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October 14, 1992, Vol 268, No. 14 >
ARTICLE | October 14, 1992

Environmental and Familial Contributions to Insulin Levels and Change in Insulin Levels in Middle-aged Women FREE

Rena R. Wing, PhD; Karen A. Matthews, PhD; Lewis H. Kuller, MD, DrPH; Delia Smith, PhD; Dorothy Becker, MBBCh; Pam L. Plantinga, MPH; Elaine N. Meilahn, PhD
[+] Author Affiliations

Reprint requests to Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213 (Dr Wing).


JAMA. 1992;268(14):1890-1895. doi:10.1001/jama.1992.03490140098042
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Article
References

Objective.  —To examine familial and environmental variables associated with elevated insulin levels and changes in insulin levels in healthy, premenopausal women.

Methods.  —A population-based sample of 518 women (aged 42 to 50 years) completed baseline assessments of weight, cardiovascular risk factors, exercise behaviors, and glucose and insulin levels (fasting and 2 hours after a glucose load); 495 of the women were reevaluated after 3 years.

Results.  —Plasma insulin levels were related to weight, activity level, race, body fat distribution, and weight gain since age 20 years. Parental history of either diabetes or hypertension was also related to elevated insulin levels, independent of body mass index, with the highest insulin levels occurring in those women with a parental history of both diseases. Increases in plasma insulin levels over the years of follow-up were related to weight gain.

Conclusions.  —This study suggests the importance of using family history to identify women who may have elevated insulin levels and of intervening to prevent weight gain during middle age.(JAMA. 1992;268:1890-1895)

REFERENCES

1 +
Reaven GM.  Role of insulin resistance in human disease. Diabetes . 1988;;37:1595-1607.
2 +
Kaplan NM.  The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med . 1989;;149:1514-1520.
3 +
Modan M, Hillel H, Sholmo A, et al.  Hyperinsulinemia: a link between hypertension, obesity, and glucose tolerance. J Clin Invest . 1985;;75:809-817.
4 +
Zimmet P.  Non-insulin-dependent (type 2) diabetes mellitus: does it really exist? Diabetic Med . 1989;;6:728-735.
5 +
Fuh MMT, Shieh SM, Wu DA, Chen YDI, Reaven GM.  Abnormalities of carbohydrate and lipid metabolism in patients with hypertension. Arch Intern Med . 1987;;147:1035-1038.
6 +
Singer P, Godicke W, Voigt S, Hajdu I, Weiss M.  Post-prandial hyperinsulinemia in patients with mild essential hypertension. Hypertension . 1985;;7:182-186.
7 +
Ferrannini E, Buzzigoli G, Banadonna R, et al.  Insulin resistance in essential hypertension. N Engl J Med . 1987;;317:350-357.
8 +
Wing R, Bunker CH, Kuller LH, et al.  Insulin, body mass index, and cardiovascular risk factors in premenopausal women. Atherosclerosis . 1989;;9:479-484.
9 +
Donahue RP, Orchard TJ, Becker DJ, et al.  Sex differences in the coronary heart disease risk profile: a possible role for insulin: the Beaver County Study. Am J Epidemiol . 1987;;125:650-657.
10 +
Fournier AM, Gladia MT, Kubrushy DB, et al.  Blood pressure, insulin, and glycemia in nondiabetic subjects. Am J Med . 1986;;80:861-864.
11 +
Donahue RP, Skyler JS, Schneiderman N, Prineas RJ.  Hyperinsulinemia and elevated blood pressure: cause, confounder, or coincidence? Am J Epidemiol . 1990;;132:827-836.
12 +
Saad MF, Lillioja S, Nyomba BL, et al.  Racial differences in the relation between blood pressure and insulin resistance. N Engl J Med . 1991;;324: 733-739.
13 +
Garcia-Webb P, Bonser AM, Whiting D, Masarei JRL.  Insulin resistance: a risk factor for coronary heart disease? Scand J Clin Lab Invest . 1983;; 43:677-685.
14 +
Orchard TJ, Becker DJ, Bates M, Kuller LH, Drash AL.  Plasma insulin and lipoprotein concentrations: an atherogenic association? Am J Epidemiol . 1983;;118:326-337.
15 +
DeFronzo RA, Ferrannini E.  Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care . 1991;; 14:173-194.
16 +
Reaven GM.  Insulin resistance, hyperinsulinemia, hypertriglyceridemia, and hypertension: parallels between human disease and rodent models. Diabetes Care . 1991;;14:195-202.
17 +
Ducimetiere P, Eschwege E, Papoz L, Richard JL, Claude JR, Rosselin G.  Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia . 1980;;19:205-210.
18 +
Pyorala K.  Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland. Diabetes Care . 1979;;2:131-141.
19 +
Welborn TA, Wearne K.  Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care . 1979;;2:154-162.
20 +
Bogardus C, Lillioja S, Nyomba BL, et al.  Distribution of in vivo insulin action in Pima Indians as mixture of three normal distributions. Diabetes . 1989;;38:1423-1432.
21 +
Haffner SM, Stern MP, Hazuda HP, Mitchel BD, Patterson JK.  Increased insulin concentrations in nondiabetic off-spring of diabetic parents. N Engl J Med . 1988;;319:1297-1301.
22 +
Leslie RDG, Volkman HP, Poncher M, Hanning I, Orskov H, Alberti KGMM.  Metabolic abnormalities in children of noninsulin dependent diabetes. BMJ . 1986;;293:840-842.
23 +
Eriksson J, Franssila-Kallunki A, Ekstrand A, et al.  Early metabolic defects in persons at increased risk for noninsulin-dependent diabetes mellitus. N Engl J Med . 1989;;321:337-343.
24 +
Zavaronni I, Mazza S, Luchetti L, et al.  High plasma insulin and triglyceride concentrations and blood pressure in offspring of people with impaired glucose tolerance. Diabetic Med . 1990;;7: 494-498.
25 +
Kolterman OG, Insel J, Saekow M, Olefsky JM.  Mechanisms of insulin resistance in human obesity: evidence for receptor and post-receptor defects. J Clin Invest . 1980;;65:1273-1284.
26 +
Horton ES.  Exercise and physical training: effect on insulin sensitivity and glucose metabolism. Diabetes Metab Rev . 1986;;2:1-17.
27 +
Owens JF, Matthews KA, Wing RR, Kuller LH.  Physical activity and cardiovascular risk: a cross-sectional study of middle-aged premenopausal women. Prev Med . 1990;;19:147-157.
28 +
Matthews KA, Kelsey SF, Meilahn EN, Kuller LH, Wing RR.  Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol . 1989;;129:1132-1144.
29 +
Herbert V, Lau K, Gottlieb C, Bleicher S.  Coated charcoal immunoassay of insulin. J Clin Endocrinol Metab . 1965;;25:1375-1384.
30 +
Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC.  Enzymatic determination of total serum cholesterol. Clin Chem . 1974;;20:470-475.
31 +
Warnick GR, Albers JJ.  A comprehensive evaluation of the heparin-managanese precipitation procedure for estimating high density lipoprotein cholesterol. J Lipid Res . 1978;;19:65-76.
32 +
Gidez JI, Miller GJ, Burstein M, Eder HA. Analyses of Plasma High Density Lipoprotein Subclasses by a Precipitation Procedure: Correlations With Preparative and Analytical Centrifugation: Report of the High Density Lipoprotein Methodology Workshop . Bethesda, Md: Dept of Health, Education, and Welfare; 1978;:328-342.
33 +
Bucolo G, David H.  Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem . 1973;;19:476-482.
34 +
Dischinger P, Duchene AG.  Quality control aspects of blood pressure measurements in the Multiple Risk Factor Intervention Trial. Controlled Clin Trials . 1986;;7:137S-157S.
35 +
Paffenbarger RS, Wing AL, Hyde RT.  Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol . 1978;;108:161-175.
36 +
Markovitz JH, Matthews KA, Wing RR, Kuller LH, Meilahn EN.  Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. J Hypertens . 1991;; 9:399-406.
37 +
Wing RR, Bunker CH, Kuller LH, Matthews KA.  Insulin, body mass index, and cardiovascular risk factors in premenopausal women. Arteriosclerosis . 1989;;9:479-484.
38 +
Holbrook TL, Barrett-Connor E, Wingard DL.  The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. Int J Obesity . 1989;;13:723-729.
39 +
Manson JE, Colditz GA, Stampfer MJ, et al.  A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med . 1990;;322: 882-889.
40 +
Krotkiewski M, Mandroukas K, Sjostrom L, Sullivan L, Wetterqvist H, Bjorntorp P.  Effects of long-term physical training on body fat, metabolism, and blood pressure in obesity. Metabolism . 1979;;28:650-658.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Reaven GM.  Role of insulin resistance in human disease. Diabetes . 1988;;37:1595-1607.
2 +
Kaplan NM.  The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med . 1989;;149:1514-1520.
3 +
Modan M, Hillel H, Sholmo A, et al.  Hyperinsulinemia: a link between hypertension, obesity, and glucose tolerance. J Clin Invest . 1985;;75:809-817.
4 +
Zimmet P.  Non-insulin-dependent (type 2) diabetes mellitus: does it really exist? Diabetic Med . 1989;;6:728-735.
5 +
Fuh MMT, Shieh SM, Wu DA, Chen YDI, Reaven GM.  Abnormalities of carbohydrate and lipid metabolism in patients with hypertension. Arch Intern Med . 1987;;147:1035-1038.
6 +
Singer P, Godicke W, Voigt S, Hajdu I, Weiss M.  Post-prandial hyperinsulinemia in patients with mild essential hypertension. Hypertension . 1985;;7:182-186.
7 +
Ferrannini E, Buzzigoli G, Banadonna R, et al.  Insulin resistance in essential hypertension. N Engl J Med . 1987;;317:350-357.
8 +
Wing R, Bunker CH, Kuller LH, et al.  Insulin, body mass index, and cardiovascular risk factors in premenopausal women. Atherosclerosis . 1989;;9:479-484.
9 +
Donahue RP, Orchard TJ, Becker DJ, et al.  Sex differences in the coronary heart disease risk profile: a possible role for insulin: the Beaver County Study. Am J Epidemiol . 1987;;125:650-657.
10 +
Fournier AM, Gladia MT, Kubrushy DB, et al.  Blood pressure, insulin, and glycemia in nondiabetic subjects. Am J Med . 1986;;80:861-864.
11 +
Donahue RP, Skyler JS, Schneiderman N, Prineas RJ.  Hyperinsulinemia and elevated blood pressure: cause, confounder, or coincidence? Am J Epidemiol . 1990;;132:827-836.
12 +
Saad MF, Lillioja S, Nyomba BL, et al.  Racial differences in the relation between blood pressure and insulin resistance. N Engl J Med . 1991;;324: 733-739.
13 +
Garcia-Webb P, Bonser AM, Whiting D, Masarei JRL.  Insulin resistance: a risk factor for coronary heart disease? Scand J Clin Lab Invest . 1983;; 43:677-685.
14 +
Orchard TJ, Becker DJ, Bates M, Kuller LH, Drash AL.  Plasma insulin and lipoprotein concentrations: an atherogenic association? Am J Epidemiol . 1983;;118:326-337.
15 +
DeFronzo RA, Ferrannini E.  Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care . 1991;; 14:173-194.
16 +
Reaven GM.  Insulin resistance, hyperinsulinemia, hypertriglyceridemia, and hypertension: parallels between human disease and rodent models. Diabetes Care . 1991;;14:195-202.
17 +
Ducimetiere P, Eschwege E, Papoz L, Richard JL, Claude JR, Rosselin G.  Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia . 1980;;19:205-210.
18 +
Pyorala K.  Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland. Diabetes Care . 1979;;2:131-141.
19 +
Welborn TA, Wearne K.  Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care . 1979;;2:154-162.
20 +
Bogardus C, Lillioja S, Nyomba BL, et al.  Distribution of in vivo insulin action in Pima Indians as mixture of three normal distributions. Diabetes . 1989;;38:1423-1432.
21 +
Haffner SM, Stern MP, Hazuda HP, Mitchel BD, Patterson JK.  Increased insulin concentrations in nondiabetic off-spring of diabetic parents. N Engl J Med . 1988;;319:1297-1301.
22 +
Leslie RDG, Volkman HP, Poncher M, Hanning I, Orskov H, Alberti KGMM.  Metabolic abnormalities in children of noninsulin dependent diabetes. BMJ . 1986;;293:840-842.
23 +
Eriksson J, Franssila-Kallunki A, Ekstrand A, et al.  Early metabolic defects in persons at increased risk for noninsulin-dependent diabetes mellitus. N Engl J Med . 1989;;321:337-343.
24 +
Zavaronni I, Mazza S, Luchetti L, et al.  High plasma insulin and triglyceride concentrations and blood pressure in offspring of people with impaired glucose tolerance. Diabetic Med . 1990;;7: 494-498.
25 +
Kolterman OG, Insel J, Saekow M, Olefsky JM.  Mechanisms of insulin resistance in human obesity: evidence for receptor and post-receptor defects. J Clin Invest . 1980;;65:1273-1284.
26 +
Horton ES.  Exercise and physical training: effect on insulin sensitivity and glucose metabolism. Diabetes Metab Rev . 1986;;2:1-17.
27 +
Owens JF, Matthews KA, Wing RR, Kuller LH.  Physical activity and cardiovascular risk: a cross-sectional study of middle-aged premenopausal women. Prev Med . 1990;;19:147-157.
28 +
Matthews KA, Kelsey SF, Meilahn EN, Kuller LH, Wing RR.  Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol . 1989;;129:1132-1144.
29 +
Herbert V, Lau K, Gottlieb C, Bleicher S.  Coated charcoal immunoassay of insulin. J Clin Endocrinol Metab . 1965;;25:1375-1384.
30 +
Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC.  Enzymatic determination of total serum cholesterol. Clin Chem . 1974;;20:470-475.
31 +
Warnick GR, Albers JJ.  A comprehensive evaluation of the heparin-managanese precipitation procedure for estimating high density lipoprotein cholesterol. J Lipid Res . 1978;;19:65-76.
32 +
Gidez JI, Miller GJ, Burstein M, Eder HA. Analyses of Plasma High Density Lipoprotein Subclasses by a Precipitation Procedure: Correlations With Preparative and Analytical Centrifugation: Report of the High Density Lipoprotein Methodology Workshop . Bethesda, Md: Dept of Health, Education, and Welfare; 1978;:328-342.
33 +
Bucolo G, David H.  Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem . 1973;;19:476-482.
34 +
Dischinger P, Duchene AG.  Quality control aspects of blood pressure measurements in the Multiple Risk Factor Intervention Trial. Controlled Clin Trials . 1986;;7:137S-157S.
35 +
Paffenbarger RS, Wing AL, Hyde RT.  Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol . 1978;;108:161-175.
36 +
Markovitz JH, Matthews KA, Wing RR, Kuller LH, Meilahn EN.  Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. J Hypertens . 1991;; 9:399-406.
37 +
Wing RR, Bunker CH, Kuller LH, Matthews KA.  Insulin, body mass index, and cardiovascular risk factors in premenopausal women. Arteriosclerosis . 1989;;9:479-484.
38 +
Holbrook TL, Barrett-Connor E, Wingard DL.  The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. Int J Obesity . 1989;;13:723-729.
39 +
Manson JE, Colditz GA, Stampfer MJ, et al.  A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med . 1990;;322: 882-889.
40 +
Krotkiewski M, Mandroukas K, Sjostrom L, Sullivan L, Wetterqvist H, Bjorntorp P.  Effects of long-term physical training on body fat, metabolism, and blood pressure in obesity. Metabolism . 1979;;28:650-658.

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