Changes in BMI, duration of overweight and obesity, and glucose metabolism: 45 years of follow-up of a birth cohort

Overview of Ethnobotanical-Pharmacological Studies Carried Out on Medicinal Plants from the Serra da Estrela Natural Park: Focus on Their Antidiabetic Potential

The Serra da Estrela Natural Park (NPSE) in Portugal stands out as a well-preserved region abundant in medicinal plants, particularly known for their pharmaceutical applications in diabetes prevention and treatment. This comprehensive review explores these plants' botanical diversity, traditional uses, pharmacological applications, and chemical composition. The NPSE boast a rich diversity with 138 medicinal plants across 55 families identified as traditionally and pharmacologically used against diabetes globally. Notably, the Asteraceae and Lamiaceae families are prevalent in antidiabetic applications. In vitro studies have revealed their significant inhibition of carbohydrate-metabolizing enzymes, and certain plant co-products regulate genes involved in carbohydrate metabolism and insulin secretion. In vivo trials have demonstrated antidiabetic effects, including glycaemia regulation, insulin secretion, antioxidant activity, and lipid profile modulation. Medicinal plants in NPSE exhibit various activities beyond antidiabetic, such as antioxidant, anti-inflammatory, antibacterial, anti-cancer, and more. Chemical analyses have identified over fifty compounds like phenolic acids, flavonoids, terpenoids, and polysaccharides responsible for their efficacy against diabetes. These findings underscore the potential of NPSE medicinal plants as antidiabetic candidates, urging further research to develop effective plant-based antidiabetic drugs, beverages, and supplements.

Excessive weight gain onset-age and risk of developing diabetes mellitus: a large, prospective Chinese cohort study

Background

Excessive weight gain and obesity are widely accepted as risk factors for diabetes mellitus, and the age at which obesity onsets may be related to the development of cardiovascular diseases and certain cancers. Here, we aimed to investigate associations between the onset-age of overweight/obesity and risk of developing diabetes mellitus in China.

Methods

42,144 people with the normal weight range and without diabetes at baseline, were enrolled from the Kailuan cohort which began on the 1st June 2006. All participants were followed-up, biennially, until 31st December 2017. During follow-up, 11,220 participants had become overweight/obese. For each case, one normal-weight control was matched according to age ( ± 1 year) and sex. Our final analysis included 10,858 case-control pairs. An age-scaled Cox model was implemented to estimate hazard ratios (HR) with corresponding 95% confidence intervals (CI) for diabetes mellitus incidence across age-groups.

Results

At a median follow-up of 5.46 years, 1,403 cases of diabetes mellitus were identified. After multivariate adjustments, age-scaled Cox modelling suggested that risk gradually attenuated with every 10 year increase in age of onset of overweight/obesity. Diabetes mellitus adjusted HRs (aHRs) for new-onset overweight/obesity at <45years, 45-54 years, and 55-64 years were 1.47 (95%CI, 1.12-1.93), 1.38 (95%CI, 1.13-1.68), 1.32 (95%CI, 1.09-1.59), respectively. However, new-onset of overweight/obesity at ≥65 years did not relate to diabetes mellitus (aHR, 1.20; 95%CI, 0.92-1.57). This trend was not observed in women or the new-onset obesity subgroup but was evident in men and the new overweight onset subgroup.

Conclusion

Participants with early onset of excessive weight gain issues are at considerably higher risk of developing diabetes mellitus compared to those who maintain a normal weight.

Association Between Weight Change During Adulthood and Chronic Kidney Disease: Results from a National Survey 2011-2018

Purpose

This study aimed to investigate the intricate relationship between weight change patterns and the onset of chronic kidney disease (CKD). Although obesity is recognized as a predisposing factor for CKD, the dynamics of weight fluctuation and its impact on CKD development are not well-defined. By analyzing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2018, we sought to elucidate the association between weight trajectories and CKD risk.

Patients and Methods

We included participants aged ≥40 years, employing body mass index (BMI) measurements at three life stages-baseline, age 25, and a decade preceding baseline-to categorize weight change patterns. Logistic regression was employed to evaluate the association of these patterns with CKD onset, adjusting for potential confounders.

Results

The study encompassed 12,284 participants, with 2893 individuals diagnosed with CKD. Transitioning from normal weight to obesity and staying obese throughout adulthood were found to increase the risk of developing CKD. These associations remained consistent after adjusting for covariates but were statistically insignificant after adjusting for comorbidities. Notably, individuals transitioning from obesity to normal weight from age 25 to baseline and from 10 years before baseline to baseline demonstrated significant correlations with CKD but not between age 25 and 10 years before baseline.

Conclusion

Obesity, weight gain throughout adulthood, and weight loss in middle-to-late adulthood are associated with an increased risk of CKD. This emphasizes the importance of long-term weight change patterns and maintaining a healthy weight throughout adulthood.

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.

Factors affecting Hemoglobin A1c in the longitudinal study of the Iranian population using mixed quantile regression

Diabetes, a major non-communicable disease, presents challenges for healthcare systems worldwide. Traditional regression models focus on mean effects, but factors can impact the entire distribution of responses over time. Linear mixed quantile regression models (LQMMs) address this issue. A study involving 2791 diabetic patients in Iran explored the relationship between Hemoglobin A1c (HbA1c) levels and factors such as age, sex, body mass index (BMI), disease duration, cholesterol, triglycerides, ischemic heart disease, and treatments (insulin, oral anti-diabetic drugs, and combination). LQMM analysis examined the association between HbA1c and the explanatory variables. Associations between cholesterol, triglycerides, ischemic heart disease (IHD), insulin, oral anti-diabetic drugs (OADs), a combination of OADs and insulin, and HbA1c levels exhibited varying degrees of correlation across all quantiles (p < 0.05), demonstrating a positive effect. While BMI did not display significant effects in the lower quantiles (p > 0.05), it was found to be significant in the higher quantiles (p < 0.05). The impact of disease duration differed between the low and high quantiles (specifically at the quantiles of 5, 50, and 75; p < 0.05). Age was discovered to have an association with HbA1c in the higher quantiles (specifically at the quantiles of 50, 75, and 95; p < 0.05). The findings reveal important associations and shed light on how these relationships may vary across different quantiles and over time. These insights can serve as guidance for devising effective strategies to manage and monitor HbA1c levels.

Obesity in children and adolescents: Overview of the diagnosis and management

Childhood obesity is one of the biggest public health challenges globally. It is associated with various adverse health consequences throughout life. Prevention and early intervention represent the most reasonable and cost-effective approaches. Considerable progress has been achieved in the management of obesity in children and adolescents; yet, implementation in the real world remains a challenge. This article aimed to present an overview of the diagnosis and management of obesity in children and adolescents.

Incidence of obesity across adulthood in the United States, 2001-2017-a national prospective analysis

BACKGROUND

In the United States, the prevalence of obesity among adults has increased 3-fold since the 1980s, but patterns of incidence of new cases of obesity are not known.

OBJECTIVES

To examine the incidence of new cases of obesity: overall, by demographic and educational subgroups, by weight status, and changes during this century.

METHODS

We analyzed adult (≥20 y) anthropometric records from the US nationally representative Panel Study of Income Dynamics from 2001 to 2017. Among those not having obesity (body mass index, BMI, ≥30 kg/m2) at first observation, we used Poisson models to estimate the incidence of obesity [cases/1000 person-years (PYs)] and incidence rate ratio (IRR).

RESULTS

Among 13,888 adults followed for 115,797 PYs, the incidence of obesity in 2001-2017 was 28.1/1000 PYs (95% CI: 26.7, 29.7). Over the periods 2001-2005, 2005-2009, and 2009-2013, the incidence of obesity was stable, but in 2013-2017 the incidence increased by 18% compared to 2009-2013 [IRR: 1.18 (95% CI: 1.06, 1.30)]. Blacks had higher obesity incidence [47.9/1000 PYs (95% CI: 42.7, 53.1)] than Whites [26.2/1000 PYs (95% CI: 24.6, 27.9)]. Risk was particularly high among Black females [57.9/1000 PYs (95% CI: 49.1, 66.8)] and Black young adults (20-29 y) [65.5/1000 PYs (95% CI: 54.2, 76.7)]. Across race, obesity incidence was highest in young adults (20-29 y) [34.1/1000 PYs (95% CI: 31.5, 36.7)] and declined with age [age 70+ y: 18.9/1000 PYs (95% CI: 16.6, 21.8)]. Those with overweight had an obesity risk 7 times higher than those with normal weight [62.1/1000 PYs (95% CI: 58.8, 65.3) vs. 8.8/1000 PYs (95% CI: 8.1, 9.6)]. Those with less than high-school education had higher obesity incidence than those with education beyond high-school [39.4/1000 PYs (95% CI: 34.4, 44.4) vs. 24.7/1000 PYs (95% CI: 23.1, 26.3)].

CONCLUSIONS

Incidence of obesity was stable over the first 13 y of the last 2 decades but increased by 18% in 2013-2017. Blacks and younger adults were at highest risk, and those with overweight were also at high risk for developing obesity.

The impact of obesity epidemic on type 2 diabetes in children and adolescents: A systematic review and meta-analysis

AIM

To assess the impact of the obesity epidemic on type 2 diabetes (T2D), prediabetes and glycometabolic indices in children and adolescents.

METHODS

We searched four electronic databases (PubMed, Embase, Cochrane and Web of Science). Cross-sectional or cohort studies that reported on obesity and the prevalence of T2D or prediabetes in children and adolescents were reviewed. The study design, sample size and clinical outcomes were extracted from each study. The prevalence of T2D and prediabetes from the studies were pooled using meta-analysis methods.

RESULTS

Meta-analysis of 228184 participants showed that the prevalence of T2D was 1.3% (95% confidence interval (CI), 0.6-2.1%) in obese subjects, which was 13 times that in normal weight subjects (0.1%, 95% CI, 0.01-0.2%). The prevalence of prediabetes in obese subjects was 3 times that in normal subjects at 17.0% (13.0-22.0%) vs. 6.0% (0.01-11.0%). Moreover, BMI was positively correlated with the prevalence of T2D, prediabetes and glycometabolic indices in obese children and adolescents.

CONCLUSION

The pooled results confirm that obesity in children and adolescents leads to statistically significant increases in the prevalence of T2D and prediabetes and in glycometabolic indicator levels.

Body Mass Index Trajectories From Childhood to Adulthood and Age at Onset of Overweight and Obesity: The Influence of Parents' Weight Status

We investigated the influence of parents' weight status on their children's growth trajectories and its association with age at onset of overweight and obesity. We used 16,396 height and weight records from 3,284 youths from the Panel Study of Income Dynamics, followed across childhood into adulthood (United States, 1997-2017). Across age groups, we modeled body mass index trajectories (ages 5-32 years) according to parents' weight status, using mixed-effect models to estimate age at onset of overweight and obesity and proportion with obesity from childhood to adulthood. There were large differences in growth patterns according to parents' weight status: Children of parents with obesity had, on average, overweight at age 6 (95% confidence interval (CI): 5, 7) and steep growth trajectories until age 12; children of normal-weight parents had slower increases in body mass index, reaching overweight on average at age 25 (95% CI: 24, 27). By age 30, 30% (95% CI: 28, 31) of youths had obesity. Differences in early-life growth persisted into adulthood: 48% (95% CI: 45, 52) of adult children of parents with obesity had obesity versus 16% (95% CI: 14, 19) of those of normal-weight parents. Trajectories to unhealthy weight were heavily influenced by parents' weight status, especially before age 12, children of parents with obesity having overweight 19 earlier in life than children of normal-weight parents.

The relationship of life-course patterns of adiposity with type 2 diabetes, depression, and their comorbidity in the Northern Finland Birth Cohort 1966

OBJECTIVES

Type 2 diabetes (T2D) and comorbid depression challenges clinical management particularly in individuals with overweight. We aim to explore the shared etiology, via lifecourse adiposity, between T2D and depression.

METHODS

We used data from birth until 46years from Northern Finland Birth Cohort 1966 (n = 6,372; 53.8% females). We conducted multivariate analyses on three outcomes: T2D (4.2%), depression (19.2%) and as comorbidity (1.8%). We conducted (i) Path analysis to clarify time-dependent body mass index (BMI) related pathways, including BMI polygenic risk scores (PRS); and (ii) Cox regression models to assess whether reduction of overweight between 7years and 31years influence T2D, depression and/or comorbidity. The models were tested for covariation with sex, education, smoking, physical activity, and diet score.

RESULTS

The odd ratios (OR) of T2D in individuals with depression was 1.68 [95% confidence interval (CI): 1.34-2.11], and no change in estimate was observed when adjusted for covariates. T2D and comorbidity showed similar patterns of relationships in the path analyses (P < 0.001). The genetic risk for obesity (PRS BMI) did not show direct effect on T2D or comorbidity in adulthood but indirectly through measures of adiposity in early childhood and mid-adulthood in the path analysis (P < 0.001). Having early-onset of overweight at 7years and 31years showed highest risk of T2D (OR 3.8, 95%CI 2.4-6.1) and comorbidity (OR 5.0, 95%CI 2.7-9.5), with mild-to-moderate attenuation with adjustments. Depression showed no significant associations.

CONCLUSIONS

We found evidence for overweight since childhood as a risk factor for T2D and co-morbidity between T2D and depression, influenced moderately by lifestyle factors in later life. However, no shared early life adiposity related risk factors were observed between T2D and depression when assessed independently in this Finnish setting.

Factors Associated with Hemoglobin A1c Level Among Women Without Prior Diabetes Diagnosis in Rural Areas of Central South China: A Cross-Sectional Study

Background

Women in rural areas of China face the unique risk of developing diabetes, but data on the glycemic status among women without prior diabetes diagnosis in rural areas are lacking which may limit the decision-making for diabetes screening or prevention. This study was aimed to describe the glycemic status of women determined by hemoglobin A1c (HbA1c) and explore its associating factors.

Methods

A cross-sectional survey was conducted among women without prior diabetes diagnosis from two counties of rural areas in Central South China from July to October 2018. On the basis of the life course framework, data on socio-demographic, environmental health, genetic, biological (blood pressure, weight and height, lipids), psychosocial, and healthy behavioral factors were collected on site either through questionnaires or field measurements. The questionnaires included social-demographic sheet, Perceived Stress Scale, Self-efficacy scales for health-related diet and exercise behaviors, and Chinese Diabetes Risk Questionnaire. Generalized linear model analysis was performed to determine the associating factors of glycemic status, which was measured by HbA1c level.

Results

A total of 647 women were included in the study. The median age of women was 51.00 years (range 35–65 years). The median HbA1c level was 5.1% (interquartile range 4.6%-5.5%, range 4–13.6%), and 8.7% (n=56) of women were identified as elevated glycemic status (HbA1c>6%). Environmental health factors (eg, living in less-developed county [β=0.206, p=0.027]), biological factors (eg, higher body mass index [β=0.201, p=0.036], higher total cholesterol [β=0.097, p=0.040], history of gestational diabetes mellitus [β=0.722, p<0.001]), and psychosocial factors (eg, higher perceived stress [β=0.247, p=0.002]) were associated with higher HbA1c level.

Conclusion

This study reported 8.7% of elevated glycemic status among women without prior diabetes diagnosis in rural Hunan Province, China. After a comprehensive investigation based on a theoretical framework, living in a less-developed county of rural areas, having larger body mass index, higher total cholesterol, higher perceived stress, and a gestational diabetes mellitus history were identified as associating factors of higher HbA1c level. Professional support regarding weight control, blood lipid control, stress management, and the prevention of gestational diabetes mellitus should be recommended among this population, especially for women from less-developed counties.

Relationship between body roundness index and the risk of heart failure in Chinese adults: the Kailuan cohort study

AIMS

Body roundness index (BRI) is an obesity-related anthropometric index that combines waist circumference and height to better reflect body fat. This study aims to prospectively explore the relationship between BRI and the risk of heart failure (HF) based on a community-based cohort.

METHODS AND RESULTS

A total of 140 362 individuals without tumour and HF at baseline were included from the Kailuan cohort study. Their demographic information, anthropometric parameters, and biochemical indexes were collected or measured. The participants were followed up until 31 December 2016 or death or diagnosed with HF, whichever came first. Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident HF. Restricted cubic spline analysis was applied to further evaluate the possible non-linear dose-response relationship between BRI and the risk of HF. After a median follow-up period of 9.84 years, we identified 1990 HF events. The participants were grouped into four groups according to the quartiles of BRI (Q1: ≤2.93, Q2: 2.93-3.59, Q3: 3.59-4.38, and Q4: ≥4.38). After adjustment for potential confounders, compared with the group of participants in the lowest quartile of BRI, the adjusted HRs (95%CI) were 1.03 (95%CI: 0.87-1.22), 1.27 (95%CI: 1.07-1.49), and 1.50 (95%CI: 1.26-1.78) for subjects in the Q2, Q3, and Q4 groups, respectively. With each standard deviation (here is 1.10) of BRI increasing, the risk of HF increased by 18% (HR: 1.18, 95%CI: 1.12-1.24). Subgroup analysis indicated that the association between BRI and HF was more prominent in younger people (HR: 2.94, 95%CI: 1.80-4.80) than older (HR: 1.89, 95%CI: 1.57-2.27) (P for interaction < 0.001). A significant linear dose-response relationship between BRI and HF was also observed (P for non-linearity = 0.730).

CONCLUSIONS

Our study suggests that higher BRI is associated with an increased risk of HF. If these findings can be replicated in other populations, future studies need to examine whether lowering the BRI may lower the risk of incident HF.

Body weight, diabetes incidence vascular events and survival 15 years after very low calorie diet in community medical clinics in the UK

Objective

To assess weight loss maintenance, diabetes status, mortality and morbidity 15 years after a very low calorie diet programme (VLCD) in patients with obesity.

Design

General practice data bases were interrogated for subjects coded for group therapy with VLCD in the 1990s. Causes of death, occurrence of vascular disease and remission or development of diabetes were ascertained from patient records and national stroke and cardiovascular disease data bases.

Results

325 subjects engaged in the programme and had sufficient data for analysis. Baseline characteristics were: age 47.8±12. 8 years; body mass index (BMI) 36.1±6.8 kg/m²; 79.1% female/20.9% male; 13.5% had type 2 diabetes. After 15±4 years weight had changed from 97.9±19 kg at baseline to 100±20.8 kg. 10 with diabetes at baseline were in remission at 3 months, but only two remained in remission at 5 years. 50 new cases of type 2 diabetes and 11 of impaired fasting glucose developed during follow-up. Only 5.9% who remained healthy at follow-up had maintained >10% body weight reduction. Neither diabetes incidence nor diabetes free survival were related to percentage body weight lost during VLCD. Only baseline BMI was related to development of new impaired fasting glucose or diabetes by 15 years (p=0.007). 37 subjects had a cardiovascular event. Age (p=0.000002) and degree of weight loss after VLCD (p=0.03) were significantly associated with subsequent vascular events.

Conclusion

Long-term maintenance of weight loss after VLCD was rare in this single centre retrospective study 15 years later. Glucose intolerance developed in 21.4%. Lasting remission of type 2 diabetes or prevention of later glucose intolerance were not achieved. Vascular events were more frequent in those who lost most weight. Risk management during weight regain should be studied in future to assess potential for reduction in adverse cardiovascular outcomes.

A retrospective cohort study on the association between poor sleep quality in junior high school students and high hemoglobin A1c level in early adults with higher body mass index values

BACKGROUND

Few epidemiological studies have been performed to clarify the association between glucose metabolism disorders in early adults (20 years old) and physiological and environmental factors, including body mass index (BMI) in junior high school days. Therefore, we examined the association between hemoglobin A1c (HbA1c) level and body size (BMI) in early adulthood and lifestyles, including sleep habits and BMI in junior high school days in Shika town, a small town in Japan, by conducting a retrospective cohort study.

METHODS

We examined the HbA1c levels and body size (BMI) of 99 early adults who turned 20 years old between 2016 and 2020 and were residing in Shika town, Ishikawa Prefecture. We obtained the information on lifestyles and living environment factors, including BMI, from a questionnaire survey conducted among the subjects during their junior high school days (13-15 years old) from 2009 to 2013.

RESULTS

No correlations were observed between the HbA1c levels and the BMI values of the early adults. A two-way analysis of covariance (with the HbA1c levels and BMI values of the early adults as main factors) of the body size and lifestyle habits of the junior high school students revealed that "sleep quality in junior high school" was significantly poorer in the high HbA1c group than in the low HbA1c group in the early adults with high BMI values only. This result was also supported by the logistic regression analysis result.

CONCLUSIONS

The present results indicate that poor sleep quality in junior high school was associated with the high HbA1c levels of the early adults with higher BMI values, which suggests that good sleep quality in junior high school prevents the development of hyperglycemia. However, the present study did not find any relationship between early-adult BMI and HbA1c level.

Clinical Significance of Lifetime Maximum Body Mass Index in Predicting the Development of T2DM: A Prospective Study in Beijing

BACKGROUND

Overweight and obesity are well-known risk factors for type 2 diabetes mellitus (T2DM). The effect of the maximum body mass index (BMImax), which indicates the highest body weight before the diagnosis of T2DM, is not fully understood. This study aimed to explore the predictive value of BMImax in the progression of diabetes.

METHODS

This prospective study recruited 2018 subjects with normal glucose tolerance in Beijing, China. The subjects were followed up for eight years, and the association between BMImax and glucose outcomes was evaluated.

RESULTS

Ninety-seven of the 2,018 participants developed diabetes by the end of the study. Compared to individuals with normal glucose tolerance, those who developed diabetes were characterized by higher levels of fasting plasma glucose (FPG), 2 h postload glucose (PBG), glycosylated hemoglobin (HbA_1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-c), a higher prevalence of a familial history of diabetes and a lower level of high-density lipoprotein cholesterol (HDL-c). Multivariate regression analysis of sex-stratified groups suggested that FPG, HbA_1c, SBP and familial history of diabetes were independent risk factors for diabetes, but that BMImax was a unique indicator for female patients.

CONCLUSIONS

BMImax might be an independent predictor of T2DM in females, but it does not seem to be associated with the risk of diabetes in males. BMImax could be regarded as an indicator in the prevention and management of diabetes.

Body Mass Index Changes and Insulin Resistance at Age 4: A Prospective Cohort Study

OBJECTIVES

The objective of this study is to investigate whether body mass index (BMI) changes are associated with fasting glucose and insulin resistance (IR) in early childhood.

METHODS

From the Environment and Development of Children (EDC) cohort, 334 children who visited at ages 2 and 4 were included in this study. Height and weight were measured at ages 2 and 4, and fasting glucose and insulin were assessed at age 4. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated as insulin (μIU/ml) × glucose (mg/dl)/405. The BMI Z-score [BMI (Z)] quartiles for each age group were defined as Q4, ≥75th percentile; Q2-3, 25th to 75th percentile; and Q1, <25th percentile. Glucose, insulin, and the HOMA-IR were compared between groups according to the change in BMI (Z) from age 2 to 4.

RESULTS

Children who stayed in Q4 at both ages had higher fasting glucose (92.2 vs. 88.0 and 87.1 mg/dl), insulin (3.2 vs. 2.5 and 2.3 μIU/ml), and HOMA-IR (0.68 vs. 0.54 and 0.52) than children who stayed in Q1 or Q2-3 (all P<0.01). Children in Q4 at both ages had higher fasting glucose than children whose BMI (Z) increased from Q1 or Q2-3 to Q4 (92.2 vs. 87.3, P<0.001). The BMI (Z) category at age 2 of children who were in Q2-3 at age 4 did not affect glucose or IR at 4 years.

CONCLUSION

The group of children within the highest BMI (Z) quartile at both 2 and 4 years of age had higher fasting glucose and IR at age 4 than any other BMI (Z) change group.

Associations between DNA methylation and BMI vary by metabolic health status: a potential link to disparate cardiovascular outcomes

Background

Body mass index (BMI), a well-known risk factor for poor cardiovascular outcomes, is associated with differential DNA methylation (DNAm). Similarly, metabolic health has also been associated with changes in DNAm. It is unclear how overall metabolic health outside of BMI may modify the relationship between BMI and methylation profiles, and what consequences this may have on downstream cardiovascular disease. The purpose of this study was to identify cytosine-phosphate-guanine (CpG) sites at which the association between BMI and DNAm could be modified by overall metabolic health.

Results

The discovery study population was derived from three Women’s Health Initiative (WHI) ancillary studies (n = 3977) and two Atherosclerosis Risk in Communities (ARIC) ancillary studies (n = 3520). Findings were validated in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort (n = 1200). Generalized linear models regressed methylation β values on the interaction between BMI and metabolic health Z score (BMI × MHZ) adjusted for BMI, MHZ, cell composition, chip number and location, study characteristics, top three ancestry principal components, smoking, age, ethnicity (WHI), and sex (ARIC). Among the 429,566 sites examined, differential associations between BMI × MHZ and DNAm were identified at 22 CpG sites (FDR q < 0.05), with one site replicated in MESA (cg18989722, in the TRAPPC9 gene). Three of the 22 sites were associated with incident coronary heart disease (CHD) in WHI. For each 0.01 unit increase in DNAm β value, the risk of incident CHD increased by 9% in one site and decreased by 6–10% in two sites over 25 years.

Conclusions

Differential associations between DNAm and BMI by MHZ were identified at 22 sites, one of which was validated (cg18989722) and three of which were predictive of incident CHD. These sites are located in several genes related to NF-kappa-B signaling, suggesting a potential role for inflammation between DNA methylation and BMI-associated metabolic health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13148-021-01194-3.

Accuracy of Flash Glucose Monitoring During Postprandial Rest and Different Walking Conditions in Overweight or Obese Young Adults

Aims: To investigate the accuracy of FreeStyle Libre^TM flash glucose monitoring (FGM) relevant to plasma glucose (PG) measurements during postprandial rest and different walking conditions in overweight/obese young adults. Methods: Data of 40 overweight/obese participants from two randomized crossover studies were pooled into four trials: (1) sitting (SIT, n = 40); (2) walking continuously for 30 min initiated 20 min before individual postprandial glucose peak (PPGP) (20iP + CONT, n = 40); (3) walking continuously for 30 min initiated at PPGP (iP + CONT, n = 20); and (4) accumulated walking for 30 min initiated 20 min before PPGP (20iP + ACCU, n = 20). Paired FGM and PG were measured 4 h following breakfast. Results: The overall mean absolute relative difference (MARD) between PG and FGM readings was 16.4 ± 8.6% for SIT, 16.2 ± 4.7% for 20iP + CONT, 16.7 ± 12.2% for iP + CONT, and 19.1 ± 6.8% for 20iP + ACCU. The Bland-Altman analysis showed a bias of -1.03 mmol⋅L^-1 in SIT, -0.89 mmol⋅L^-1 in 20iP + CONT, -0.82 mmol⋅L^-1 in iP + CONT, and -1.23 mmol⋅L^-1 in 20iP + ACCU. The Clarke error grid analysis showed that 99.6-100% of the values in all trials fell within zones A and B. Conclusion: Although FGM readings underestimated PG, the FGM accuracy was overall clinically acceptable during postprandial rest and walking in overweight/obese young adults.

Contribution of 20-year body mass index and waist circumference history to poor cardiometabolic health in overweight/obese and normal weight adults: A cohort study

BACKGROUND AND AIMS

We investigated the associations of 20-year body mass index (BMI) and waist circumference (WC) histories with risk of being 1) metabolically unhealthy overweight/obese (MUOO) vs metabolically healthy overweight/obese (MHOO) and 2) metabolically unhealthy normal weight (MUNW) vs metabolically healthy normal weight (MHNW).

METHODS AND RESULTS

Participants comprised 3018 adults (2280 males; 738 females) with BMI and WC measured, every ~5 years, in 1991-1994, 1997-1999, 2002-2004, 2007-2009, and 2012-2013. Mean age in 2012-2013 was 69.3 years, with a range of 59.7-82.2 years. Duration was defined as the number of times a person was overweight/obese (or centrally obese) across the 5 visits, severity as each person's mean BMI (or WC), and variability as the within-person standard deviation of BMI (or WC). At the 2013-2013 visit, participants were categorised based on their weight (overweight/obese or normal weight; body mass index (BMI) ≥25 kg/m2) and health status (healthy or unhealthy; two or more of hypertension, low high-density lipoprotein cholesterol, high triglycerides, high glucose, and high homeostatic model assessment of insulin resistance). Logistic regression was used to estimate associations with the risk of being MUNW (reference MHNW) and MUOO (reference MHOO) at the last visit. BMI and WC severity were each related to increased risk of being unhealthy, with estimates being stronger among normal weight than overweight/obese adults. The estimates for variability exposures became null upon adjustment for severity. Individuals who were overweight/obese at all 5 time points had a 1.60 (0.96-2.67) times higher risk of being MUOO than MHOO compared to those who were only overweight/obese at one (i.e., the last) time point. The corresponding estimate for central obesity was 4.20 (2.88-6.12). Greater duration was also related to higher risk of MUNW than MHNW.

CONCLUSION

Being overweight/obese yet healthy seems to be partially attributable to lower exposure to adiposity across 20 years of adulthood. The results highlight the importance of maintaining optimum and stable BMI and WC, both in adults who become and do not become overweight/obese.

Depression-related weight change and incident diabetes in a community sample

This cohort study aimed to compare the incidence of type 2 diabetes in adults with depression-related weight gain, depression-related weight loss, depression with no weight change, and no depression. The study sample included 59,315 community-dwelling adults in Ontario, Canada. Depression-related weight change in the past 12 months was measured using the Composite International Diagnostic Interview-Short Form. Participants were followed for up to 20 years using administrative health data. Cox proportional hazards models compared the incidence of type 2 diabetes in adults with depression-related weight change and in adults with no depression. Adults with depression-related weight gain had an increased risk of type 2 diabetes compared to adults no depression (HR 1.70, 95% CI 1.32-2.20), adults with depression-related weight loss (HR 1.62, 95% CI 1.09-2.42), and adults with depression with no weight change (HR 1.39, 95% CI 1.03-1.86). Adults with depression with no weight change also had an increased risk of type 2 diabetes compared to those with no depression (HR 1.23, 95% CI 1.04-1.45). Associations were stronger among women and persisted after adjusting for attained overweight and obesity. Identifying symptoms of weight change in depression may aid in identifying adults at higher risk of type 2 diabetes and in developing tailored prevention strategies.

Breakfast patterns and weight status among adolescents: a study on the Brazilian National Dietary Survey 2008-2009

Examining the composition of breakfast concerning weight status is essential for evaluating adolescent health and understanding this gap. This study aimed to identify breakfast patterns and investigate the relationship with weight status among Brazilian adolescents. We used a subsample of 7425 adolescents aged 10-19 years from the 2008-2009 Brazilian Household Budget Survey. Breakfast eaters were those with intake of at least 50 kcal (209·2 kJ) between 05.00 and 10.00 hours. Breakfast dietary patterns were derived by principal component factor analysis with varimax rotation. We performed logistic regression analyses between breakfast patterns and weight status, considering the complexity of the survey sample design. Three breakfast patterns were identified explaining 44·8 % of data variability: (1) the Cereal, protein, fruit beverages and Northern/Northeastern pattern, characterised by high consumption of cookies, meats, dairy products, preparations with maize, eggs, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals, and negative adherence to cold cut meat and savoury snacks/crackers; (2) the Protein-based pattern, characterised by positive loadings for cold cut meat, milk and cheese, and negative for cookies, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals; and (3) the Mixed pattern, with positive loadings for cakes, coffee/tea, bread, fruit juices/fruit drinks/soya-based drinks, chocolate/desserts and savoury snacks/crackers. No association was found between skipping and weight status. Overweight adolescents had lower adherence to the Cereal, protein, fruit beverages and Northern/Northeastern pattern (OR = 0·67; 95 % CI 0·47, 0·96). This is the first study to address dietary patterns at the meal level with adolescent population-based data, which requires further investigation.

Birthweight, lifetime obesity and physical functioning in mid-adulthood: a nationwide birth cohort study

BACKGROUND

Evidence is scant on long-term implications of childhood obesity and body mass index (BMI) gains over the life-course for poor physical functioning (PF). The objective was to establish whether (i) birthweight and BMI across the life-course, (ii) BMI gains at specific life-stages and (iii) age of obesity onset were associated with PF at 50 y.

METHODS

In the 1958 British birth cohort (n = 8674), BMI (kg/m2) was calculated using height and weight [measured (7, 11, 16, 33 and 45 y); self-reported (23 and 50 y)]. PF was assessed at 50 y using the validated PF subscale of the Short-form 36 survey; the bottom (gender-specific) 10% was classified as poor PF. Missing data were imputed via multiple imputation. Associations were examined using logistic regression, adjusting for health and social factors.

RESULTS

Birthweight was not associated with PF. At each adult age, odds of poor PF were highest for obese (vs normal), e.g. for 23 y obesity the odds ratio (OR)adjusted for poor PF was 2.28 (1.34, 3.91) and 2.67 (1.72, 4.14) in males and females respectively. BMI gains were associated with poor PF, e.g. for females, ORadjusted per standard deviation (SD) in BMI gain 16-23 y was 1.28 (1.13, 1.46); for BMI gains 45-50 y it was 1.36 (1.11, 1.65). Longer duration of obesity was associated with poor PF, e.g. in males, ORadjusted was 2.32 (1.26, 4.29) for childhood obesity onset and 1.50 (1.16, 1.96) for mid-adulthood onset (vs never obese, P-trend < 0.001).

CONCLUSION

Obesity, BMI gains, and earlier obesity onset were associated with poor PF in mid-adulthood, reinforcing the importance of preventing and delaying obesity onset.

Weight change from childhood to adulthood and cardiovascular risk factors and outcomes in adulthood: A systematic review of the literature

The magnitude of the associations between life-course change in weight status and health outcomes in adulthood has been inconsistent. This study aims to examine the associations between weight change from childhood to adulthood and cardiovascular disease (CVD) risk factors and outcomes in adulthood. PubMed, Embase and ISI Web of Science between 1 August 1953 and 13 July 2020 were searched, and a total of 52 eligible articles were included. The systematic review supported significant associations between the life-course increase in BMI and high odds of markers in adulthood. In the meta-analyses, normal weight in childhood but excess weight in adulthood or persistent excess weight was associated with increased odds of adult markers. However, those who had excess weight in childhood but were normal weight in adulthood did not have increased odds of nearly all adult markers. This systematic review and meta-analysis suggest that individuals who developed excess weight in adulthood or had excess weight in both periods had higher odds of developing CVD risk factors and outcomes in adulthood. In contrast, the probability of these adult markers could be limited or eliminated for children with excess weight who are able to become adults with normal weight.

Metabolically healthy overweight in young adulthood: is it a matter of duration and degree of overweight?

BACKGROUND AND AIM

Given the controversy regarding metabolically healthy obesity, we studied the association between duration and degree of body mass index (BMI) from adolescence to early adulthood and metabolic status of both overweight/obese and under/normal weight subjects.

METHODS AND RESULTS

Participants of the EPITeen cohort were evaluated at 13, 17, 21 and 24 years (n = 1040). Duration and degree of BMI in the 11-year period was summarized through the area under the curve of BMI (BMI_AUC). Metabolic health at 24 y was defined as optimal levels of lipids, blood pressure and glucose. The association between BMI_AUC per year and metabolic health was estimated through binary logistic regression models, adjusted for confounders and stratified by BMI. The proportion of metabolically healthy overweight/obesity at 24 y was 13.4%. After adjustment for sociodemographic and behavioural factors, the increase of one kg/m² in BMI on average per year during the period between 13 and 24 y was associated with 14% lower odds of being metabolically healthy among under/normal weight participants (OR = 0.86, 95% CI 0.78-0.94); and 8% lower odds of metabolic health among obese/overweight participants (OR = 0.92, 95% CI 0.85-1.00). After additional adjustment for waist circumference, the association was attenuated, especially in the obese/overweight group (OR = 1.03, 95% CI 0.93-1.14). About 20% of the metabolically healthy obese/overweight at 13 y transitioned to metabolically unhealthy obesity/overweight at 24 y.

CONCLUSION

The results support the hypothesis that the healthy obesity phenotype could be explained by a lower exposure to adiposity, either by shorter time or lower quantity, and a more favourable body fat distribution.

Different Percentile Regression of Blood Glucose Among Adolescents Aged 12-20 - United States, 1999-2018

WHAT IS ALREADY KNOWN ON THIS TOPIC?

The incidence of diabetes is on the rise in the world, and it is increasingly affecting young people. The American Diabetes Association (ADA) has published the 2020 Diabetes Medical Standard, but there is no blood glucose standard for teenagers by age and sex.

WHAT IS ADDED BY THIS REPORT?

In this study, quantile regression was used to analyze the data of National Health and Nutrition Examination Survey (NHANES) and found that blood glucose varied significantly based on demographics.

WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?

This study provides reference for formulating the normal ranges of adolescent blood glucose and helping to screen out high-risk groups at an early stage for key interventions. The quantile regression method can give a set of curves, which could better describe the situation.

Periodontitis and identification of undiagnosed hyperglycemia

Abstract Introduction Individuals with pre-diabetes have altered glycemic levels, are generally asymptomatic, and are at increased risk for developing type 2 diabetes mellitus. Objective Identify the prevalence of periodontal individuals with undiagnosed hyperglycemia and associated impact factors. Material and method Fifty-six patients with periodontitis and without diabetes self-report, users of dental clinic services at Federal University of Juiz de Fora were included in this research, during one year and a half of experimental evaluation. Socioeconomic and demographic data, anthropometric patterns, fasting capillary blood glucose, and complete periodontal examination (six sites per tooth) were evaluated. Result The sample consisted of 58.9% female, mean age 53 years old, 58.9% obese/overweight and 45.3% had a low level of education. A total of 28.6% (n=16) participants had undiagnosed hyperglycemia (between 100 to 160 mm / dL), of which 81.3% were obese/overweight, 25% were smokers, 56.3% reported having a history of diabetes in the family, 93.8% had a family income up to 2 brazilian´s minimum wages. BMI values were higher in the group of patients with hyperglycemia (29.8 ± 5.7, p = 0.03) compared to the group without hyperglycemia (26.6 ± 5.6). Patients with hyperglycemia had a greater number of sites with clinical attachment loss (CAL) between 4 and 6 mm (p = 0.04) when compared with the normoglycemic group. Conclusion Undiagnosed CAL attachment loss between 4 and 6 mm due to periodontitis than normoglycemic individuals.

Duration of obesity exposure between ages 10 and 40 years and its relationship with cardiometabolic disease risk factors: A cohort study

BACKGROUND

Individuals with obesity do not represent a homogeneous group in terms of cardiometabolic risk. Using 3 nationally representative British birth cohorts, we investigated whether the duration of obesity was related to heterogeneity in cardiometabolic risk.

METHODS AND FINDINGS

We used harmonised body mass index (BMI) and cardiometabolic disease risk factor data from 20,746 participants (49.1% male and 97.2% white British) enrolled in 3 British birth cohort studies: the 1946 National Survey of Health and Development (NSHD), the 1958 National Child Development Study (NCDS), and the 1970 British Cohort Study (BCS70). Within each cohort, individual life course BMI trajectories were created between 10 and 40 years of age, and from these, age of obesity onset, duration spent obese (range 0 to 30 years), and cumulative obesity severity were derived. Obesity duration was examined in relation to a number of cardiometabolic disease risk factors collected in mid-adulthood: systolic (SBP) and diastolic blood pressure (DBP), high-density-lipoprotein cholesterol (HDL-C), and glycated haemoglobin (HbA1c). A greater obesity duration was associated with worse values for all cardiometabolic disease risk factors. The strongest association with obesity duration was for HbA1c: HbA1c levels in those with obesity for <5 years were relatively higher by 5% (95% CI: 4, 6), compared with never obese, increasing to 20% (95% CI: 17, 23) higher in those with obesity for 20 to 30 years. When adjustment was made for obesity severity, the association with obesity duration was largely attenuated for SBP, DBP, and HDL-C. For HbA1c, however, the association with obesity duration persisted, independent of obesity severity. Due to pooling of 3 cohorts and thus the availability of only a limited number harmonised variables across cohorts, our models included adjustment for only a small number of potential confounding variables, meaning there is a possibility of residual confounding.

CONCLUSIONS

Given that the obesity epidemic is characterised by a much earlier onset of obesity and consequently a greater lifetime exposure, our findings suggest that health policy recommendations aimed at preventing early obesity onset, and therefore reducing lifetime exposure, may help reduce the risk of diabetes, independently of obesity severity. However, to test the robustness of our observed associations, triangulation of evidence from different epidemiological approaches (e.g., mendelian randomization and negative control studies) should be obtained.

Predicting the Development of Type 2 Diabetes in a Large Australian Cohort Using Machine-Learning Techniques: Longitudinal Survey Study

BACKGROUND

Previous conventional models for the prediction of diabetes could be updated by incorporating the increasing amount of health data available and new risk prediction methodology.

OBJECTIVE

We aimed to develop a substantially improved diabetes risk prediction model using sophisticated machine-learning algorithms based on a large retrospective population cohort of over 230,000 people who were enrolled in the study during 2006-2017.

METHODS

We collected demographic, medical, behavioral, and incidence data for type 2 diabetes mellitus (T2DM) in over 236,684 diabetes-free participants recruited from the 45 and Up Study. We predicted and compared the risk of diabetes onset in these participants at 3, 5, 7, and 10 years based on three machine-learning approaches and the conventional regression model.

RESULTS

Overall, 6.05% (14,313/236,684) of the participants developed T2DM during an average 8.8-year follow-up period. The 10-year diabetes incidence in men was 8.30% (8.08%-8.49%), which was significantly higher (odds ratio 1.37, 95% CI 1.32-1.41) than that in women at 6.20% (6.00%-6.40%). The incidence of T2DM was doubled in individuals with obesity (men: 17.78% [17.05%-18.43%]; women: 14.59% [13.99%-15.17%]) compared with that of nonobese individuals. The gradient boosting machine model showed the best performance among the four models (area under the curve of 79% in 3-year prediction and 75% in 10-year prediction). All machine-learning models predicted BMI as the most significant factor contributing to diabetes onset, which explained 12%-50% of the variance in the prediction of diabetes. The model predicted that if BMI in obese and overweight participants could be hypothetically reduced to a healthy range, the 10-year probability of diabetes onset would be significantly reduced from 8.3% to 2.8% (P<.001).

CONCLUSIONS

A one-time self-reported survey can accurately predict the risk of diabetes using a machine-learning approach. Achieving a healthy BMI can significantly reduce the risk of developing T2DM.

Association of Body Mass Index in Youth With Adult Cardiometabolic Risk

Background

Whether long‐term exposure to overweight or obesity from early life to adulthood has a detrimental influence on health outcomes is unknown. We aimed to investigate whether duration of overweight or obesity from youth to adulthood is associated with adult cardiometabolic risk.

Methods and Results

A population‐based cohort study was performed of 1268 youths, aged 3 to 18 years, with follow‐ups at 3, 6, 9, 12, 21, 27, and 31 years. Duration of overweight or obesity over 31‐year follow‐up was calculated. Adulthood outcomes included type 2 diabetes mellitus, impaired fasting glucose, high insulin levels, high carotid intima‐media thickness, hypertension, low high‐density lipoprotein cholesterol, high low‐density lipoprotein cholesterol and triglycerides, arterial pulse wave velocity, carotid artery compliance, Young elastic modulus, and stiffness index. Rates of overweight/obesity were 7.9% at baseline and 55.9% after 31 years. After adjustment for confounders, longer duration of overweight or obesity was associated with increased risk of all outcomes (relative risk ranged from 1.45–9.06 for type 2 diabetes mellitus, impaired fasting glucose, carotid intima‐media thickness, hypertension, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and triglycerides; β from 0.370–0.543 m/s for pulse wave velocity; –0.193 to –0.237 %/10 mm Hg for carotid artery compliance; 52.1–136.8 mm Hg·mm for Young elastic modulus; and 0.554–0.882 for stiffness index). When body mass index was further adjusted, these associations disappeared or were substantially reduced. Detrimental associations of adult body mass index with all outcomes were robust to adjustment for confounders and duration of overweight or obesity.

Conclusions

Overweight or obesity in adulthood rather than childhood appears to be more important for adult cardiometabolic health.

Weight Status Change From Adolescence to Young Adulthood and the Risk of Hypertension and Diabetes Mellitus

It is still unclear whether the risk of hypertension and diabetes mellitus in adulthood remains increased if excess weight in adolescence recedes later in life. This study examines the effect of change in weight status from adolescence to young adulthood on the risk of hypertension and diabetes mellitus. A total of 4454 adolescents aged 12 to 19 years from the US National Longitudinal Study of Adolescent Health (1994-1995) were followed up to young adulthood (25-32 years, 2007-2008). After a median follow-up time of 13 years, compared with normal weight in both adolescence and young adulthood (n=1328, 29.8%), excess weight in the 2 periods (n=1077, 24.2%) was associated with an increased risk of hypertension (odds ratio, 3.72 [95% CI, 2.86-4.84]) and diabetes mellitus (3.32 [2.11-5.21]). Normal weight in adolescence but excess weight in young adulthood (n=1983, 44.5%) was associated with a lower but still significant risk of hypertension (2.49 [1.98-3.15]) and diabetes mellitus (1.59 [1.01-2.51]). In contrast, the risk of hypertension (1.37 [0.64-2.95]) and diabetes mellitus (1.65 [0.45-6.05]) was low in the few participants with excess weight in adolescence but normal weight in young adulthood (n=66, 1.5%). In conclusion, excess weight in young adulthood was associated with an increased risk of hypertension and diabetes mellitus, irrespective of weight status in adolescence. In contrast, excess weight in adolescence but normal weight in young adulthood did not seem to be associated with an increased cardiovascular risk in young adulthood.

Longitudinal Associations Between Body Mass Index During Young Adulthood, Subsequent Weight Change, and Incident Diabetes During Mid- and Older-Adulthood in Non-Hispanic White and African American Populations: The Atherosclerosis Risk in Communities Study

Background: Excess body mass index (BMI) and weight gain are well-known risk factors for diabetes. Nevertheless, the associations of BMI and weight gain in young adulthood with subsequent diabetes in African Americans, and the standardized effects of these weight variables have not been well studied. Methods: We studied 12,672 white and African American men and women 45-64 years of age (i.e., during mid-adulthood) who participated in the Atherosclerosis Risk in Communities Study visit 1 (1987-1989), and were reexamined at three follow-up examinations. Associations between recalled BMI at age 25 (i.e., during young adulthood) and subsequent weight change with incident diabetes at ages 45 and above (i.e., during mid-adulthood to older adulthood) were examined using Cox proportional hazard models. Results: Over the 9-year follow-up, we identified 1,501 cases of incident diabetes. The incidence rates were higher among African Americans (men: 24.5 and women: 26.3 per 1,000 person-years) compared to whites (men: 16.3 and women: 10.5 per 1,000 person years). Compared to normal-weight individuals at age 25, those who were overweight or obese and those who gained more weight after age 25 had a higher risk of developing diabetes later in all four race-sex groups with the highest risk in African Americans. In the race-sex groups combined, the mutually adjusted hazard ratio for BMI at age 25 and percent weight change were 1.97 (1.79-2.17) and 2.89 (2.59-3.11), respectively, comparing the 85th to the 15th percentiles of the exposures. Conclusions: African Americans were at higher risk of diabetes than whites. Both higher BMI at age 25 and subsequent weight gain were independently associated with higher risk for diabetes in all the race-sex groups; however, overall weight gain was more potent than BMI.

Weight Regain in Formerly Obese Mice Hastens Development of Hepatic Steatosis Due to Impaired Adipose Tissue Function

OBJECTIVE

Weight regain after weight loss is common, and there is evidence to suggest negative effects on health because of weight cycling. This study sought to investigate the impact of weight regain in formerly obese mice on adipose tissue architecture and stromal cell function.

METHODS

A diet-switch model was employed for obesity induction, weight loss, and weight regain in mice. Flow cytometry quantified adipose tissue leukocytes in adipose tissue. Liver and adipose tissue depots were compared to determine tissue-specific effects of weight cycling.

RESULTS

Epididymal white adipose tissue of formerly obese mice failed to expand in response to repeat exposure to high-fat diet and retained elevated numbers of macrophages and T cells. Weight regain was associated with disproportionally elevated liver mass, hepatic triglyceride content, serum insulin concentration, and serum transaminase concentration. These effects occurred despite an extended 6-month weight loss cycle and they demonstrate that formerly obese mice maintain durable alterations in their physiological response to weight regain. Conditioned media from epididymal adipose tissue of formerly obese mice inhibited adipogenesis of 3T3-L1 preadipocytes, suggesting a potential mechanism to explain failed epididymal adipose tissue expansion during weight regain.

CONCLUSIONS

Metabolic abnormalities related to defects in adipose tissue expansion and ongoing dysfunction manifest in formerly obese mice during weight regain.

Evaluating the association of free sugars intake and glycemic load on cardiometabolic outcomes: A prospective analysis throughout adolescence into early adulthood

PURPOSE

To prospectively evaluate the relation of free sugars intake and glycemic load with adiposity and insulin resistance, from adolescence into early adulthood.

METHODS

Data from the population-based cohort EPITeen (Porto, Portugal) at 13 and 21 years old was used (n = 1034). At both ages, dietary assessment was obtained by food frequency questionnaires (FFQ). Added sugar of each food item was estimated based on a systematic methodology described by Louie et al. Free sugars (FS) were defined according to World Health Organization. To each food item of the FFQ, a calculated mean value of FS and glycemic index was assigned. Dietary glycemic load (GL) was determined for each participant. Sex- and age-specific body mass index z-score (BMIz) and waist-to-weight ratio (WWr) were used as measures of adiposity, and the homeostasis model assessment (HOMA-IR) as a measure of insulin resistance. A cross-lagged path analysis was performed to examine causal relationships between FS intake or dietary GL with BMIz, WWr or HOMA-IR.

RESULTS

No significant association was found between intake of FS and dietary GL at 13 years with BMIz, WWr or HOMA-IR at 21. A significant inverse association was found between BMIz at 13 and FS (β = -0.595,95%CI -0.830, -0.359) and dietary GL (β = -0.687,95%CI -0.937,-0.437) at 21 years. Intake of FS, dietary GL, as well as BMIz, WWr and HOMA-IR tracked from 13 to 21 years.

CONCLUSION

No significant association was found between consumption of FS and GL at 13 years with cardiometabolic features at 21 years. Dietary intake and cardiometabolic outcomes tracked from adolescence into early adulthood.

Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

OBJECTIVE

We investigated the association between changes in weight status from childhood through adulthood and subsequent type 2 diabetes risks and whether educational attainment, smoking, and leisure time physical activity (LTPA) modify this association.

RESEARCH DESIGN AND METHODS

Using data from 10 Danish and Finnish cohorts including 25,283 individuals, childhood BMI at 7 and 12 years was categorized as normal or high using age- and sex-specific cutoffs (<85th or ≥85th percentile). Adult BMI (20-71 years) was categorized as nonobese or obese (<30.0 or ≥30.0 kg/m², respectively). Associations between BMI patterns and type 2 diabetes (989 women and 1,370 men) were analyzed using Cox proportional hazards regressions and meta-analysis techniques.

RESULTS

Compared with individuals with a normal BMI at 7 years and without adult obesity, those with a high BMI at 7 years and adult obesity had higher type 2 diabetes risks (hazard ratio [HR]_girls 5.04 [95% CI 3.92-6.48]; HR_boys 3.78 [95% CI 2.68-5.33]). Individuals with a high BMI at 7 years but without adult obesity did not have a higher risk (HR_girls 0.74 [95% CI 0.52-1.06]; HR_boys 0.93 [95% CI 0.65-1.33]). Education, smoking, and LTPA were associated with diabetes risks but did not modify or confound the associations with BMI changes. Results for 12 years of age were similar.

CONCLUSIONS

A high BMI in childhood was associated with higher type 2 diabetes risks only if individuals also had obesity in adulthood. These associations were not influenced by educational and lifestyle factors, indicating that BMI is similarly related to the risk across all levels of these factors.

Trajectories of early to mid-life adulthood BMI and incident diabetes: the China Health and Nutrition Survey

INTRODUCTION

This longitudinal study aims to characterize distinct body mass index (BMI) trajectories during early to mid-life adulthood and to explore the association between BMI change from young adulthood to midlife and incident diabetes.

RESEARCH DESIGN AND METHODS

This study included 7289 adults who had repeatedly measured BMI 3-9 times during 1989-2011 and information on incident diabetes. Latent class growth mixed model (LCGMM) was used to identify different BMI trajectories. Cox proportional hazard models were used to investigate the association between the trajectory group membership and incident hyperglycemia, adjusting for covariates. The hyperglycemia group included individuals with prediabetes or diabetes. The model-estimated BMI levels and slopes were calculated at each age point in 1-year intervals according to the model parameters and their first derivatives, respectively. Logistic regression analyses were used to examine the association of model-estimated levels and slopes of BMI at each age point with incident hyperglycemia. The area under the curve (AUC) was computed from longitudinal growth curve models during the follow-up for each individual. Prior to the logistic regression analyses, quartiles of total, baseline, and incremental AUC values were calculated.

RESULTS

Three distinct trajectories were characterized by LCGMM, comprising of low-increasing group (n=5136), medium-increasing group (n=1914), and high-increasing group (n=239). Compared with the low-increasing group, adjusted HRs and 95% CIs were 1.21 (0.99 to 1.48) and 1.56 (1.06 to 2.30) for the medium-increasing and the high-increasing group, respectively. The adjusted standardized ORs of model-estimated BMI levels increased among 20-50 years, ranging from 0.98 (0.87 to 1.10) to 1.19 (1.08 to 1.32). The standardized ORs of level-adjusted linear slopes increased gradually from 1.30 (1.16 to 1.45) to 1.42 (1.21 to 1.67) during 20-29 years, then decreased from 1.41 (1.20 to 1.66) to 1.20 (1.08 to 1.33) during 30-43 years, and finally increased to 1.20 (1.04 to 1.38) until 50 years. The fourth quartile of incremental AUC (OR=1.31, 95% CI 1.03 to 1.66) was significant compared with the first quartile, after adjustment for covariates.

CONCLUSIONS

These findings indicate that the BMI trajectories during early adulthood were significantly associated with later-life diabetes. Young adulthood is a crucial period for the development of diabetes, which has implications for early prevention.

Assessment of Cardiovascular Risk Factors in Patients with Type 2 Diabetes in Upper Egypt Villages

BACKGROUND

A large percentage of diabetic patients also have other components of metabolic syndrome, which is a group of cardiovascular (CV) hazard factors related to both diabetes mellitus (DM) and cardiovascular diseases (CVD). We do not know about the prevalence of CV risk factors in diabetic patients in Upper Egypt. We aimed to assess the CV risk factors in type 2 diabetic patients in Upper Egypt villages.

METHODS

We conducted a cross-sectional study that included 800 patients with type 2 DM. We classified the participants into three groups according to the hemoglobin A1c (HbA1c) levels. We assessed the prevalence of other cardiovascular risk factors and their association with HbA1c levels through a detailed history, full clinical examination, and laboratory tests.

RESULTS

We found that 75% of the participants were males, 25.5% elderly, 60.25% had hypertension, 60.75% had dyslipidemia, 33.25% were overweight or obese, 19.75% had a family history of coronary artery disease (CAD), 55.75% had established CVD, 42.5% were smokers, and only 12.25% were physically inactive. We found that 84% of the participants had ≥ two cardiovascular risk factors other than DM. HbA1c level was ≥ 7% in 77% of patients. After multivariate regression analysis, we found a significant association of higher systolic blood pressure (BP), more elevated diastolic BP, higher body mass index (BMI), increased waist circumference, old age, long duration of DM, and an increase in the number of clustered CV risk factors with a higher HbA1c level. At the same time, insulin therapy was significantly associated with a lower HbA1c level.

CONCLUSION

All type 2 diabetic patients in Upper Egypt villages have other associated CV risk factors. The clustering of cardiovascular risk factors showed a significant association with higher HbA1c levels. These findings require the thought of associated CV risk factors in choosing medical treatments to optimize glycemic control and multifactorial intervention to improve CV risk.

Invited Commentary: The Causal Association Between Obesity and Stillbirth-Strengths and Limitations of the Consecutive-Pregnancies Approach

There has been a resurgence in analyses of consecutive pregnancies (or similarly, sibling designs) in perinatal and pediatric epidemiology. These approaches have attractive qualities for estimating associations with complex multifactorial exposures like obesity. In an article appearing in this issue of the Journal, Yu et al. (Am J Epidemiol. 2019;188(7):1328-1336) apply a consecutive-pregnancies approach to characterize the risk of stillbirth among women who develop obesity between pregnancies ("incident obesity"). Working within a causal framework and using parametric and nonparametric estimation techniques, the authors find an increase in stillbirth risk associated with incident obesity. Risk differences varied between 0.4 per 1,000 births (95% confidence interval (CI): 0.1, 0.7) and 6.9 per 1,000 births (95% CI: 3.7, 10.0), and risk ratios ranged from 1.12 (95% CI: 1.02, 1.23) to 2.99 (95% CI: 2.19, 4.08). The strengths of this approach include starting from a clearly defined causal estimand and exploring the sensitivity of parameter estimates to model selection. In this commentary, we put these findings in the broader context of research on obesity and birth outcomes and highlight concerns regarding the generalizability of results derived from within-family designs. We conclude that while causal inference is an important goal, in some instances focusing on formulation of a causal question drives results away from broad applicability.

Effects of obesity on the lipid and metabolite profiles of young adults by serum 1H-NMR spectroscopy

BACKGROUND

Overweight (OW) is considered a risk for various metabolic diseases. However, its effects as a mechanism that alters the metabolite profiles remain unclear. The purpose of this study is to investigate the effects that OW has on the lipid and metabolite profiles in young adults.

METHODS

The serum metabolite profiles of 46 young adults of normal weight and those considered OW were studied by Proton nuclear magnetic resonance spectroscopy (1H NMR) technique.

RESULTS

1H NMR metabolite analysis shows the alteration of metabolic levels and increased levels of CH2 lipids and CH3 lipids, which are used as unique biomarkers to identify OW subjects from the normal weight groups.

CONCLUSION

This present study reveals that OW contributes to the systemic metabolism and the metabolite alteration among young adults. The alteration in serum lipids level could shed the light on metabolic syndrome pathogenesis in young adults and needs further elucidation.

A body mass index over 22 kg/m2 at college age is a risk factor for future diabetes in Japanese men

Background

There is a high incidence of type 2 diabetes in Asian adults, even those with a normal body mass index (BMI) (<25.0 kg/m²). For example, it has been shown that a slightly increased BMI (>23 kg/m²) at middle age is a risk factor for type 2 diabetes in Asians. In this historical cohort study, we investigated whether a slightly increased BMI at college age was also a risk factor for future diabetes in Japanese men.

Methods

Six hundred and sixty-one male alumni who graduated from a physical education school between 1971 and 1991 and who responded to follow-up investigation between 2007 and 2017 were included in this study. Participants were categorized into four categories: college BMI of <21.0 kg/m², 21.0–22.0 kg/m², 22.0–23.0 kg/m², and ≥23.0 kg/m², and the incidence and risk ratio of diabetes were compared between groups.

Results

The median follow-up period was 32 years (interquartile range, IQR: 27–36), which included 20,983 person-years of observation. Subjects were 22 (22–22) years old at college graduation, and 55 (50–59) years old at the final follow-up investigation. During the study period, 56 men developed diabetes; the prevalence rates for the lowest to highest BMI categories were 4.4%, 7.6%, 10.5%, and 11.3%, respectively, and their adjusted hazard ratios were 1.00 (reference), 1.77 (95% CI: 0.68–4.30), 2.42 (1.00–5.84), and 2.53 (1.06–6.07), respectively (p = 0.03 for trend).

Conclusion

Our data suggest that a BMI over 22.0 kg/m² at college age is a risk factor for diabetes later in life in Japanese men.

Trajectories of childhood BMI and adult diabetes: the Bogalusa Heart Study

AIMS/HYPOTHESIS

The aim of this study was to characterise longitudinal profiles of BMI from childhood and to examine the impact of level-independent childhood BMI trajectories on adult type 2 diabetes.

METHODS

The longitudinal cohort consisted of 2449 adults (1613 white and 836 black) who had their BMI measured between four and 15 times from childhood (4-19 years) to adulthood (20-51 years) and fasting glucose measured in adulthood. Model-estimated levels and linear slopes of BMI at childhood age points were calculated in 1-year intervals using growth-curve parameters and their first derivatives, respectively.

RESULTS

BMI from childhood to adulthood fit cubic growth curves; linear and non-linear curve parameters differed significantly between race-sex groups. BMI showed race and sex differences from 15 years onwards. Individuals with hyperglycaemia had higher long-term BMI levels than those who were normoglycaemic in race-sex groups. Linear and non-linear slope parameters of BMI differed consistently and significantly between adult hyperglycaemia groups. The OR of childhood BMI levels for ages 4-19 years was 1.45-1.83 (p < 0.001 for all) for adult hyperglycaemia after adjustment for confounders. Level-adjusted linear slopes of BMI at ages 10-19 years showed significantly positive associations with adult hyperglycaemia (OR 1.17-1.50, p < 0.01 for all). The associations of childhood BMI linear slopes with adult hyperglycaemia were not significant during the age period 5-9 years. The trends in these associations were consistent across race-sex groups.

CONCLUSIONS/INTERPRETATION

These observations indicate that childhood BMI trajectories have a significant impact on adult diabetes, independent of BMI levels. The adolescence age period is a crucial window for the development of diabetes in later life, which has implications for early-life prevention.

DATA AVAILABILITY

All data and materials are publicly available at the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository and can be accessed at https://biolincc.nhlbi.nih.gov/studies/bhs .

Association between beverage intake and obesity in children: The Korea National Health and Nutrition Examination Survey (KNHANES) 2013-2015

BACKGROUND/OBJECTIVES

Numerous researches have studied the association between sugar intake and obesity of children in many countries. This study was undertaken to investigate the association between beverage intake and obesity of children by reviewing a database for total sugar contents established in all foods and presented in a nutrition survey by the Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS

Data of 1,520 children aged 6-11 years in the 6th KNHANES (2013-2015) were analyzed for this study. A database for total sugar intake comprises the total sugar contents of all foods included in the results of a nutrition survey using the 24-hour recall method of 6th KNHANES. Beverages were categorized into carbonated beverages, fruit & vegetable drinks, other drinks, tea, and coffee.

RESULTS

The average daily beverage intake of all children was 131.75 g/day, and the average daily total sugar intake in beverages was 13.76 g/day. Carbonated beverages had the highest intake rate (58.85 g/day) and also ranked highest for sugar intake (6.36 g/day). After adjusting for confounding variables, the odds ratio for obesity in children with beverage intake of ≥ 200 mL/day significantly increased by 1.83 times (95% CI, 1.11-3.00) as compared to children with beverage intake of < 200 mL/day. Also, a significant increase was observed in the odds ratio for obesity in total children (2.41 times; 95% CI, 1.35-4.33) and boys (3.15 times; 95% CI, 1.53-6.49) with carbonated beverage intake of ≥ 200 mL/day when compared with children who consumed < 200 mL/day.

CONCLUSION

A positive association is observed between beverage intake and obesity in Korean children. In particular, an intake of carbonated beverages has a positive correlation with childhood obesity in boys. This study can therefore be used as scientific evidence for reducing sugar, and for the continuous management and research on beverages.

Change in Overweight from Childhood to Early Adulthood and Risk of Type 2 Diabetes

BACKGROUND

Childhood overweight is associated with an increased risk of type 2 diabetes in adulthood. We investigated whether remission of overweight before early adulthood reduces this risk.

METHODS

We conducted a study involving 62,565 Danish men whose weights and heights had been measured at 7 and 13 years of age and in early adulthood (17 to 26 years of age). Overweight was defined in accordance with Centers for Disease Control and Prevention criteria. Data on type 2 diabetes status (at age ≥30 years, 6710 persons) were obtained from a national health registry.

RESULTS

Overweight at 7 years of age (3373 of 62,565 men; 5.4%), 13 years of age (3418 of 62,565; 5.5%), or early adulthood (5108 of 62,565; 8.2%) was positively associated with the risk of type 2 diabetes; associations were stronger at older ages at overweight and at younger ages at diagnosis of type 2 diabetes. Men who had had remission of overweight before the age of 13 years had a risk of having type 2 diabetes diagnosed at 30 to 60 years of age that was similar to that among men who had never been overweight (hazard ratio, 0.96; 95% confidence interval [CI], 0.75 to 1.21). As compared with men who had never been overweight, men who had been overweight at 7 and 13 years of age but not during early adulthood had a higher risk of type 2 diabetes (hazard ratio, 1.47; 95% CI, 1.10 to 1.98), but their risk was lower than that among men with persistent overweight (hazard ratio [persistently overweight vs. never overweight], 4.14; 95% CI, 3.57 to 4.79). An increase in body-mass index between 7 years of age and early adulthood was associated with an increased risk of type 2 diabetes, even among men whose weight had been normal at 7 years of age.

CONCLUSIONS

Childhood overweight at 7 years of age was associated with increased risks of adult type 2 diabetes only if it continued until puberty or later ages. (Funded by the European Union.).

Self-reported body silhouette trajectories across the lifespan and excessive daytime sleepiness in adulthood: a retrospective analysis. The Paris Prospective Study III

OBJECTIVES

Excessive daytime sleepiness (EDS) is a common sleep complaint in the population and is increasingly recognised as deleterious for health. Simple and sensitive tools allowing identifying individuals at greater risk of EDS would be of public health importance. Hence, we determined trajectories of body silhouette from early childhood to adulthood and evaluated their association with EDS in adulthood.

DESIGN

A retrospective analysis in a prospective community-based study.

PARTICIPANTS

6820 men and women self-reported their silhouette at ages 8, 15, 25, 35 and 45 using the body silhouettes proposed by Stunkard et al. EDS was defined by an Epworth Sleepiness Scale score ≥11.

MAIN OUTCOME MEASURE

Presence of EDS in adulthood.

RESULTS

The study population comprised 6820 participants (mean age 59.8 years, 61.1% men). Five distinct body silhouettes trajectories over the lifespan were identified: 31.9% 'lean stable', 11.1% 'lean increase', 16.1% 'lean-marked increase', 32.5% 'moderate stable' and 8.4% 'heavy stable'. Subjects with a 'heavy-stable' trajectory (OR 1.24, 95% CI 0.94 to 1.62) and those with a 'lean-marked increase' trajectory (OR 1.46, 95% CI 1.18 to 1.81) were more likely to have EDS when compared with the 'lean-stable' group after adjusting for confounding. Further adjustment for birth weight strengthened the magnitude of the ORs.

CONCLUSION

Increasing body silhouette and to a lesser extent constantly high body silhouette trajectory from childhood to adulthood are associated with increased likelihood of EDS, independently of major confounding variables.

TRIAL REGISTRATION NUMBER

NCT00741728; Pre-results.

Factors Associated with High Weight Gain and Obesity Duration: The Norwegian Women and Cancer (NOWAC) Study

AIM

To identify factors associated with high weight gain and obesity duration in a representative sample of Norwegian women.

METHODS

66,618 Norwegian women aged 34-70 years at baseline were included in the analysis. Baseline and follow-up questionnaires completed in 1991-2011 provided information on height, weight as well as sociodemographic, lifestyle and reproductive factors. We assessed the association with multivariable logistic regression.

RESULTS

Women gained on average 0.5 kg/year (95% CI 0.5-0.5 kg/year) during 6 years of follow-up, and 3.5% maintained in obesity during 13 years of follow-up. The factors with strongest association with high weight gain (≥10 kg) were smoking cessation (cessation vs. no change, OR = 4.39, 95% CI 3.91-4.94) and decreased physical activity level (decrease vs. no change, OR = 2.40, 95% CI 2.21-2.61). Low physical activity level (high vs. low, OR = 0.17, 95% CI 0.14-0.20), higher than median age at menarche (over median vs. median or under median, OR = 0.36, 95% CI 0.31-0.41), and less than 10 years of education (>12 years vs. <10 years, OR = 0.44, 95% CI 0.37-0.51) were strongly associated with obesity duration.

CONCLUSION

The modifiable factor with the strongest association with adverse weight development and potential for prevention was low or decreased physical activity level.

Obesity as a Disease

Obesity is a complex disease with many causal factors, associated with multiple comorbidities that contribute to significant morbidity and mortality. It is a highly prevalent disease that poses an enormous health and economic burden to society. This article reviews the mechanisms of obesity and its related comorbidities.

The Predictive Role of Tooth Extractions, Oral Infections, and hs-C-Reactive Protein for Mortality in Individuals with and without Diabetes: A Prospective Cohort Study of a 12 1/2-Year Follow-Up

The predictive role of high-sensitivity C-reactive protein (hs-CRP), number of tooth extractions, and oral infections for mortality in people with and without diabetes is unclear. This prospective cohort study is a 12 1/2-year follow-up of the Oslo II study, a health survey in 2000. In all, 12,764 men were invited. Health information was retrieved from 6434 elderly men through questionnaire information, serum measurements, and anthropometric and blood pressure measurements. Diabetes was reported by 425 men. Distinct differences were observed in baseline characteristics in individuals with and without diabetes. In the diabetes group, age and hs-CRP were statistically significant whereas in the nondiabetes group, age, hs-CRP, number of tooth extractions, tooth extractions for infections and oral infections combined, nonfasting glucose, systolic blood pressure, total cholesterol, regular alcohol drinking, daily smoking, and level of education were independent risk factors. The number of tooth extractions <5 was inversely related whereas more extractions increased the risk. Multivariate analyses showed that hs-CRP was a significant predictor in persons with diabetes and tooth extractions and oral infections combined; the number of teeth extracted and hs-CRP were for persons without diabetes. Infection and inflammation were associated with mortality in individuals both with and without diabetes.

Duration and degree of adiposity: effect on cardiovascular risk factors at early adulthood

BACKGROUND/OBJECTIVES

The effect of adiposity dynamics throughout adolescence on adult cardiometabolic outcomes is not well known. We aimed to assess the effect of duration and degree of adiposity from adolescence to early adulthood on blood pressure and insulin resistance at 24 years.

SUBJECTS/METHODS

We used data from 2253 participants evaluated at 13, 17, 21 and 24 years of age in the EPITeen cohort, Porto, Portugal. The area under the curve of body mass index (BMI_AUC) was computed to summarize duration and degree of BMI for the 11-year period. Outcomes were systolic blood pressure (SBP) and insulin resistance at 24 years. The homeostasis model assessment of insulin resistance (HOMA-IR) was used as an indicator of insulin resistance and the variable was log-transformed. Associations between BMI_AUC and each outcome were estimated by linear regression models.

RESULTS

The median BMI_AUC was 243.1 (223.9-268.6) kg m^-2 in 11 years, corresponding to 22.1 kg m^-2 on average per year. In crude analyses, both BMI_AUC and BMI at 24 years were positively associated with SBP (β=0.096 mm Hg, 95% confidence interval (CI) 0.077; 0.115 for BMI_AUC; β=4.616 mm Hg, 95% CI 3.082; 6.151 for BMI at 24 years) and ln HOMA-IR (β=0.004, 95% CI 0.003; 0.005 for BMI_AUC; β=0.047, 95% CI 0.036; 0.057 for BMI at 24 years). After adjustment for confounders and for BMI at 24 years, the magnitude of the association of BMI_AUC attenuated for both outcomes, mostly for SBP, but the association remained statistically significant. Results using standardized variables confirmed that both outcomes were more strongly associated with BMI at 24 years than with BMI_AUC.

CONCLUSIONS

In addition to the effect of adult attained BMI, cumulative exposure to higher BMI throughout adolescence, taking into account duration and degree, was also relevant for adult cardiovascular risk factors, mainly for insulin resistance.