Cardiometabolic Risk: Unto the 3rd Generation

Family history, even involving grandparents, predicts disease markers

Children with a strong family history of cardiovascular disease (CVD) and/or type 2 diabetes were more likely to have various unfavorable disease markers when compared with children who had no family history, researchers found.

In a study of 1,374 children (mean age 13 at evaluation), nearly one-third (29%) of the children had a strong family history of CVD and/or diabetes based on data gathered about their parents and grandparents. And those children were more likely than others in the study to have a larger waist circumference, higher total cholesterol (TC), and higher TC/HDL-cholesterol ratio, reported Nina Berentzen, PhD, of the National Institute for Public Health and the Environment in Bilthoven, Netherlands, and colleagues in Diabetologia.

Data for the study, including family history information obtained from parents as well as clinical and lab evaluations, came from the Dutch birth cohort study called Prevention and Incidence of Asthma and Mite Allergy (PIAMA) that began in 1996.

Berentzen and colleagues said the findings suggest that gathering complete family histories of cardiometabolic diseases, especially diabetes, is of the utmost importance, and might help prevent the development of unfavorable conditions in children.

"Family history of MI may be most relevant for children's cholesterol levels (HDL, TC, and TC/HDLC ratio), whereas family history of diabetes may be relevant for children's waist circumference," they also indicated.

The data suggested that diabetes was underreported as compared with CVD, which the researchers said could have resulted from underdiagnosis.

Joel Zonszein, MD, director of the Clinical Diabetes Center at the University Hospital of the Albert Einstein College of Medicine in New York City, commented to MedPage Today that underdiagnosis is common in diabetics, "both in hospitalized patients ... and in the outpatient arena." Zonszein, who was not involved in the study, noted also that many people in the outpatient setting also have prediabetes but are unaware.

There were specific symptoms likely to occur in children whose family had a history of MI as compared with those children whose family had a history of diabetes. Children who had a strong family history of MI had mean total cholesterol that was 0.12 mmol/L higher (4.6 mg/dL; P<.05). Similarly, children whose family had a strong history of diabetes had an average waist circumference that was 2.25 cm larger (95% CI 1.08-3.41) than those children with no family history.

The children were classified into three categories: "no family history," "moderate family history," and "strong family history." "No family history" included children without any affected parents or grandparents. "Moderate family history" included children with one or two grandparents with late disease onset. Finally, "strong family history" included those children with at least one parent with one or more of the conditions, one grandparent with early disease onset, or three/four grandparents with late disease onset.

"Children of immigrants were under-represented in the PIAMA study" noted the authors, "and we cannot exclude the possibility that different associations of family history of diabetes/CVD with offspring cardiometabolic markers would be observed for other ethnicities" they added.

The reliance on questionnaire-based data gathered for an asthma study was a limitation of the study. Another was its inability to analyze the effects of having a combined family history of both CVD and diabetes. The study's design did not allow for the investigation of combinations of two or more of the diseases. Even though a majority of the children with strong family history only had one of the diseases, the researchers said it would be interesting to assess the correlates of having a strong family history of a combination of the conditions.

Study authors declared they had no duality of interest associated with this manuscript.

Primary Source: Berentzen N, et al "Family history of myocardial infarction, stroke and diabetes and cardiometabolic marker in children" Diabetologia 2016; DOI: 10.1007/s00125-016-3988-2.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.