Cord Blood Insulin Concentration and Hypertension Among Children and Adolescents Enrolled in a US Racially Diverse Birth Cohort

Abstract

Background: Although insulin resistance is closely related to hypertension, the debate continues as to whether insulin resistance is a cause or a consequence of hypertension. This study investigated the associations of cord blood insulin concentration with blood pressure (BP) and hypertension in childhood and adolescence. Methods: This study included 951 children enrolled from 1998 to 2012 and followed from birth onwards at the Boston Medical Center, Boston, MA. Cord blood insulin concentration was measured using a sandwich immunoassay. Hypertension in childhood and adolescence was defined based on the 2017 American Academy of Pediatrics Clinical Practice Guidelines. Results: The median (interquartile range) for cord blood insulin concentration was 12.1 (7.2–19.0) µIU/mL. The age range of BP measurements was 3 to 18 years (median, 10.6 years). Cord blood insulin concentration was positively associated with systolic and diastolic BP as well as the risk of hypertension at age 3 to 18 years. Compared with the lowest tertile of cord blood insulin concentration, the top tertile insulin concentration was associated with a 5.18 (95% CI, 1.97–8.39) percentile increase in systolic BP, 4.29 (95% CI, 1.74–6.84) percentile increase in diastolic BP, and 1.62-fold (95% CI, 1.27–2.08) higher risk of hypertension. The association between insulin and hypertension was stronger among children born preterm ( P for interaction=0.048). Furthermore, preterm birth and childhood overweight or obesity enhanced the associations. Conclusions: Our results suggest that elevated insulin concentration at birth plays a critical role in the early life origins of hypertension and support the hypothesis implicating insulin resistance in the etiology of hypertension.

High Amino Acid Intake in Early Life Is Associated With Systolic but Not Diastolic Arterial Hypertension at 5 Years of Age in Children Born Very Preterm

“…Although the intake of all macronutrients was higher in the exposed group among the 3 macronutrients measured (amino acid, carbohydrate, and lipid), only early amino acid intake was significantly correlated to systolic BP. This is consistent with the results of the study reported by Wang et al, 29 where a relationship between random plasma insulin levels at birth and later HBP in early childhood was observed. Though serum insulin was not measured in our study, serum insulin level likely was higher in the exposed group, because a higher intake of amino acid, particularly of branched‐chain amino acids, is known to enhance insulin secretion.…”