The earlybird study

The EarlyBird Diabetes Study recruited 307 healthy 5 year olds randomly from Plymouth primary schools during 2000/2001, and observed them in detail at six-month intervals to the age of 16 years in 2011/2012. The aim of the study was to capture the natural history of metabolic development in contemporary children, many of whom are overweight or obese. The study asked the question Which children develop insulin resistance and why? and was predicated on the Accelerator Hypothesis for type 1 diabetes that Terence J Wilkin published in 2001. Insulin resistance is a metabolic state, related largely to obesity, that renders the organs less sensitive to insulin and is believed to underpin the rise in diabetes, cardiovascular disease and cancer that has characterised the past 25 years.

Analysis: EarlyBird’s longitudinal analyses have been able to explore associations in a way that cross-sectional studies cannot. It established early on that insulin resistance is no longer affected by birth weight – rather, the driver is now weight gained in the early years. It showed obesity is not the result of inactivity in children, but the cause, and that physical activity imposed at one time of day is compensated for – with remarkable precision – at another, creating the concept of the ‘activitystat’. It was concluded that today’s obese girls are largely the daughters of obese mothers, and obese boys, the sons of obese fathers. The offspring of normal weight parents are no heavier than a generation ago. Height, like weight, is dependent on nutrition and, while the focus has been on being overweight, there is evidence that many of today’s children are overheight, with metabolic consequences. Finally, EarlyBird offers unique evidence that the stress of insulin resistance among overweight children wears down their insulin production to the point where over 20% of the cohort showed evidence of pre-diabetes by the age of 16 years. This is the most worrying spectre of all to have emerged from the EarlyBird study, because pre-diabetes frequently spells diabetes within a few years.

Media Coverage: By its closure in 2013, EarlyBird had published more than 60 peer-reviewed papers, had given over 70 podium presentations at scientific meetings, and had been personally invited to address national and international audiences on more than 50 occasions. The study is known around the world, and has been widely disseminated in the broadsheets (e.g. The Times, The Telegraph, The Observer, The Independent), on radio (e.g. Today Programme, Case Notes, Inside Health) and on television (e.g. Panorama, News at 10, Discovery Channel).

Legacy: EarlyBird leaves a substantial legacy. Its archive of frozen DNA and serum has been shared for epigenetic and metabolic studies with the University of Southampton and at the Ecole Polytechnique Federale de Lausanne /Nestle Institute of Health Sciences respectively. Both are new sciences, truly [...] edge, and the archived material amounting to 12 annual blood samples on each of 300 healthy children is unique. Furthermore, it has recently been possible to fund ‘EarlyBird 2’, a final sweep of the cohort at 19/20 years when the influence of puberty will have passed, and the final metabolic outcomes can be fully explored. Lastly, an intervention trial to test the Accelerator Hypothesis, on which EarlyBird was originally based, has been funded by JDRF, the world’s largest funding agency for research into childhood diabetes.

Further Links: www.earlybird.co.uk