Association between duration of obesity and risk of non-insulin-dependent diabetes mellitus. The Sotetsu Study

Current and past depression as risk factors for incident type 2 diabetes mellitus and pre-diabetes in men and women: evidence from a longitudinal community cohort

BACKGROUND

Depression is associated with an increased risk for type 2 diabetes mellitus. However, depression may take different courses, and it is not fully understood how these affect the development of diabetes. It is further to be determined whether sex modifies the association between depression and type 2 diabetes.

METHODS

We analyzed data from the Gutenberg Health Study, a longitudinal and population-based cohort study (N = 15,010) in Germany. Depressive symptoms (measured by PHQ-9), history of depression, diabetes mellitus, and relevant covariates were assessed at baseline, and the outcomes of prediabetes and type 2 diabetes mellitus were evaluated 5 years later. Logistic regression was used to estimate odds ratios of incident prediabetes and type 2 diabetes mellitus, adjusting for potential confounders as identified in a Directed Acyclic Graph.

RESULTS

In the confounder adjusted model, current depression (PHQ-9 ≥ 10 at baseline; OR = 1.79, 95% CI = 1.11 to 2.74, p = 0.011), and persistent depression had a statistically significant (OR = 2.44, 95% CI = 1.62 to 3.54, p = 0.005) effect on incident type 2 diabetes mellitus. A history of depression without current depression had no statistically significant effect on type 2 diabetes (OR = 1.00, 95% CI = 0.68 to 1.43, p = 0.999). The effect of depression on incident diabetes did not differ significantly between women (OR = 2.02; 95% CI = 1.32 to 3.09) and men (OR = 2.16; 95% CI = 1.41 to 3.31; p-value for interaction on the multiplicative scale p = 0.832 and on the additive scale p = 0.149). Depression did not have a significant effect on incident prediabetes.

CONCLUSION

This study shows how the history and trajectory of depression shape the risk for diabetes. This raises interesting questions on the cumulative effects of depression trajectories on diabetes and body metabolism in general. Depression can negatively affect physical health, contributing to increased morbidity and mortality in people with mental disorders.

Obesity Duration and Cardiometabolic Disease

Cardiovascular disease risk is known to be influenced by both the severity of a risk factor and the duration of exposure (eg, LDL [low-density lipoprotein] cholesterol, tobacco smoke). However, this concept has been largely neglected within the obesity literature. While obesity severity has been closely linked with cardiometabolic diseases, the risk of developing these conditions among those with obesity may be augmented by greater obesity duration over the life span. Few longitudinal or contemporary studies have investigated the influence of both factors in combination-cumulative obesity exposure-instead generally focusing on obesity severity, often at a single time point, given ease of use and lack of established methods to encapsulate duration. Our review focuses on what is known about the influence of the duration of exposure to excess adiposity within the obesity-associated cardiometabolic disease risk equation by means of summarizing the hypothesized mechanisms for and evidence surrounding the relationships of obesity duration with diverse cardiovascular and metabolic disease. Through the synthesis of the currently available data, we aim to highlight the importance of a better understanding of the influence of obesity duration in cardiovascular and metabolic disease pathogenesis. We underscore the clinical importance of aggressive early attention to obesity identification and intervention to prevent the development of chronic diseases that arise from exposure to excess body weight.

Cardiovascular Risk and Diseases in Patients With and Without Leptin-Melanocortin Pathway Variants

OBJECTIVE

To study differences in cardiovascular risk factors and diseases between patients with and without genetic variants in the leptin-melanocortin pathway.

METHODS

A cross-sectional study of patients with a history of severe obesity genotyped in June 2019 as participants of the Mayo Clinic Biobank was conducted in March 2022 to assess differences in cardiovascular risk and diseases between carriers of a heterozygous variant in the leptin-melanocortin pathway and noncarriers. Cardiovascular risk factors included hypertension, diabetes, dyslipidemia, and smoking. Cardiovascular disease includes coronary artery disease, peripheral artery disease, and cerebrovascular accidents. Patients with a history of bariatric surgery were excluded. We used logistic regression models to estimate the odds ratio and 95% CI, adjusting for age, body mass index (BMI), and sex.

RESULTS

Among a total of 168 carriers (8%; 121 [72%] female; mean [SD] age, 65.1 [14.9] years; BMI, 44.0 [7.4] kg/m2) and 2039 noncarriers (92%; 1446 [71%] female; mean [SD] age, 64.9 [14.4] years; BMI, 42.9 [6.6] kg/m2), carriers had higher prevalence odds of hypertension (odds ratio, 3.26; 95% CI, 2.31 to 4.61; P<.001) and reported higher number of cardiovascular risk factors compared with noncarriers (2.4 [1.1] vs 2.0 [1.1]; P<.001). There were no significant differences in the adjusted odds associated with diabetes, dyslipidemia, smoking, or cardiovascular disease.

CONCLUSION

Despite having similar body weight and BMI, carriers of heterozygous variants in the leptin-melanocortin pathway had higher rates of hypertension than noncarriers. These findings point to an association between hypertension and leptin-melanocortin pathway variants.

The Early Life Course of Body Weight and Gene Expression Signatures for Disease

We examined the way body-weight patterns through the first 4 decades of life relate to gene expression signatures of common forms of morbidity, including cardiovascular disease (CVD), type 2 diabetes (T2D), and inflammation. As part of wave V of the nationally representative National Longitudinal Study of Adolescent to Adult Health (1997–2018) in the United States, mRNA abundance data were collected from peripheral blood (n = 1,132). We used a Bayesian modeling strategy to examine the relative associations between body size at 5 life stages—birth, adolescence, early adulthood, young adulthood, and adulthood—and gene expression–based disease signatures. We compared life-course models that consider critical or sensitive periods, as well as accumulation over the entire period. Our results are consistent with a sensitive-period model when examining CVD and T2D gene expression signatures: Birth weight has a prominent role for the CVD and T2D signatures (explaining 33.1% and 22.1%, respectively, of the total association accounted for by body size), while the most recent adult obesity status (ages 33–39) is important for both of these gene expression signatures (24.3% and 35.1%, respectively). Body size in all life stages was associated with inflammation, consistent with the accumulation model.

Diet, Stress and Mental Health

Introduction: There has long been an interest in the effects of diet on mental health, and the interaction of the two with stress; however, the nature of these relationships is not well understood. Although associations between diet, obesity and the related metabolic syndrome (MetS), stress, and mental disorders exist, causal pathways have not been established. Methods: We reviewed the literature on the relationship between diet, stress, obesity and psychiatric disorders related to stress. Results: Diet and obesity can affect mood through direct effects, or stress-related mental disorders could lead to changes in diet habits that affect weight. Alternatively, common factors such as stress or predisposition could lead to both obesity and stress-related mental disorders, such as depression and posttraumatic stress disorder (PTSD). Specific aspects of diet can lead to acute changes in mood as well as stimulate inflammation, which has led to efforts to assess polyunsaturated fats (PUFA) as a treatment for depression. Bidirectional relationships between these different factors are also likely. Finally, there has been increased attention recently on the relationship between the gut and the brain, with the realization that the gut microbiome has an influence on brain function and probably also mood and behavior, introducing another way diet can influence mental health and disorders. Brain areas and neurotransmitters and neuropeptides that are involved in both mood and appetite likely play a role in mediating this relationship. Conclusions: Understanding the relationship between diet, stress and mood and behavior could have important implications for the treatment of both stress-related mental disorders and obesity.

Predictors of Risk and Success of Obesity Surgery

BACKGROUND

Obesity surgery has proven successful for weight loss and the resolution of comorbidities. There is, however, little evidence on its success and the risk of complications when considering age of onset of obesity (AOO), years of obesity (YOO), preoperative body mass index (BMI), Edmonton obesity staging system (EOSS) score, and age as possible predictors of weight loss, the resolution of comorbidities, and the risk of complications.

METHODS

Patients who underwent Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) from a prospective database were analyzed. Multiple regression analyses were used to predict comorbidities and their resolution, percentage excess weight loss (%EWL) and total weight loss (%TWL) 12 months after surgery, and the risk of complications using the predictors AOO, YOO, age, EOSS, and BMI.

RESULTS

180 patients aged 46.8 ± 11.1 years with a preoperative BMI 49.5 ± 7.5 were included. The number of preoperative comorbidities was higher with older age (β = 0.054; p = 0.023) and a greater BMI (β = 0.040; p = 0.036) but was not related to AOO and YOO. Patients with AOO as a child or adolescent were more likely to have an EOSS score of ≥2. Greater preoperative BMI was negatively associated with %EWL (β = -1.236; p < 0.001) and older age was negatively associated with %TWL (β = -0.344; p = 0.020). Postoperative complications were positively associated with EOSS score (odds ratio [OR] 1.147; p = 0.042) and BMI (OR 1.010; p = 0.020), but not with age. AOO and YOO were not related to postoperative outcome.

CONCLUSION

Greater BMI was associated with a lower %EWL and age was associated with a low %TWL. YOO and AOO did not influence outcome. Age, BMI, and EOSS score were the most important predictors for risk and success after obesity surgery. Surgery should be performed early enough for optimal outcomes.

The effects of economic development and built environment on diabetes in CHINA

Background

With rapid economy growth, the prevalence of obesity, and related chronic diseases, has increased greatly. Although this has been widely recognized, little attention has been paid to the influence of built environment and economic growth, particularly for developing countries. The main purpose of this study is to investigate the potential relationship between the prevalence of diabetes and the built environment while considering the effects of socioeconomic change in China.

Methods

Three nationally representative samples are constructed and employed mainly based on various sources of data, such as the China National Nutrition and Health Survey, World Health Organization, and China Health and Retirement Longitudinal Survey in 2013. The explanatory variables representing the built environment and influential factors include the health outcomes, economic indicators, local health facilities, regional dummies, and demographic features. OLS, robust regressions, and a set of binary choice models are used to estimate the possible relationship.

Results

It is suggested that the prevalence of diabetes is associated with both the broader built environment and individual economic factors in China. China’s sharp economic growth in the recent decades has greatly increased the prevalence of obesity and diabetes, when also considering other influential factors.

Conclusions

Although the results can not specify causal mechanism, some useful results can be clearly discovered and subsequently a few important policy implications can be provided for the sustainable and healthy development of China’s urban planning or built environment.

Evidence for Association between SH2B1 Gene Variants and Glycated Hemoglobin in Nondiabetic European American Young Adults: The Add Health Study

Glycated hemoglobin (HbA1c) is used to classify glycaemia and type 2 diabetes (T2D). Body mass index (BMI) is a predictor of HbA1c levels and T2D. We tested 43 established BMI and obesity loci for association with HbA1c in a nationally representative multiethnic sample of young adults from the National Longitudinal Study of Adolescent to Adult Health [Add Health: age 24-34 years; n = 5641 European Americans (EA); 1740 African Americans (AA); 1444 Hispanic Americans (HA)] without T2D, using two levels of covariate adjustment (Model 1: age, sex, smoking, and geographic region; Model 2: Model 1 covariates plus BMI). Bonferroni adjustment was made for 43 SNPs and we considered P < 0.0011 statistically significant. Means (SD) for HbA1c were 5.4% (0.3) in EA, 5.7% (0.4) in AA, and 5.5% (0.3) in HA. We observed significant evidence for association with HbA1c for two variants near SH2B1 in EA (rs4788102, P = 2.2 × 10(-4) ; rs7359397, P = 9.8 × 10(-4) ) for Model 1. Both results were attenuated after adjustment for BMI (rs4788102, P = 1.7 × 10(-3) ; rs7359397, P = 4.6 × 10(-3) ). No variant reached Bonferroni-corrected significance in AA or HA. These results suggest that SH2B1 polymorphisms are associated with HbA1c, largely independent of BMI, in EA young adults.

Agreement between BMI and body fat obesity definitions in a physically active population

OBJECTIVES

Body mass index (BMI) is a widely used proxy of body composition (BC). Concerns exist regarding possible BMI misclassification among active populations. We compared the prevalence of obesity as categorized by BMI or by skinfold estimates of body fat percentage (BF%) in a physically active population.

SUBJECTS AND METHODS

3,822 military firefighters underwent a physical fitness evaluation including cardiorespiratory fitness (CRF) by the 12 min-Cooper test, abdominal strength by sit-up test (SUT) and body composition (BC) by BF% (as the reference), as well as BMI. Obesity was defined by BF% > 25% and BMI ≥ 30 kg/m2. Agreement was evaluated by sensitivity and specificity of BMI, positive and negative predictive values (PPV/NPV), positive and negative likelihood (LR+/LR-), receiver operating characteristic (ROC) curves and also across age, CRF and SUT subgroups.

RESULTS

The prevalence of obesity estimated by BMI (13.3%) was similar to BF% (15.9%). Overall agreement was high (85.8%) and varied in different subgroups (75.3-94.5%). BMI underestimated the prevalence of obesity in all categories with high specificity (≥ 81.2%) and low sensitivity (≤ 67.0). All indices were affected by CRF, age and SUT, with better sensitivity, NPV and LR- in the less fit and older groups; and higher specificity, PPV and LR+ among the fittest and youngest groups. ROC curves showed high area under the curve (≥ 0.77) except for subjects with CRF ≥ 14 METs (= 0.46).

CONCLUSION

Both measures yielded similar obesity prevalences, with high agreement. BMI did not overestimate obesity prevalence. BMI ≥ 30 was highly specific to exclude obesity. Because of systematic under estimation, a lower BMI cut-off point might be considered in this population.

Cumulative Exposure to Ideal Cardiovascular Health and Incident Diabetes in a Chinese Population: The Kailuan Study

Background

It is unclear whether ideal cardiovascular health (CVH), and particularly cumulative exposure to ideal CVH (cumCVH), is associated with incident diabetes. We aimed to fill this research gap.

Methods and Results

The Kailuan Study is a prospective cohort of 101 510 adults aged 18 to 98 years recruited in 2006–2007 and who were subsequently followed up at 2‐ (Exam 2), 4‐ (Exam 3), and 6 (Exam 4)‐year intervals after baseline. The main analysis is restricted to those individuals with complete follow‐up at all 4 examinations and who had no history of diabetes until Exam 3. Cumulative exposure to ideal CVH (cumCVH) was calculated as the summed CVH score for each examination multiplied by the time between the 2 examinations (score×year). Logistic regression models were used to assess the association between cumCVH and incident diabetes. In fully adjusted models, compared with the lowest quintile of cumCVH, individuals in the highest quintile had ~68% (95% confidence interval [CI] 60‐75) lower risk for incident diabetes (compared with 61% [95% CI 52‐69] lower risk when using baseline CVH). Every additional year lived with a 1‐unit increase in ideal CVH was associated with a 24% (95% CI 21‐28) reduction in incident diabetes.

Conclusions

Ideal CVH is associated with a reduced incidence of diabetes, but the association is likely to be underestimated if baseline measures of CVH exposure are used. Measures of cumulative exposure to ideal CVH are more likely to reflect lifetime risk of diabetes and possibly other health outcomes.

Clinical Trial Registration

URL: https://www.chictr.org. Unique identifier: ChiCTRTNC‐11001489.

Duration and Degree of Weight Gain and Incident Diabetes in Younger Versus Middle-Aged Black and White Adults: ARIC, CARDIA, and the Framingham Heart Study

OBJECTIVE

To determine whether duration and degree of weight gain are differentially associated with diabetes risk in younger versus middle-aged black and white adults.

RESEARCH DESIGN AND METHODS

We combined data from three cohort studies: Atherosclerosis Risk in Communities (ARIC), Coronary Artery Risk Development in Young Adults (CARDIA), and the Framingham Heart Study. A total of 17,404 participants (56% women; 21% black) were stratified by baseline age (younger: ≥30 and <45 years; middle-aged: ≥45 and <60 years) and examined for incident diabetes (median follow-up 9 years). Duration and degree of gain in BMI were calculated as "BMI-years" above one's baseline BMI.

RESULTS

Diabetes incidence per 1,000 person-years in the younger and middle-aged groups was 7.2 (95% CI 5.7, 8.7) and 24.4 (22.0, 26.8) in blacks, respectively, and 3.4 (2.8, 4.0) and 10.5 (9.9, 11.2) in whites, respectively. After adjusting for sex, baseline BMI and other cardiometabolic factors, and age and race interaction terms, gains in BMI-years were associated with higher risk of diabetes in the younger compared with middle-aged groups: hazard ratios for 1-unit increase in log BMI-years in younger versus middle-aged blacks were 1.18 (P = 0.02) and 1.02 (P = 0.39), respectively (P for interaction by age-group = 0.047), and in whites were 1.35 (P < 0.001) and 1.11 (P < 0.001), respectively (P for interaction by age-group = 0.008).

CONCLUSIONS

Although middle-aged adults have higher rates of diabetes, younger adults are at greater relative risk of developing diabetes for a given level of duration and degree of weight gain.

Childhood Obesity Is a Chronic Disease Demanding Specific Health Care--a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO)

Childhood obesity is one of the greatest health challenges of the 21st century. The EASO COTF is convinced that classifying obesity as a chronic disease in children and adolescents is a crucial step for increasing individual and societal awareness, and for improving early diagnosis and intervention. Such a classification will enhance the development of novel preventive and treatment approaches, health care policies and systems, and the education of healthcare workers. The management of obesity prior to the appearance of co-morbidities may prevent their escalation into significant medical and psychosocial problems, and reduce their economic and societal impact. Childhood is a unique window of opportunity to influence lifetime effects on health, quality of life, prevention of non-communicable chronic diseases and disabilities. The Convention on the Rights of the Child by UNICEF states that parties shall strive to ensure that no child is deprived of his or her right of access to health care services. The EASO COTF is aiming to address these issues via educational activities for health care workers, identification of research agendas, and the promotion of collaborations among clinicians, researchers, health institutions, organizations and states across Europe.

Duration of obesity and overweight and risk of type 2 diabetes among US women

OBJECTIVE

The purpose of this study was to examine the association between duration of adiposity and risk of type 2 diabetes (T2D) in US women.

METHODS

Nearly 61,821 participants were prospectively followed from the Nurses' Health Study (1984-2008) and 63,653 participants from Nurses' Health Study II (1991-2011). Participants were considered overweight (BMI 25-30 kg m(-2) ) or obese (BMI ≥ 30 kg m(-2) ) if their BMI was above the cutoffs for two successive assessments. The time-dependent Cox proportional hazard models were used to assess associations between excess weight duration and T2D risk.

RESULTS

In pooled multivariable analyses of the two cohorts, each two extra years of being overweight was associated with 9% (RR = 1.09, 95% CI 1.08-1.09) increased risk of developing T2D. For each 2-year increment in obesity duration, the risk of T2D was increased by 14% (RR = 1.14, 95% CI 1.14-1.15). Adjustment for current BMI greatly attenuated the association for obesity duration (RR = 1.02, 95% CI 1.01-1.03), although the attenuation was less for overweight duration (RR = 1.04, 95% CI 1.04-1.05).

CONCLUSIONS

Both overweight and obesity duration were associated with a significantly higher risk of T2D, and these associations were mainly explained by current BMI, especially for obesity duration.

Longitudinal trajectories of BMI and cardiovascular disease risk: the national longitudinal study of adolescent health

OBJECTIVE

In adulthood, excess BMI is associated with cardiovascular disease (CVD); it is unknown whether risk differs by BMI trajectories from adolescence to adulthood.

DESIGN AND METHODS

The National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal adolescent cohort (mean age: 16.9 years) followed into adulthood (mean age: 28.8 years) [n = 13,984 individuals (41,982 observations)] was examined. Separate logistic regression models for diabetes, hypertension, and inflammation were used to examine odds of risk factors at given adult BMI according to varying BMI trajectories from adolescence to adulthood.

RESULTS

CVD risk factor prevalence at follow-up ranged from 5.5% (diabetes) to 26.4% (hypertension) and 31.3% (inflammation); risk differed across BMI trajectories. For example, relative to men aged 27 years (BMI = 23 kg/m(2) maintained over full study period), odds for diabetes were comparatively higher for men of the same age and BMI ≈ 30 kg/m(2) with ≈8 BMI unit gain between 15 and 20 years (OR = 2.35; 95% CI, 1.51, 3.66) or in those who maintained BMI ≈ 30 kg/m(2) across the study period (OR = 2.33; 1.92, 2.83) relative to the same ≈8 BMI unit gain, but between 20 and 27 years (OR = 1.44; 1.10, 1.87).

CONCLUSIONS

Specific periods and patterns of weight gain in the transition from adolescence to adulthood might be critical for CVD preventive efforts.

Association between duration of overall and abdominal obesity beginning in young adulthood and coronary artery calcification in middle age

IMPORTANCE

Younger individuals are experiencing a greater cumulative exposure to excess adiposity over their lifetime. However, few studies have determined the consequences of long-term obesity.

OBJECTIVE

To examine whether the duration of overall and abdominal obesity was associated with the presence and 10-year progression of coronary artery calcification (CAC), a subclinical predictor of coronary heart disease.

DESIGN, SETTING, AND PARTICIPANTS

Prospective study of 3275 white and black adults aged 18 to 30 years at baseline in 1985-1986 who did not initially have overall obesity (body mass index [BMI] ≥30) or abdominal obesity (men: waist circumference [WC] >102 cm; women: >88 cm) in the multicenter, community-based Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants completed computed tomography scanning for the presence of CAC during the 15-, 20-, or 25-year follow-up examinations. Duration of overall and abdominal obesity was calculated using repeat measurements of BMI and WC, respectively, performed 2, 5, 7, 10, 15, 20, and 25 years after baseline.

MAIN OUTCOMES AND MEASURES

Presence of CAC was measured by computed tomography at the year 15 (2000-2001), year 20 (2005-2006), or year 25 (2010-2011) follow-up examinations. Ten-year progression of CAC (2000-2001 to 2010-2011) was defined as incident CAC in 2010-2011 or an increase in CAC score of 20 Agatston units or greater.

RESULTS

During follow-up, 40.4% and 41.0% developed overall and abdominal obesity, respectively. Rates of CAC per 1000 person-years were higher for those who experienced more than 20 years vs 0 years of overall obesity (16.0 vs 11.0, respectively) and abdominal obesity (16.7 vs 11.0). Approximately 25.2% and 27.7% of those with more than 20 years of overall and abdominal obesity, respectively, experienced progression of CAC vs 20.2% and 19.5% of those with 0 years. After adjustment for BMI or WC and potential confounders, the hazard ratios for CAC for each additional year of overall or abdominal obesity were 1.02 (95% CI, 1.01-1.03) and 1.03 (95% CI, 1.02-1.05), respectively. The adjusted odds ratios for CAC progression were 1.04 (95% CI, 1.01-1.06) and 1.04 (95% CI, 1.01-1.07), respectively. Associations were attenuated but largely persisted following additional adjustment for potential intermediate metabolic factors during follow-up.

CONCLUSIONS AND RELEVANCE

Longer duration of overall and abdominal obesity was associated with subclinical coronary heart disease and its progression through midlife independent of the degree of adiposity. Preventing or at least delaying the onset of obesity in young adulthood may lower the risk of developing atherosclerosis through middle age.

Midlife obesity and risk of frailty in old age during a 22-year follow-up in men and women: the Mini-Finland Follow-up Survey

BACKGROUND

Long-term predictors of geriatric syndrome of frailty are unclear. Several obesity-related conditions are associated with frailty. This study examines the predictive role of midlife overweight and obesity on development of frailty more than 22 years of follow-up.

METHODS

Data are from 1,119 men and women aged 30 or older without frailty at baseline participating in a population-based Mini-Finland Health Examination Survey (1978-1980) with follow-up measurement in 2000-2001. At baseline (1978-1980), body weight and height were measured. At follow-up (2000-2001), the dependent variable prefrailty was defined as the presence of one or two of five frailty indicators (shrinking, weakness, exhaustion, slowness, and low physical activity) and frailty was defined as three or more indicators.

RESULTS

The mean age at the baseline was 43.6 (SD 9.7) years, and majority of the participants (95%) were 30-60 years old. Incidence of prefrailty was 5% and frailty 36%. Based on adjusted multinomial logistic regression, persons with overweight (body mass index 25-29.9kg/m(2)) and obesity (body mass index ≥ 30kg/m(2)) at baseline had increased risk of prefrailty (odds ratio 1.45, 95% CI 1.08, 1.96; odds ratio 2.36, 95% CI 1.41, 3.93) and frailty (odds ratio 2.49, 95% CI 1.22, 5.06; odds ratio 5.02, 95% CI 1.89, 13.33) at follow-up in comparison to normal-weight persons after adjusting for age, sex, lifestyle factors and chronic conditions.

CONCLUSIONS

Development of frailty may start already in midlife, and obesity is one of the underlying causes of frailty.

Risk of type 2 diabetes and cumulative excess weight exposure in the Framingham Offspring Study

AIM

Mid-life obesity is associated with T2D risk. However, less is known about the cumulative effect of obesity during adulthood.

METHODS

Framingham Offspring Study participants who had an examination at 35±2 years and were initially free of T2D were included in this study (N=1026). A cumulative excess weight (CEW) score (year*kg/m²) was calculated until T2D diagnostic or the end of follow-up.

RESULTS

Eighty-four individuals (8.2%) developed T2D over 20±6 years. Mean CEW scores were 118.0±114.6 year*kg/m² in individuals who developed T2D and 30.2±91.4 year*kg/m² in those who did not develop T2D (P<0.01). T2D risk was doubled for each standard deviation increase in the CEW score (OR=1.99 [1.64-2.40]; P<0.001). However, CEW score was only significantly associated with T2D incidence for participants with a baseline BMI <25 kg/m² (OR =2.13 [1.36-3.36]; P<0.001).

CONCLUSIONS

Accumulating weight between the mid-thirties to the mid-fifties increases the risk of developing T2D. However, BMI in mid-thirties remains a stronger predictor of T2D risk.

Duration of abdominal obesity beginning in young adulthood and incident diabetes through middle age: the CARDIA study

OBJECTIVE

To examine whether the duration of abdominal obesity determined prospectively using measured waist circumference (WC) is associated with the development of new-onset diabetes independent of the degree of abdominal adiposity.

RESEARCH DESIGN AND METHODS

The Coronary Artery Risk Development in Young Adults Study is a multicenter, community-based, longitudinal cohort study of 5,115 white and black adults aged 18-30 years in 1985 to 1986. Years spent abdominally obese were calculated for participants without abdominal obesity (WC >102 cm in men and >88 cm in women) or diabetes at baseline (n = 4,092) and was based upon repeat measurements conducted 2, 5, 7, 10, 15, 20, and 25 years later.

RESULTS

Over 25 years, 392 participants developed incident diabetes. Overall, following adjustment for demographics, family history of diabetes, study center, and time varying WC, energy intake, physical activity, smoking, and alcohol, each additional year of abdominal obesity was associated with a 4% higher risk of developing diabetes [hazard ratio (HR) 1.04 (95% CI 1.02-1.07)]. However, a quadratic model best represented the data. HRs for 0, 1-5, 6-10, 11-15, 16-20, and >20 years of abdominal obesity were 1.00 (referent), 2.06 (1.43-2.98), 3.45 (2.28-5.22), 3.43 (2.28-5.22), 2.80 (1.73-4.54), and 2.91 (1.60-5.29), respectively; P-quadratic < 0.001.

CONCLUSIONS

Longer duration of abdominal obesity was associated with substantially higher risk for diabetes independent of the degree of abdominal adiposity. Preventing or at least delaying the onset of abdominal obesity in young adulthood may lower the risk of developing diabetes through middle age.

Timing and duration of obesity in relation to diabetes: findings from an ethnically diverse, nationally representative sample

OBJECTIVE

The influence on diabetes of the timing and duration of obesity across the high-risk period of adolescence to young adulthood has not been investigated in a population-based, ethnically diverse sample.

RESEARCH DESIGN AND METHODS

A cohort of 10,481 individuals aged 12-21 years enrolled in the U.S. National Longitudinal Study of Adolescent Health (1996) was followed over two visits during young adulthood (18-27 years, 2001-2002; 24-33 years, 2007-2009). Separate logistic regression models were used to examine the associations of diabetes (A1C ≥6.5% or diagnosis by a health care provider) in young adulthood with 1) obesity timing (never obese, onset <16 years, onset 16 to <18 years, onset ≥18 years) and 2) obesity duration over time (never obese, incident obesity, fluctuating obesity, and persistent obesity), testing differences by sex and race/ethnicity.

RESULTS

Among 24- to 33-year-old participants, 4.4% had diabetes (approximately half were undiagnosed), with a higher prevalence in blacks and Hispanics than whites. In multivariable analyses, women who became obese before age 16 were more likely to have diabetes than women who became obese at or after age 18 (odds ratio 2.77 [95% CI 1.39-5.52]), even after accounting for current BMI, waist circumference, and age at menarche. Persistent (vs. adult onset) obesity was associated with increased likelihood of diabetes in men (2.27 [1.41-3.64]) and women (2.08 [1.34-3.24]).

CONCLUSIONS

Diabetes risk is particularly high in individuals who were obese as adolescents relative to those with adult-onset obesity, thus highlighting the need for diabetes prevention efforts to address pediatric obesity.

Etiology of insulin resistance in youth with type 2 diabetes

Type 2 diabetes (T2DM), historically an adult disease, is now increasingly prevalent in obese youth. Poor diet and increased sedentary behavior contribute to the increasing rates of obesity in youth, yet not all obese children develop T2DM. In general, T2DM is characterized by both insulin resistance (IR) and pancreatic beta-cell insufficiency. In children, IR is related to elevated body mass index (BMI) and pubertal hormones, along with abnormal fat partitioning, elevated free fatty acids, inflammation, and/or mitochondrial dysfunction. Hyperglycemia and T2DM develop when the pancreas cannot match the increased insulin demands resulting from IR. Unique to youth, IR varies with stage of pubertal development, and some children may have resolution of hyperglycemia post-puberty once the IR of puberty resolves. Further understanding of IR, the progression to T2DM in youth, and later outcomes as adults will help direct future therapies and interventions for youth at risk.

Excess body mass index-years, a measure of degree and duration of excess weight, and risk for incident diabetes

OBJECTIVE

To evaluate the relation between excess body mass index (BMI)-years, a measure of the degree to which an individual's BMI (calculated as weight in kilograms divided by height in meters squared) exceeds the reference BMI and the duration for which he or she carries excess BMI, and incident diabetes.

DESIGN

Longitudinal analysis.

SETTING

United States of America.

PARTICIPANTS

A total of 8157 adolescents and young adults aged 14 to 21 years at the start of the National Longitudinal Survey of Youth 1979 with self-reported measures of height, weight, and diabetes status (type unspecified) from 1981 through 2006.

MAIN EXPOSURE

Excess BMI-years, which were calculated by subtracting the [corrected] reference BMI (25.0 for adults or 85th percentile for adolescents) from the actual BMI [corrected] for each study year and cumulating excess BMI for the study duration.

MAIN OUTCOME MEASURE

We conducted logistic regression models to predict presumed type 2 diabetes (after excluding presumed type 1 diabetes) as a function of age, sex, race, excess BMI-years, and specific interactions.

RESULTS

A higher level of excess BMI-years was associated with an increased risk of diabetes. For example, on average, white men aged 40 years with 200 excess BMI-years had 2.94 times (95% confidence interval, 2.36-3.67) higher odds of developing diabetes compared with men of the same age and race with 100 excess BMI-years. For a given level of excess BMI-years, younger compared with older and Hispanic and black compared with white individuals had higher risk of developing diabetes. Our study is limited by use of self-reported data without specification of diabetes type.

CONCLUSIONS

Because younger compared with older individuals have a higher risk of self-reported diabetes for a given level of excess BMI-years and cumulative exposure to excess BMI is increasing among younger US birth cohorts, public health interventions should target younger adults.

Obesity and diabetes, the built environment, and the 'local' food economy in the United States, 2007

Obesity and diabetes are increasingly attributed to environmental factors, however, little attention has been paid to the influence of the 'local' food economy. This paper examines the association of measures relating to the built environment and 'local' agriculture with U.S. county-level prevalence of obesity and diabetes. Key indicators of the 'local' food economy include the density of farmers' markets and the presence of farms with direct sales. This paper employs a robust regression estimator to account for non-normality of the data and to accommodate outliers. Overall, the built environment is associated with the prevalence of obesity and diabetes and a strong local' food economy may play an important role in prevention. Results imply considerable scope for community-level interventions.

Association between obesity history and hand grip strength in older adults--exploring the roles of inflammation and insulin resistance as mediating factors

BACKGROUND

To examine the association between obesity history and hand grip strength, and whether the association is partly explained by subclinical inflammation and insulin resistance.

METHODS

Data are from 2,021 men and women aged 55 years and older participating in the representative population-based Health 2000 Survey in Finland. Body mass and body height, maximal hand grip strength, C-reactive protein, and insulin resistance based on homeostasis model assessment (HOMA-IR) were measured in a health examination. Recalled weight at 20, 30, 40, and 50 years of age were recorded to obtain a hierarchical classification of obesity history. Obesity was defined as body mass index ≥ 30 kg/m².

RESULTS

Earlier onset of obesity was associated with lower hand grip strength (p < .001) after controlling for age, sex, education, smoking, alcohol use, physical activity, several chronic diseases, and current body weight. Based on adjusted logistic regression models, the odds (95% confidence interval) for very low relative hand grip strength were 2.76 (1.78-4.28) for currently obese, 5.57 (3.02-10.28) for obese since age of 50 years, 6.53 (2.98-14.30) for obese since age of 40 years, and 10.36 (3.55-30.24) for obese since age of 30 years compared with never obese participants. The associations remained highly significant even after adjusting for current C-reactive protein and HOMA-IR, but these variables had only minor role in explaining the association between obesity history and hand grip strength.

CONCLUSIONS

Long-term exposure to obesity is associated with poor hand grip strength later in life. Maintaining healthy body weight throughout the life span may help to maintain adequate muscle strength in old age. Prospective studies with information on prior muscle strength are needed to examine in detail the causal association between obesity history and muscle strength.

The duration of obesity and the risk of type 2 diabetes

Objective

The evidence for the association between obesity and the risk of type 2 diabetes has been derived mainly from the analysis of the degree of obesity. The role of the duration of obesity as an independent risk has not been fully explored. The objective of the present study was to investigate the association between the duration of obesity and the risk of type 2 diabetes.

Design

Prospective cohort study.

Setting

The Framingham Heart Study (FHS), follow-up from 1948 to 1998.

Subjects

A total of 1256 FHS participants who were free from type 2 diabetes at baseline, but were obese on at least two consecutive of the study’s twenty-four biennial examinations, were included. Type 2 diabetes status was collected throughout the 48 years of follow-up of the study. The relationship between duration of obesity and type 2 diabetes was analysed using time-dependent Cox models, adjusting for a number of covariates.

Results

The unadjusted hazard ratio (HR) for the risk of type 2 diabetes for men was 1·13 (95 % CI 1·09, 1·17) and for women was 1·12 (95 % CI 1·08, 1·16) per additional 2-year increase in the duration of obesity. Adjustment for sociodemographic variables, family history of diabetes, health behaviour and physical activity made little difference to these HR. For women the evidence of a dose–response relationship was less clear than for men, particularly for women with an older age at obesity onset.

Conclusions

The duration of obesity is a relevant risk factor for type 2 diabetes, independent of the degree of BMI.

Pre-transplant weight but not weight gain is associated with new-onset diabetes after transplantation: a multi-centre cohort Spanish study

Background. New-onset diabetes after transplantation (NODAT) is associated with poorer outcomes in kidney transplantation (KT). Thus, identification of modifiable risk factors may be crucial for ameliorating the impact of this entity on transplant outcomes. We assessed the relationships between the weight, body mass index (BMI) and weight gain with NODAT.Methods. We retrospectively analysed 2168 KT performed in Spain during 1990, 1994, 1998 and 2002, with a functioning graft after the first year. At 1 year after KT, three groups were considered: (i) NODAT group (n = 215); (ii) impaired fasting glucose (IFG) group (n = 389); (iii) control group (n = 1564).Results. The incidence of NODAT was 10.8%, 9.9% and 10.0% at 3, 12 and 24 months post-transplantation, respectively. Older recipient age (P < 0.0001) and greater use of tacrolimus (P < 0.0001) were observed in NODAT group. Obesity was more frequent in NODAT group (P < 0.0001), but patients with NODAT had a lower weight gain during the first year after KT (P = 0.038). On multivariate analysis, independent risk factors associated with the development of NODAT were: recipient age [odds ratio (OR): 1.060, P = 0.0001], tacrolimus (OR: 1.611, P = 0.005), triglycerides (OR: 1.511, P = 0.018), positive hepatitis C virus (HCV) status (OR: 1.969, P = 0.001) and pre-transplant body mass index (BMI) (OR: 1.135, P = 0.0001), but not the weight gain.Conclusions. BMI, but not the weight gain at 1 year after transplant, is an independent risk factor for NODAT. Tailoring clinical strategies may minimize the impact of this complication.

Child-to-adult body mass index and height trajectories: a comparison of 2 British birth cohorts

Markers of growth and changes of body mass index (BMI) are associated with adult chronic disease risk. To better understand such associations, the authors examined the 1946 (n approximately 5,300) and 1958 (n approximately 17,000) British birth cohorts to establish how child-to-adult height and BMI have changed across generations. Individuals born in 1958 were no heavier at birth than those born in 1946, but they were taller in childhood by about 1 cm on average, grew faster thereafter, and were 3-4 cm taller by adolescence. The 1958 cohort achieved adult height earlier and were taller by 1 cm, an increase that was entirely due to their longer leg length. BMI trajectories diverged from early adulthood, with a faster rate of BMI gain in the 1958 cohort than in the 1946 cohort, although the mean BMI at 7 years and rate of childhood gain had not shown an increase. By midadulthood, the 1958 cohort had on average a greater BMI (1-2 kg/m(2)), larger waist (6-7 cm) and hip (5 cm) circumferences, and a higher prevalence of obesity (25.1% vs. 10.8% in males and 23.7% vs. 14.8% in females). Changes in height and adiposity over a relatively short period of 12 years suggest the likelihood of opposing trends of influences on later disease risk in these populations.

The relationship between body mass index and per cent body fat in the severely obese

BACKGROUND

International standards define clinical obesity according to body mass index (BMI) without reference to age and gender. Recent studies among adults in the normal to mildly obese BMI ranges have shown that the relationship between BMI and per cent body fat (% fat) differs by age and gender. The extent to which age and gender affect the relationship between BMI and % fat among more severely obese individuals is less known.

AIM

The aim was to examine the age-gender association between measured BMI and % fat from a large cohort of adults, including a large number of severely obese subjects (1862 with a BMI > or = 35 kg/m(2)).

METHODS

BMI was computed from measured height and weight, and % fat was estimated from bioelectrical impedance in 3068 adults. Two impedance equations, the Sun equation and the Heath equation (specific to severe obesity), were used to calculate % fat.

RESULTS

Average age for 991 men and 2077 women was 46 +/- 15 vs. 44 +/- 14 years respectively (p = 0.0003). The average BMI was 36 +/- 9 kg/m(2) for men and 39 +/- 10 kg/m(2) for women (p < 0.0001), with a combined gender BMI range of 19-74 kg/m(2). Using the Sun equation, average % fat was 31 +/- 8 vs. 46 +/- 8% (p < 0.0001) for all men and women respectively. With the Sun equation, age-adjusted Spearman correlations between all BMI and % fat values were r = 0.80 and r = 0.83 for men and women, respectively, but only 0.60 (n = 479) and 0.61 (n = 1383) in severely obese participants (BMI > or = 35 kg/m(2)). Using the Heath equation, only for participants with BMI > or = 35 kg/m(2), the age-adjusted Spearman correlations improved to r = 0.82 (n = 479) and r = 0.70 (n = 1383) for men and women respectively. Finally, by combining the Sun equation for subjects with BMI < 35 kg/m(2) and the Heath equation for those with BMI > or = 35 kg/m(2), correlations improved to 0.89 for men and 0.87 for women. Using these combined equations, the relationship between BMI and % fat was best fit as a linear function for men and curvilinear function (both p < 0.001) for women across the range of BMI. The % fat was approximately 10% higher for any BMI value among women vs. men even among the severely obese (p < 0.0001).

CONCLUSIONS

These data that include a large cohort of severely obese individuals demonstrated a linear association between BMI and % fat for men and a curvilinear association between BMI and % fat for women when Sun and Heath equations were combined. Assuming disease risk is driven by adiposity, this study suggests a need to further explore the appropriateness of gender-specific BMI cutpoints for clinical risk assessment due to the marked difference in the BMI-per cent fat relation observed in men and women across the entire range of BMI.

Obesity history as a predictor of walking limitation at old age

OBJECTIVE

To study whether walking limitation at old age is determined by obesity history.

RESEARCH METHODS AND PROCEDURES

In a retrospective longitudinal study based on a representative sample of the Finnish population of 55 years and older (2055 women and 1337 men), maximal walking speed, body mass, and body height were measured in a health examination. Walking limitation was defined as walking speed<1.2 m/s or difficulty in walking 0.5 km. Recalled height at 20 years of age and recalled weight at 20, 30, 40, and 50 years of age were recorded.

RESULTS

Subjects who had been obese at the age of 30, 40, or 50 years had almost a 4-fold higher risk of walking limitation compared to non-obese. Obesity duration increased the age- and gender-adjusted risk of walking limitation among those who had been obese since the age of 50 (odds ratio, 4.33; 95% confidence interval, 2.59 to 7.23, n=114), among the obese since the age of 40 [6.01 (2.55 to 14.14), n=39], and among the obese since the age of 30 [8.97 (3.06 to 26.29), n=14]. The risk remained elevated even among those who had previously been obese but lost weight during their midlife or late adulthood [3.15 (1.63 to 6.11), n=71].

DISCUSSION

Early onset of obesity and obesity duration increased the risk of walking limitation, and the effect was only partially mediated through current BMI and higher risk of obesity-related diseases. Preventing excess weight gain throughout one's life course is an important goal in order to promote good health and functioning in older age.

Long-term influences of body-weight changes, independent of the attained weight, on risk of impaired glucose tolerance and Type 2 diabetes

AIM

To investigate if weight gain during adulthood has effects on the risk of developing impaired glucose tolerance (IGT) or Type 2 diabetes beyond effect of attained weight.

RESEARCH DESIGN AND METHODS

Data were obtained from a longitudinal study of two cohorts: one of juvenile-onset obese (n = 248) and one of randomly selected control (n = 320) men, weighed at average ages of 20, 33, 44 and 51 years, respectively.

RESULTS

For any given BMI, the risk of IGT was higher the greater the weight gain since age 20 (odds ratio of 1.10 per unit kg/m2 of BMI gain, confidence interval 1.03-1.17, P = 0.004), and weight gain during both the early and later ages contributed to the increased risk. Obese men, maintaining weight since age 20, had lower risk of IGT than non-obese men who became similarly obese by age 51. The risk of Type 2 diabetes increased by weight gain in early adult life, but not by more recent weight gain in the later periods, probably because of the development of Type 2 diabetes leading to weight loss.

CONCLUSIONS

Independent of attained level of body weight in middle-aged men, weight gain is associated with increased risk of IGT, and is greater in those not overweight in childhood.

Duration of overweight and metabolic health risk in American men and women

PURPOSE

To investigate the association between overweight duration and metabolic health risk.

METHODS

Subjects consisted of 4,874 participants, aged 30 to 64 years, from the Third National Health and Nutrition Examination Survey. Duration of overweight was determined from recalled weights from 10 years prior to the survey. Metabolic health risk was determined from a fasting blood sample and blood pressure measurements.

RESULTS

After adjusting for current body mass index, the relative odds for obesity-related comorbidities were not higher in men who had been overweight for < 10 years compared with men with a normal weight. However, the likelihood [odds ratios (95% confidence intervals)] of hypertriglyceridemia [2.39 (1.34-4.27)] and the metabolic syndrome [2.15 (1.01-4.57)] were increased in men who had been overweight for > or = 10 years compared with normal weight men. In women there was a graded increase (p < 0.001) in the likelihood of numerous metabolic disorders when moving from the normal weight to overweight < 10 year to overweight > or = 10 year categories.

CONCLUSIONS

The duration of overweight has a significant effect on obesity-related comorbidities in men and women.

Duration of obesity is not a risk factor for type 2 diabetes mellitus, arterial hypertension and hyperlipidemia

BACKGROUND

Obesity is known to be a risk factor for type 2 diabetes mellitus (DM), arterial hypertension (HT) and hyperlipidaemia (HL), but the relationship between the duration of obesity and these outcomes is variable in the literature.

AIMS

The aims of this study were 1) to evaluate whether the duration of obesity is a risk factor for type 2 DM, HT and HL, 2) to determine the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), type 2 DM, HT and HL in the patients attending our clinic because of obesity and 3) to determine the correlation between DM, HT and HL and age, body mass index (BMI), duration of obesity and waist-hip ratio (WHR).

METHODS

Informed consent was obtained from 200 consecutive women presenting to our Endocrinology and Metabolism Unit for the first time because of obesity. The patient's history of the age at onset of obesity, HT and family history of DM were obtained. Anthropometric measurements and a 75-g oral glucose tolerance test (OGTT) were performed.

RESULTS

On OGTT, 15 (7.5%) had IFG, 36 (18%) had IGT and 18 (9%) had type 2 DM; in addition, 96 (48%) had HT and 76 (38%) had HL. Upon multivariate logistic regression analysis, age was a common risk factor for IGT, type 2 DM, HT and HL, and a family history of diabetes was an additional risk factor for type 2 DM.

CONCLUSION

The duration of obesity, as reported by women presenting for treatment of obesity, is not a risk factor for type 2 DM, HT and HL.

[Epidemiology of diabetes and its non-coronary complications]

Diabetes mellitus is among the diseases with great impact on health and society, not only for its high prevalence but also for its chronic complications and high mortality. The most precise method to investigate the prevalence of diabetes is by oral glucose tolerance testing. In Spain, the prevalence of diabetes in the 30-65 year-old population is estimated to be 6.5% among 30-to-65- year old, and 10.3% among the 30-to-89 year-old population. The ratio of known to unknown diabetes ranges from 1:3 to 2:3. The incidence of diabetes mellitus type 2 in Spain is 8/1000 persons per year, and the incidence of type 1 is 11 to 12 cases per 100,000 persons per year. The prevalence of chronic complications varies according to type of diabetes, time since onset and degree of metabolic control: neuropathy 25%, retinopathy 32% and nephropathy 23%. Diabetes is one of the most important causes of death in Spain, occupying third place for women and seventh for men.

Duration of obesity and risk of non-insulin-dependent diabetes mellitus

Although obesity is one of the major risk factors for diabetes mellitus, the association of the duration of obesity with glucose intolerance or insulin dysregulation has not yet been clarified. Thirteen articles were picked up from the MEDLINE database by using the four key-word phrases, "duration of obesity," "duration of overweight," "prolonged obesity," and "prolonged overweight." Although the definition of overweight was similar among the children-based studies (> = 20% or 2 SD over ideal weight), the cutoff point for adults ranged from 25.0 to 30.0 kg/m2 of body mass index. With regard to the definition of the duration of obesity, the articles were roughly divided into two groups, with some researchers bearing the definition on the number of years from the onset of overweight and some calculating using the person-years method. The prevalence or incidence of non-insulin-dependent diabetes mellitus (NIDDM) or impaired glucose tolerance (IGT) are probably associated with the duration of obesity. The effect of prolonged obesity on insulin dysregulation is still unclear.