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Insulin Secretion and Sensitivity in Black Versus White Prepubertal Healthy Children¹

Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children’s Hospital, University of Pittsburgh; and the Department of Family Medicine and Clinical Epidemiology, Division of Biostatistics, University of Pittsburgh School of Medicine (J.E.J.), Pittsburgh, Pennsylvania 15213

Address all correspondence and requests for reprints to: Silva Arslanian, M.D., Division of Endocrinology, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue at Desoto Street, Pittsburgh, Pennsylvania 15213.

We had previously demonstrated greater insulin secretion and lower insulin sensitivity in black pubertal adolescents compared with whites. This study aimed to investigate whether similar black/white differences are present in the prepubertal period or are characteristics of the pubertal period. Twelve black and 11 white healthy prepubertal children, matched for age, body mass index, and Tanner I pubertal development, underwent a 2-h hyperglycemic clamp (225 mg/dL). Physical fitness was assessed by maximal oxygen consumption (VO_2max) measurement during graded bicycle ergometry, and resting energy expenditure was measured by indirect calorimetry after overnight fast.

Fasting and first phase insulin concentrations were higher in blacks than in whites [14.7 ± 1.3 vs. 10.4 ± 1.2 (P = 0.02) and 76.9 ± 6.8 vs. 52.1 ± 6.4 µU/mL (P = 0.016)]. There were no differences in second phase insulin levels and insulin sensitivity index. Both maximal oxygen consumption (VO_2max) and resting energy expenditure were lower in black children, whereas insulin-like growth factor I was higher. After controlling for these differences, race contributed significantly to basal insulin, but not to first phase insulin.

In summary, previously reported black/white differences in insulin secretion and sensitivity during adolescence may have their origin in early childhood manifested as hyperinsulinemia. However, genetic (race) vs. environmental factors (physical activity/fitness and energy balance) should be carefully scrutinized as potential factors responsible for such differences.

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