to accelerated atherosclerosis and subsequent coronary artery disease.