Risk of metabolic syndrome and diabetes among young twins and singletons in Guinea-Bissau

Morten Bjerregaard-Andersen, Lone Hansen, Leontina I da Silva, Luis C Joaquím, Ditte E Hennild, Lene Christiansen, Peter Aaby, Christine S Benn, Kaare Christensen, Morten Sodemann, Dorte M Jensen, Henning Beck-Nielsen, Morten Bjerregaard-Andersen, Lone Hansen, Leontina I da Silva, Luis C Joaquím, Ditte E Hennild, Lene Christiansen, Peter Aaby, Christine S Benn, Kaare Christensen, Morten Sodemann, Dorte M Jensen, Henning Beck-Nielsen

Abstract

Objective: Twins in Africa may be at increased risk of metabolic disorders due to strained conditions in utero, including high exposure to infections. We studied metabolic syndrome (MS) and diabetes mellitus (DM) among young twins and singletons in Guinea-Bissau.

Research design and methods: The study was cross-sectional and occurred from October 2009 until August 2011 at the Bandim Health Project, a demographic surveillance site in the capital Bissau. Twins and singleton controls between 5 and 32 years were visited at home. Fasting blood samples for metabolic measurements were collected. Zygosity was established genetically for a subset. DM was defined as HbA1c ≥6.5% (48 mmol/mol) and MS by the International Diabetes Federation criteria.

Results: HbA1c was available for 574 twins and 463 singletons. Mean age was 15.3 years versus 15.8 years, respectively. Eighteen percent of twins were monozygotic. There were no DM cases among twins but one among singletons. A total of 1.4% (8 of 574) of twins had elevated HbA1c (6.0-6.4%, 42-46 mmol/mol) compared with 2.4% (11 of 463) of singletons (P = 0.28). Mean HbA1c was 5.3% (34 mmol/mol) for both groups. MS data were available for 364 twins and 360 singletons. The MS prevalence was 3.0% (11 of 364) among twins and 3.6% (13 of 360) among singletons (P = 0.66). The prevalence of fasting blood glucose (F-glucose) ≥5.6 mmol/L was 34.9% (127 of 364) for twins versus 24.7% (89 of 360) for singletons (P = 0.003). Median homeostasis model assessment-insulin resistance did not differ (P = 0.34).

Conclusions: The MS and DM prevalences among young individuals in Guinea-Bissau were low. Twins did not have a higher MS and DM burden than singletons, though elevated F-glucose was more common among twins.

Figures

Figure 1
Figure 1
Study flow chart of twins and singletons.
Figure 2
Figure 2
Zygosity distribution among 187 twin pairs for whom HbA1c results were available for both twins.

References

    1. Hall JG. Twinning. Lancet 2003;362:735–743
    1. Pison G. Twins in Sub-Saharan Africa: Frequency, social status and mortality. In Mortality and Society in Africa. van de Walle E, Pison G, Sala-Diakanda M, Eds. Oxford, Oxford University Press, 1992, p. 253–278
    1. Vaag A, Poulsen P. Twins in metabolic and diabetes research: what do they tell us? Curr Opin Clin Nutr Metab Care 2007;10:591–596
    1. Barker DJ. The fetal and infant origins of adult disease. BMJ 1990;301:1111.
    1. Hales CN, Barker DJ. The thrifty phenotype hypothesis. Br Med Bull 2001;60:5–20
    1. Yajnik CS. Nutrient-mediated teratogenesis and fuel-mediated teratogenesis: two pathways of intrauterine programming of diabetes. Int J Gynaecol Obstet 2009;104(Suppl. 1):S27–S31
    1. Yajnik CS. Fetal programming of diabetes: still so much to learn! Diabetes Care 2010;33:1146–1148
    1. Poulsen P, Grunnet LG, Pilgaard K, et al. Increased risk of type 2 diabetes in elderly twins. Diabetes 2009;58:1350–1355
    1. Petersen I, Nielsen MM, Beck-Nielsen H, Christensen K. No evidence of a higher 10 year period prevalence of diabetes among 77,885 twins compared with 215,264 singletons from the Danish birth cohorts 1910-1989. Diabetologia 2011;54:2016–2024
    1. Phillips DI, Davies MJ, Robinson JS. Fetal growth and the fetal origins hypothesis in twins—problems and perspectives. Twin Res 2001;4:327–331
    1. Poulsen P, Vaag A. The intrauterine environment as reflected by birth size and twin and zygosity status influences insulin action and intracellular glucose metabolism in an age- or time-dependent manner. Diabetes 2006;55:1819–1825
    1. Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet 2010;375:2254–2266
    1. Osei K, Schuster DP, Amoah AG, Owusu SK. Diabetes in Africa. Pathogenesis of type 1 and type 2 diabetes mellitus in sub-Saharan Africa: implications for transitional populations. J Cardiovasc Risk 2003;10:85–96
    1. Gill GV, Mbanya JC, Ramaiya KL, Tesfaye S. A sub-Saharan African perspective of diabetes. Diabetologia 2009;52:8–16
    1. Jaffar S, Jepson A, Leach A, Greenwood A, Whittle H, Greenwood B. Causes of mortality in twins in a rural region of The Gambia, West Africa. Ann Trop Paediatr 1998;18:231–238
    1. Justesen A, Kunst A. Postneonatal and child mortality among twins in Southern and Eastern Africa. Int J Epidemiol 2000;29:678–683
    1. Bjerregaard-Andersen M, Gomes MA, Joaquim LC, et al. Establishing a Twin Registry in Guinea-Bissau. Twin Res Hum Genet 2013;16:179–184
    1. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419
    1. Christiansen L, Frederiksen H, Schousboe K, et al. Age- and sex-differences in the validity of questionnaire-based zygosity in twins. Twin Res 2003;6:275–278
    1. International Expert Committee International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327–1334
    1. Zimmet P, Alberti KG, Kaufman F, et al. IDF Consensus Group The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8:299–306
    1. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640–1645
    1. McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5.0-16.9 y. Eur J Clin Nutr 2001;55:902–907
    1. Falkner B, Daniels SR. Summary of the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Hypertension 2004;44:387–388
    1. Misra A, Garg S. HbA1c and blood glucose for the diagnosis of diabetes. Lancet 2011;378:104–106
    1. Motala AA, Esterhuizen T, Pirie FJ, Omar MA. The prevalence of metabolic syndrome and determination of the optimal waist circumference cutoff points in a rural South african community. Diabetes Care 2011;34:1032–1037
    1. Christensen K, Petersen I, Skytthe A, Herskind AM, McGue M, Bingley P. Comparison of academic performance of twins and singletons in adolescence: follow-up study. BMJ 2006;333:1095.
    1. Ekelund U, Anderssen S, Andersen LB, et al. Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin Nutr 2009;89:90–96
    1. Clausen TD, Mathiesen ER, Hansen T, et al. Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes. J Clin Endocrinol Metab 2009;94:2464–2470
    1. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005;115:e290–e296
    1. Xu H, Li Y, Liu A, et al. Prevalence of the metabolic syndrome among children from six cities of China. BMC Public Health 2012;12:13.
    1. Tran A, Gelaye B, Girma B, Lemma S, Berhane Y, Bekele T, et al. Prevalence of Metabolic Syndrome among Working Adults in Ethiopia. Int J Hypertens 2011;2011:193719.
    1. Ulasi II, Ijoma CK, Onodugo OD. A community-based study of hypertension and cardio-metabolic syndrome in semi-urban and rural communities in Nigeria. BMC Health Serv Res 2010;10:71.
    1. Adegoke OA, Adedoyin RA, Balogun MO, Adebayo RA, Bisiriyu LA, Salawu AA. Prevalence of metabolic syndrome in a rural community in Nigeria. Metab Syndr Relat Disord 2010;8:59–62
    1. Fezeu L, Balkau B, Kengne AP, Sobngwi E, Mbanya JC. Metabolic syndrome in a sub-Saharan African setting: central obesity may be the key determinant. Atherosclerosis 2007;193:70–76
    1. Bjerregaard-Andersen M, Lund N, Jepsen FS, et al. A prospective study of twinning and perinatal mortality in urban Guinea-Bissau. BMC Pregnancy Childbirth 2012;12:140.
    1. Guyatt HL, Snow RW. Impact of malaria during pregnancy on low birth weight in sub-Saharan Africa. Clin Microbiol Rev 2004;17:760–769
    1. Habib NA, Daltveit AK, Bergsjø P, Shao J, Oneko O, Lie RT. Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. BJOG 2008;115:616–624
    1. Christensen K, Vaupel JW, Holm NV, Yashin AI. Mortality among twins after age 6: fetal origins hypothesis versus twin method. BMJ 1995;310:432–436
    1. Johansson S, Iliadou A, Bergvall N, et al. The association between low birth weight and type 2 diabetes: contribution of genetic factors. Epidemiology 2008;19:659–665

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