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Asgari S, Khalili D, Azizi F, Hadaegh F. Weight change and risk of incident type 2 diabetes: short, medium and long-term follow-up in tehran lipid and glucose study. Cardiovasc Diabetol 2024; 23:207. [PMID: 38890609 PMCID: PMC11186083 DOI: 10.1186/s12933-024-02297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Despite the high burden of obesity and Type 2 diabetes (T2DM) in the Middle East/West Asia region, the effect of weight change on the development of T2DM is poorly addressed. Therefore, we aimed to assess the impact of 3-year body weight change on incident of T2DM over 3-, 6-, and 9-year periods among Iranian adults. METHODS A total of 6930 participants (men = 2567) aged ≥ 20 years free of T2DM or cancer at baseline were included. Weight measurements were taken at baseline (2002-2005) and approximately 3 years later. Participants were categorized based on their weight change ratio into ≥ 5% loss, stable (± 5%), and ≥ 5% gain. Generalized estimating equations (GEE), adjusted with age, sex, education levels, baseline measurements of fasting plasma glucose, weight, waist circumference, triglycerides to high-density lipoprotein cholesterol ratio, family history of diabetes, current smoker, hypertension, and prevalent cardiovascular disease were applied to estimate the Odds ratios (ORs) and 95% confidence intervals (CIs) of weight change categories for incident T2DM, considering stable weight as a reference. RESULTS During median follow-ups of 3-, 6-, and 9-year, 295, 505, and 748 cases of T2DM occurred, respectively. Weight gain of ≥ 5%, as compared to stable weight group (± 5%), was associated with increased T2DM risk, with ORs of 1.58 (95% CI 1.16-2.14), 1.76 (1.41-2.20), and 1.70 (1.40-2.05) for the 3-, 6-, and 9-year follow-ups, respectively, in multivariable analysis; corresponding values for weight loss ≥ 5% were 0.48 (0.29-0.80), 0.57 (0.40-0.81), and 0.51 (0.38-0.68), respectively. This association persisted even after adjusting for attained weight. Subgroup analysis showed consistent associations across age, gender, and body mass index categories. CONCLUSION Weight gain and loss of ≥ 5% were associated with increased and decreased risks of incident T2DM, respectively, regardless of attained weight. This association was consistent over various follow-up durations among the Iranian population as recommended by guidelines.
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Affiliation(s)
- Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Islamic Republic of Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Islamic Republic of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Islamic Republic of Iran.
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Jiang Y, Lai X. Clinical features of early-onset type 2 diabetes and its association with triglyceride glucose-body mass index: a cross-sectional study. Front Endocrinol (Lausanne) 2024; 15:1356942. [PMID: 38529395 PMCID: PMC10962922 DOI: 10.3389/fendo.2024.1356942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Objective The incidence of early-onset type 2 diabetes (T2D) has increased significantly, with insulin resistance (IR) and obesity being the main drivers of its onset. This study aims to investigate the clinical characteristics of early-onset T2D and its association with triglyceride glucose body mass index (TyG-BMI), an emerging surrogate of IR. Methods A total of 1000 adults newly diagnosed with T2D were enrolled and divided into early-onset T2D (18~40 years, N=500) and late-onset T2D groups (≥40 years, N=500). Independent t and chi-squared tests were used to compare the characteristics of the two groups, and logistic regression analysis, trend tests, restricted cubic spline curves (RCSs), and receiver operating characteristic (ROC) curves were used to identify the relationship between TyG-BMI and early-onset T2D. Results Patients with early-onset T2D were more likely to have a higher body mass index (BMI), hemoglobin A1C (HbA1c), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), triglyceride glucose index (TyG), and TyG-BMI (P < 0.05). A higher TyG-BMI was associated with an increased risk of early-onset T2D (P < 0.001). The RCSs showed a nonlinear relationship between TyG-BMI and early-onset T2D, and the slope of the curve increased with an increase in TyG-BMI (P for nonlinearity < 0.001). In the subgroup analysis, additive interactions between TyG-BMI and the risk of early-onset T2D were observed for sex, family history of diabetes, BMI, fatty liver, and hypertension (P < 0.001). ROC curve showed that the area under the curve of TyG-BMI was 0.6781, which was larger than its main components (TyG, BMI, FPG, TG). The best cutoff value was 254.865, the sensitivity was 74.6%, and the specificity was 53.6%. Conclusion Patients with early-onset T2D are characterized by severe IR, metabolic disorders, and being overweight/obese and an increase in TyG-BMI is independently associated with an increased risk of early-onset T2D.
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Affiliation(s)
| | - Xiaoyang Lai
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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3
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Rego MLM, Leslie E, Capra BT, Helder M, Yu W, Katz B, Davy KP, Hedrick VE, Davy BM, DiFeliceantonio AG. The influence of ultra-processed food consumption on reward processing and energy intake: Background, design, and methods of a controlled feeding trial in adolescents and young adults. Contemp Clin Trials 2023; 135:107381. [PMID: 37935307 PMCID: PMC10872704 DOI: 10.1016/j.cct.2023.107381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The greatest age-related weight gain occurs in the early/mid-20s. Overall dietary quality among adolescents and emerging adults (age 18-25) is poor, with ultra-processed foods (UPF) representing more than two-thirds of adolescents' total energy intake (i.e., 68%). UPF consumption may impact cognitive and neurobiological factors that influence dietary decision-making and energy intake (EI). To date, no research has addressed this in this population. METHODS Participants aged 18-25 will undergo two 14-day controlled feeding periods (81% UPF, 0% UPF) using a randomly assigned crossover design, with a 4-week washout between conditions. Brain response to a UPF-rich milkshake, as well as behavioral measures of executive function, will be evaluated before and after each diet. Following each diet, measurements include ad libitum buffet meal EI, food selection, eating rate, and eating in the absence of hunger (EAH). Prior to initiating recruitment, controlled diet menus, buffet, and EAH snacks were developed and evaluated for palatability. Sensory and texture attributes of buffet and EAH snack foods were also evaluated. RESULTS Overall diet palatability was rated "like very much" (8)/"like moderately"(7) (UPF: 7.6 ± 1.0; Non-UPF: 6.8 ± 1.5). Subjective hardness rating (range = 1-9 [1 = soft, 9 = hard] was similar between UPF and Non-UPF buffet and snack items (UPF:4.22 ± 2.19, Non-UPF: 4.70 ± 2.03), as was the objective measure of hardness (UPF: 2874.33 ± 2497.06 g, Non-UPF: 2243.32 ± 1700.51 g). CONCLUSIONS Findings could contribute to an emerging neurobiological understanding of the effects of UPF consumption including energy overconsumption and weight gain among individuals at a critical developmental stage.
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Affiliation(s)
- Maria L M Rego
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA.
| | - Emma Leslie
- Fralin Biomedical Research Institute, Virginia Tech, USA
| | - Bailey T Capra
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA
| | - Mckenna Helder
- Department of Food Science and Technology, Virginia Tech, USA
| | - Wenjing Yu
- Fralin Biomedical Research Institute, Virginia Tech, USA
| | - Benjamin Katz
- Department of Human Development and Family Science, Virginia Tech, USA
| | - Kevin P Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA
| | - Alexandra G DiFeliceantonio
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA; Fralin Biomedical Research Institute, Virginia Tech, USA
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Killian AC, Reed RD, McLeod MC, MacLennan PA, Kumar V, Pittman SE, Maynor AG, Stanford LA, Baker GA, Schinstock CA, Silkensen JR, Roll GR, Segev DL, Orandi BJ, Lewis CE, Locke JE. Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study. PLoS One 2022; 17:e0276882. [PMID: 36399462 PMCID: PMC9674148 DOI: 10.1371/journal.pone.0276882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Approval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity. METHODS This longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival. FINDINGS Among 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15). CONCLUSIONS LKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.
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Affiliation(s)
- A. Cozette Killian
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - M. Chandler McLeod
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Paul A. MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sydney E. Pittman
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Andrew G. Maynor
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Luke A. Stanford
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Gavin A. Baker
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Carrie A. Schinstock
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - John R. Silkensen
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States of America
| | - Garrett R. Roll
- Division of Transplant, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Babak J. Orandi
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, United States of America
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5
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Gaillard T, Chen H, Effoe VS, Correa A, Carnethon M, Kalyani RR, Echouffo-Tcheugui JB, Joseph JJ, Bertoni AG. Glucometabolic State Transitions: The Jackson Heart Study. Ethn Dis 2022; 32:203-212. [PMID: 35909644 PMCID: PMC9311302 DOI: 10.18865/ed.32.3.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Diabetes and prediabetes are common among African Americans (AA), but the frequency and predictors of transition between normal, impaired glucose metabolism, and diabetes are not well-described. The aim of this study was to examine glucometabolic transitions and their association with the development of type 2 diabetes (T2D). Methods AA participants of the Jackson Heart Study who attended baseline exam (2000-2004) and at least one of two subsequent exams (2005-2008 and 2009-2013, ~8 years) were classified according to glycemic status. Transitions were defined as progression (deterioration) or remission (improvement) of glycemic status. Multinomial logistic regression models with repeated measures were used to estimate the odds ratios (OR) for remission and progression with adjustment for demographic, anthropometric, behavioral, and biochemical factors. Results Among 3353 participants, (mean age 54.6±12.3 years), 43% were normoglycemic, 32% were prediabetes, and 25% had diabetes at baseline. For those with normal glucose at a visit, the probability at the next visit (~4years) of having prediabetes or diabetes was 38.5% and 1.8%, respectively. For those with prediabetes, the probability was 9.9% to improve to normal and 19.9% to progress to diabetes. Progression was associated with baseline BMI, diabetes status, triglycerides, family history of diabetes, and weight gain (OR 1.04 kg, 95% CI:1.03-1.06, P=<.0001). Remission was strongly associated with weight loss (OR .97 kg, 95%CI: .95-.98, P<.001). Conclusions In AAs, glucometabolic transitions were frequent and most involved deterioration. From a public health perspective additional emphasis should be placed on weight control to preserve glucometabolic status and prevent progression to T2D.
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Affiliation(s)
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Valery S. Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rita R. Kalyani
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem NC
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Life-course trajectories of weight and their impact on the incidence of type 2 diabetes. Sci Rep 2021; 11:12494. [PMID: 34127722 PMCID: PMC8203741 DOI: 10.1038/s41598-021-91910-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/01/2021] [Indexed: 12/25/2022] Open
Abstract
Although exposure to overweight and obesity at different ages is associated to a higher risk of type 2 diabetes, the effect of different patterns of exposure through life remains unclear. We aimed to characterize life-course trajectories of weight categories and estimate their impact on the incidence of type 2 diabetes. We categorized the weight of 7203 participants as lean, normal or overweight at five time-points from ages 7–55 using retrospective data. Participants were followed for an average of 19 years for the development of type 2 diabetes. We used latent class analysis to describe distinctive trajectories and estimated the risk ratio, absolute risk difference and population attributable fraction (PAF) associated to different trajectories using Poisson regression. We found five distinctive life-course trajectories. Using the stable-normal weight trajectory as reference, the stable overweight, lean increasing weight, overweight from early adulthood and overweight from late adulthood trajectories were associated to higher risk of type 2 diabetes. The estimated risk ratios and absolute risk differences were statistically significant for all trajectories, except for the risk ratio of the lean increasing trajectory group among men. Of the 981 incident cases of type 2 diabetes, 47.4% among women and 42.9% among men were attributable to exposure to any life-course trajectory different from stable normal weight. Most of the risk was attributable to trajectories including overweight or obesity at any point of life (36.8% of the cases among women and 36.7% among men). The overweight from early adulthood trajectory had the highest impact (PAF: 23.2% for woman and 28.5% for men). We described five distinctive life-course trajectories of weight that were associated to increased risk of type 2 diabetes over 19 years of follow-up. The variability of the effect of exposure to overweight and obesity on the risk of developing type 2 diabetes was largely explained by exposure to the different life-course trajectories of weight.
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Kim K, Joyce BT, Zheng Y, Schreiner PJ, Jacobs DR, Catov JM, Shikany JM, Carnethon MR, Greenland P, Van Horn LV, Allen NB, Lloyd-Jones DM, Gunderson EP, Hou L. DNA Methylation GrimAge and Incident Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Diabetes 2021; 70:1404-1413. [PMID: 33820761 PMCID: PMC8275890 DOI: 10.2337/db20-1167] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/27/2021] [Indexed: 12/21/2022]
Abstract
DNA methylation (DNAm)-based biological age (epigenetic age) has been suggested as a useful biomarker of age-related conditions including type 2 diabetes (T2D), and its newest iterations (GrimAge measurements) have shown early promise. In this study, we explored the association between epigenetic age and incident T2D in the context of their relationships with obesity. A total of 1,057 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included in the current analyses. We stratified the participants into three groups: normal weight, overweight, and obese. A 1-year increase of GrimAge was associated with higher 10-year (study years 15-25) incidence of T2D (odds ratio [OR] 1.06, 95% CI 1.01-1.11). GrimAge acceleration, which represents the deviation of GrimAge from chronological age, was derived from the residuals of a model of GrimAge and chronological age, and any GrimAge acceleration (positive GrimAA: having GrimAge older than chronological age) was associated with significantly higher odds of 10-year incidence of T2D in obese participants (OR 2.57, 95% CI 1.61-4.11). Cumulative obesity was estimated by years since obesity onset, and GrimAge partially mediated the statistical association between cumulative obesity and incident diabetes or prediabetes (proportion mediated = 8.0%). In conclusion, both older and accelerated GrimAge were associated with higher risk of T2D, particularly among obese participants. GrimAge also statistically mediated the associations between cumulative obesity and T2D. Our findings suggest that epigenetic age measurements with DNAm can potentially be used as a risk factor or biomarker associated with T2D development.
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Affiliation(s)
- Kyeezu Kim
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Brian T Joyce
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yinan Zheng
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lifang Hou
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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8
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Yu Z, Grams ME, Ndumele CE, Wagenknecht L, Boerwinkle E, North KE, Rebholz CM, Giovannucci EL, Coresh J. Association Between Midlife Obesity and Kidney Function Trajectories: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2021; 77:376-385. [PMID: 32979415 PMCID: PMC7904650 DOI: 10.1053/j.ajkd.2020.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/21/2020] [Indexed: 01/13/2023]
Abstract
RATIONALE & OBJECTIVE Obesity has been related to risk for chronic kidney disease. However, the associations of different measures of midlife obesity with long-term kidney function trajectories and whether they differ by sex and race are unknown. STUDY DESIGN Observational study. SETTING & PARTICIPANTS 13,496 participants from the Atherosclerosis Risk in Communities (ARIC) Study. PREDICTORS Midlife obesity status as measured by body mass index (BMI), waist-to-hip ratio, and predicted percent fat at baseline. OUTCOMES Estimated glomerular filtration rate (eGFR) calculated using serum creatinine level measured at 5 study visits, and incident kidney failure with replacement therapy (KFRT). ANALYTICAL APPROACH Mixed models with random intercepts and random slopes for eGFR. Cox proportional hazards models for KFRT. RESULTS Baseline mean age was 54 years, median eGFR was 103mL/min/1.73m2, and median BMI was 27kg/m2. Over 30 years of follow-up, midlife obesity measures were associated with eGFR decline in White and Black women but not consistently in men. Adjusted for age, center, smoking, and coronary heart disease, the differences in eGFR slope per 1-SD higher BMI, waist-to-hip ratio, and predicted percent fat were 0.09 (95% CI, -0.18 to 0.36), -0.25 (95% CI, -0.50 to 0.01), and-0.14 (95% CI, -0.41 to 0.13) mL/min/1.73m2 per decade for White men; -0.91 (95% CI, -1.15 to-0.67), -0.82 (95% CI, -1.06 to-0.58), and-1.02 (95% CI, -1.26 to-0.78) mL/min/1.73m2 per decade for White women; -0.70 (95% CI, -1.54 to 0.14), -1.60 (95% CI, -2.42 to-0.78), and-1.24 (95% CI, -2.08 to-0.40) mL/min/1.73m2 per decade for Black men; and-1.24 (95% CI, -2.08 to-0.40), -1.50 (95% CI, -2.05 to-0.95), and-1.43 (95% CI, -2.00 to-0.86) mL/min/1.73m2 per decade for Black women. Obesity indicators were independently associated with risk for KFRT for all sex-race groups except White men. LIMITATIONS Loss to follow-up during 3 decades of follow-up with 5 eGFR assessments. CONCLUSIONS Obesity status is a risk factor for future decline in kidney function and development of KFRT in Black and White women, with less consistent associations among men.
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Affiliation(s)
- Zhi Yu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Chiadi E Ndumele
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Lynne Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health; Department of Nutrition, Harvard T. H. Chan School of Public Health; Channing Division of Network Medicine, Brigham and Women's Hospital
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
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9
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Simchoni M, Hamiel U, Pinhas-Hamiel O, Zucker I, Cukierman-Yaffe T, Lutski M, Derazne E, Beer Z, Behar D, Keinan-Boker L, Mosenzon O, Tzur D, Afek A, Tirosh A, Raz I, Twig G. Adolescent BMI and early-onset type 2 diabetes among Ethiopian immigrants and their descendants: a nationwide study. Cardiovasc Diabetol 2020; 19:168. [PMID: 33023586 PMCID: PMC7542395 DOI: 10.1186/s12933-020-01143-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background We assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin. Methods Normoglycemic adolescents (range 16–20 years old), including 93,806 native Israelis (≥ 3rd generation in Israel) and 27,684 Israelis of Ethiopian origin, were medically assessed for military service between 1996 and 2011. Weight and height were measured. Data were linked to the Israeli National Diabetes Registry. Incident type 2 diabetes by December 31, 2016 was the outcome. Cox regression models stratified by sex and BMI categories were applied. Results 226 (0.29%) men and 79 (0.18%) women developed diabetes during 992,980 and 530,814 person-years follow-up, respectively, at a mean age of 30.4 and 27.4 years, respectively. Among native Israeli men with normal and high (overweight and obese) BMI, diabetes incidence was 9.5 and 62.0 (per 105 person-years), respectively. The respective incidences were 46.9 and 112.3 among men of Ethiopian origin. After adjustment for sociodemographic confounders, the hazard ratios for type 2 diabetes among Ethiopian men with normal and high BMI were 3.4 (2.3–5.1) and 15.8 (8.3–30.3) respectively, compared to third-generation Israelis with normal BMI. When this analysis was limited to Israeli-born Ethiopian men, the hazard ratios were 4.4 (1.7–11.4) and 29.1 (12.9–70.6), respectively. Results persisted when immigrants of other white Caucasian origin were the reference; and among women with normal, but not high, BMI. Conclusions Ethiopian origin is a risk factor for early-onset type 2 diabetes among young men at any BMI, and may require selective interventions.
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Affiliation(s)
- Maya Simchoni
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Uri Hamiel
- Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Endocrinology, Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Miri Lutski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zivan Beer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | | | - Lital Keinan-Boker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel. .,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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10
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Wright AK, Welsh P, Gill JMR, Kontopantelis E, Emsley R, Buchan I, Ashcroft DM, Rutter MK, Sattar N. Age-, sex- and ethnicity-related differences in body weight, blood pressure, HbA 1c and lipid levels at the diagnosis of type 2 diabetes relative to people without diabetes. Diabetologia 2020; 63:1542-1553. [PMID: 32435821 PMCID: PMC7351865 DOI: 10.1007/s00125-020-05169-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to determine how weight patterns together with blood glucose, BP and lipids vary at diagnosis of diabetes by age, sex and ethnicity. METHODS Using the UK Clinical Practice Research Datalink, we identified people with type 2 diabetes (n = 187,601) diagnosed in 1998-2015 and compared their weights, HbA1c, BP and lipid levels at diagnosis with age-matched people without diabetes (n = 906,182), by sex and ethnic group. RESULTS Younger age at diagnosis was associated with greater adjusted mean difference (95% CI) in weight between those with vs without type 2 diabetes: 18.7 (18.3, 19.1) kg at age 20-39 years and 5.3 (5.0, 5.5) kg at age ≥ 80 years. Weight differentials were maximal in white women, and were around double in white people compared with South Asian and black people. Despite lower absolute values, BP differences were also greater at younger age of diabetes onset: 7 (6, 7) mmHg at age 20-39 years vs -0.5 (-0.9, -0.2) at age ≥ 80 years. BP differences were greatest in white people, and especially in women. Triacylglycerol level differences were greatest in younger men. Finally, HbA1c levels were also higher with younger onset diabetes, particularly in black people. CONCLUSIONS/INTERPRETATION At diagnosis of type 2 diabetes, when compared with people without diabetes, weight and BP differentials were greater in younger vs older people, in women vs men and in white vs South Asian and black people. These differences were observed even though South Asian and black people tend to develop diabetes a decade earlier with either similar or greater dysglycaemia. These striking patterns may have implications for management and prevention. Graphical abstract.
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Affiliation(s)
- Alison K Wright
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Jason M R Gill
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain Buchan
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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11
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Twig G, Zucker I, Afek A, Cukierman-Yaffe T, Bendor CD, Derazne E, Lutski M, Shohat T, Mosenzon O, Tzur D, Pinhas-Hamiel O, Tiosano S, Raz I, Gerstein HC, Tirosh A. Adolescent Obesity and Early-Onset Type 2 Diabetes. Diabetes Care 2020; 43:1487-1495. [PMID: 32321731 DOI: 10.2337/dc19-1988] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/01/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) is increasingly diagnosed at younger ages. We investigated the association of adolescent obesity with incident T2D at early adulthood. RESEARCH DESIGN AND METHODS A nationwide, population-based study evaluated 1,462,362 adolescents (59% men, mean age 17.4 years) during 1996-2016. Data were linked to the Israeli National Diabetes Registry. Weight and height were measured at study entry. Cox proportional models were applied. RESULTS During 15,810,751 person-years, 2,177 people (69% men) developed T2D (mean age at diagnosis 27 years). There was an interaction among BMI, sex, and incident T2D (P interaction = 0.023). In a model adjusted for sociodemographic variables, the hazard ratios for diabetes diagnosis were 1.7 (95% CI 1.4-2.0), 2.8 (2.3-3.5), 5.8 (4.9-6.9), 13.4 (11.5-15.7), and 25.8 (21.0-31.6) among men in the 50th-74th percentile, 75th-84th percentile, overweight, mild obesity, and severe obesity groups, respectively, and 2.2 (1.6-2.9), 3.4 (2.5-4.6), 10.6 (8.3-13.6), 21.1 (16.0-27.8), and 44.7 (32.4-61.5), respectively, in women. An inverse graded relationship was observed between baseline BMI and mean age of T2D diagnosis: 27.8 and 25.9 years among men and women with severe obesity, respectively, and 29.5 and 28.5 years among low-normal BMI (5th-49th percentile; reference), respectively. The projected fractions of adult-onset T2D that were attributed to high BMI (≥85th percentile) at adolescence were 56.9% (53.8-59.9%) and 61.1% (56.8-65.2%) in men and women, respectively. CONCLUSIONS Severe obesity significantly increases the risk for incidence of T2D in early adulthood in both sexes. The rise in adolescent severe obesity is likely to increase diabetes incidence in young adults in coming decades.
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Affiliation(s)
- Gilad Twig
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and the Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Cole D Bendor
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and the Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Lutski
- The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Tammy Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and the Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shmuel Tiosano
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medicine, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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12
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Bendor CD, Bardugo A, Pinhas-Hamiel O, Afek A, Twig G. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol 2020; 19:79. [PMID: 32534575 PMCID: PMC7293793 DOI: 10.1186/s12933-020-01052-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/08/2020] [Indexed: 02/08/2023] Open
Abstract
Severe obesity among children and adolescents is a significant global public health concern. The prevalence has markedly increased over the last decades, becoming common in many countries. Overwhelming rates of obesity among youth have prompted efforts to identify an evidence-based immediate- and long-term cardiometabolic risk factor profile in childhood-onset severe obesity, and to highlight gaps that require further investigation. The PubMed database was systematically searched in accordance with PRISMA guidelines. The search yielded 831 results, of which 60 fulfilled stringent criteria and were summarized in this review. The definition of severe obesity was variable, with only one half the publications using the definition BMI > 120% of the 95th percentile. Point estimates of the prevalence of at least one cardiometabolic risk factor in children with severe obesity reportedly range from 67 to 86%. Cross-sectional studies indicate that children and adolescents with severe obesity are at greater risk than those with mild obesity for type 2 diabetes, hypertension, fatty liver disease and dyslipidemia, already at childhood and adolescence. Robust epidemiological data on the long-term risk and actual point estimates in adulthood are lacking for these diseases as well as for other diseases (coronary heart disease, stroke, chronic kidney disease and cancer). Recent longitudinal studies indicate an increased risk for cardiomyopathy, heart failure, cardiovascular mortality and all-cause mortality in adulthood for adolescents with severe obesity compared to those with mild obesity. Given the alarming increase in the prevalence of severe obesity, the persistence of adiposity from childhood to adulthood and the precarious course of young adults with chronic comorbidities, the economic and clinical services burden on the healthcare system is expected to rise.
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Affiliation(s)
- Cole D Bendor
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.,Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | - Aya Bardugo
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.,Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel. .,Academy and Research Division, Surgeon General Headquarters, Israel Defense Forces, Medical Corps, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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13
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Fitzpatrick SL, Rosales AG, Brown SD, Arterburn DE, Daley MF, Horberg M, Koebnick C, Oshiro C, Young DR. Behavioural and psychosocial factors associated with 5-year weight trajectories within the PORTAL Overweight/Obesity Cohort. Obes Sci Pract 2020; 6:272-281. [PMID: 32523716 PMCID: PMC7278910 DOI: 10.1002/osp4.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The purpose of this study was to model weight trajectories over a 5‐year time period (2012–2016) and their association with behavioural and psychosocial characteristics and health care–related experiences using data from the Patient Outcomes Research to Advance Learning (PORTAL) overweight/obesity cohort. Methods Weight trajectories for each eligible patient in the PORTAL overweight/obesity cohort (n = 2864) were identified first using growth modelling; trajectories were then grouped using a hierarchical cluster analysis. Weight trajectory clusters that emerged were compared on demographics, and predictors of cluster membership were examined. Clusters were also compared on responses to a survey assessing health behaviours, quality of life, and health care experience completed in 2015 by 49% of the total sample (n = 1391). Results Seven distinct weight trajectory clusters were identified: (a) significant weight loss then maintenance; (b) higher stable weight; (c) moderate stable weight; (d) steady weight loss then relapse; (e) weight gain then weight loss; (f) steady weight gain then maintenance; and (g) lower stable weight. Age, sex, race/ethnicity, and body mass index at baseline predicted patient's weight trajectory (P < .001). Over two thirds of patients maintained their weight over the 5‐year period. Significant weight loss then maintenance, weight gain then weight loss, and higher stable weight patients were more likely to report receiving weight counselling from their provider. Patients in the significant weight loss then maintenance and lower stable weight clusters were more likely to be physically active than the other clusters. Conclusion Findings suggest variability in patterns of weight change among adults with overweight or obesity who have access to health care and that these patterns differ on demographic, behavioural and psychosocial factors, and health care experience.
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Affiliation(s)
| | - Ana G Rosales
- Kaiser Permanente Center for Health Research Portland Oregon
| | - Susan D Brown
- Division of Research Kaiser Permanente Oakland California
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute Seattle Washington
| | - Matthew F Daley
- Institute for Health Research Kaiser Permanente Colorado Aurora Colorado
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute Kaiser Permanente Mid-Atlantic States Rockville Maryland
| | - Corinna Koebnick
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena California
| | - Caryn Oshiro
- Kaiser Permanente Center for Health Research Hawaii Honolulu Hawaii
| | - Deborah R Young
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena California
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14
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Lamichhane AP, Couper D, Jenkins GP, Stevens J. 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. Metab Syndr Relat Disord 2020; 18:313-320. [PMID: 32522113 DOI: 10.1089/met.2020.0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Archana P Lamichhane
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gabrielle P Jenkins
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Marlatt KL, Redman LM, Beyl RA, Smith SR, Champagne CM, Yi F, Lovejoy JC. Racial differences in body composition and cardiometabolic risk during the menopause transition: a prospective, observational cohort study. Am J Obstet Gynecol 2020; 222:365.e1-365.e18. [PMID: 31610152 DOI: 10.1016/j.ajog.2019.09.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/29/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity disproportionately affects more women than men. The loss of ovarian function during the menopause transition coincides with weight gain, increases in abdominal adiposity, and impaired metabolic health. Racial differences in obesity prevalence that results from the menopause transition are not well understood. OBJECTIVE The purpose of the study was to assess longitudinal changes in body composition and cardiometabolic risk among black and white women during the menopausal transition. STUDY DESIGN In a secondary analysis of a prospective, observational cohort study (the Healthy Transitions study), 161 women ≥43 years old with a body mass index of 20-40 kg/m2 and who had not yet transitioned through menopause were enrolled at Pennington Biomedical Research Center. Women were seen annually for body composition by dual-energy X-ray absorptiometry, for abdominal adipose tissue distribution by computed tomography, for sex steroid hormones, and for cardiometabolic risk factors that include fasting glucose, insulin, and lipids. Surrogate measures of insulin sensitivity were also calculated. RESULTS Ninety-four women (25 black, 69 white) transitioned through menopause and were included within the analyses. At menopause onset, black women weighed more (77.8±3.0 vs 70.8±1.8 kg) and had a higher systolic (125±16 vs 118±14 mm Hg) and diastolic (80±8 vs 74±7 mm Hg) blood pressure compared with white women (all P≤.05). No other differences in body composition, sex steroid hormones, or cardiometabolic risk factors were observed at menopause onset. Before menopause, white women gained significant weight (3 kg), total body adiposity (6% percent body fat, 9% fat mass, 12% trunk fat mass) and abdominal adipose tissue (19% subcutaneous fat, 15% visceral fat, 19% total adipose tissue), which coincided with significant decreases in estradiol, sex hormone-binding globulin, and estrone sulfate and increases in follicle-stimulating hormone, total cholesterol, and low-density lipoprotein cholesterol. Conversely, black women had more abdominal adipose tissue before menopause, which was maintained across the menopause transition. Black women also had significant decreases in estrone sulfate and total testosterone and increases in follicle-stimulating hormone before menopause. In the postmenopausal years, abdominal subcutaneous adipose tissue, total adipose tissue, follicle-stimulating hormone, total cholesterol, and low-density and high-density lipoprotein cholesterol increased only in white women. CONCLUSION White women gained more abdominal adiposity during the menopause transition compared with black women, which, in part, may be due to differences in the pattern of sex steroid hormone changes between women of different racial backgrounds. The gains in abdominal adiposity in white women were observed in tandem with increased cardiometabolic risk factors. Future studies should consider comprehensive lifestyle approaches to target these increased gains in abdominal adiposity (ie, nutrition and physical activity coaching), while taking into account the potential interactions of race, body adiposity, sex steroid hormones, and their influence on cardiometabolic risk.
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Affiliation(s)
| | | | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Steve R Smith
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, FL
| | | | - Fanchao Yi
- Center for Collaborative Research, Advent Health, Orlando, FL
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16
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Wu WC, Wei JN, Chen SC, Fan KC, Lin CH, Yang CY, Lin MS, Shih SR, Hua CH, Hsein YC, Chuang LM, Li HY. Progression of insulin resistance: A link between risk factors and the incidence of diabetes. Diabetes Res Clin Pract 2020; 161:108050. [PMID: 32035116 DOI: 10.1016/j.diabres.2020.108050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
Abstract
AIMS Insulin resistance (IR) changes over time during the development of type 2 diabetes. Some reports showed that obesity was associated with progression of IR. However, no study has explored if change of IR predicts incident diabetes, and no study has investigated other factors associated with the change. METHODS In this study, 1184 subjects without diabetes at baseline were enrolled in 2006-2016 with a median follow-up period of 4.5 years. Diabetes was diagnosed by oral glucose tolerance test and hemoglobin A1c, or if anti-diabetic agents were used. HOMA2-IR and ISI0,120 were used to estimate IR. RESULTS The annual changes of HOMA2-IR(ΔHOMA2-IR/year) and ISI0,120(ΔISI0,120/year) were associated with BMI, waist circumference(WC), glucose, HbA1c, triglyceride and HDL-cholesterol. Subjects with pre-diabetes or metabolic syndrome were associated with a more rapid increase of IR. ΔHOMA2-IR/year and ΔISI0,120/year were correlated with annual changes of BMI and WC. The hazard ratios for ΔHOMA2-IR/year and ΔISI0,120/year to predict incident diabetes were 1.39 (95% CI 1.22-1.59, p < 0.001) and 0.13 (95% CI 0.09-0.19, p < 0.001) in adjusted models, respectively. CONCLUSIONS Change of IR can be used as a surrogate marker of incident diabetes. The progression of IR is an important pathophysiologic link between risk factors and the incidence of diabetes.
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Affiliation(s)
- Wan-Chen Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jung-Nan Wei
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Szu-Chi Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Kang-Chih Fan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chung-Yi Yang
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan; Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyang-Rong Shih
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cyue-Huei Hua
- Division of Clinical Pathology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Yenh-Chen Hsein
- Division of Clinical Pathology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Lee-Ming Chuang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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17
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Xu Z, Steffen LM, Selvin E, Rebholz CM. Diet quality, change in diet quality and risk of incident CVD and diabetes. Public Health Nutr 2020; 23:329-338. [PMID: 31511110 PMCID: PMC6992481 DOI: 10.1017/s136898001900212x] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/29/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study was to assess the prospective association between diet quality, as well as a 6-year change in diet quality, and risk of incident CVD and diabetes in a community-based population. DESIGN We used Cox regression models to estimate the prospective association between diet quality, assessed using the Healthy Eating Index (HEI)-2015 and the Alternative HEI (AHEI)-2010 scores, as well as change in diet quality, and incident CVD and diabetes. SETTING The ARIC Study recruited 15 792 black and white men and women (45-64 years) from four US communities. PARTICIPANTS We included 10 808 study participants who reported usual dietary intake via FFQ at visit 1 (1987-1989) and who had not developed CVD, diabetes, or cancer at baseline. RESULTS Overall, 3070 participants developed CVD (median follow-up of 26 years) and 3452 developed diabetes (median follow-up of 22 years) after visit 1. Higher diet score at the initial visit was associated with a significantly lower risk of CVD (HR per 10 % higher HEI-2015 diet quality score: 0·90 (95 % CI: 0·86, 0·95) and HR per 10 % higher AHEI-2010 diet quality score: 0·96 (95 % CI: 0·93, 0·99)). We did not observe a significant association between initial diet score and incident diabetes. There were no significant associations between change in diet score and CVD or diabetes risk in the overall study population. CONCLUSIONS Higher diet quality assessed using HEI-2015 and AHEI-2010 was strongly associated with lower CVD risk but not diabetes risk within a middle-aged, community-based US population.
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Affiliation(s)
- Zhe Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Hussein A, Mahmoud SED, Awad MS, Mahmoud HEM. Assessment of Cardiovascular Risk Factors in Patients with Type 2 Diabetes in Upper Egypt Villages. Diabetes Metab Syndr Obes 2020; 13:4737-4746. [PMID: 33311991 PMCID: PMC7725276 DOI: 10.2147/dmso.s282888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/03/2020] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Ahmed Hussein
- Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag82524, Egypt
- Correspondence: Ahmed Hussein Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag82524, EgyptTel +20 1011145537Fax +20 934600349 Email
| | - Sharaf E D Mahmoud
- Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag82524, Egypt
| | - Mohammad Shafiq Awad
- Department of Cardiology, Faculty of Medicine, Beni Suef University, Beni Suef City62511, Egypt
| | - Hossam Eldin M Mahmoud
- Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena City83511, Egypt
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19
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Hu H, Kawasaki Y, Kuwahara K, Nakagawa T, Honda T, Yamamoto S, Eguchi M, Kochi T, Nishihara A, Imai T, Yamamoto M, Okazaki H, Miyamoto T, Tomita K, Uehara A, Ogasawara T, Sasaki N, Hori A, Nagahama S, Shimizu M, Murakami T, Chen S, Kabe I, Mizoue T, Sone T, Dohi S. Trajectories of body mass index and waist circumference before the onset of diabetes among people with prediabetes. Clin Nutr 2019; 39:2881-2888. [PMID: 31926761 DOI: 10.1016/j.clnu.2019.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/17/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND & AIMS To investigate trajectories of body mass index (BMI) and waist circumference (WC) among prediabetic people who progressed to diabetes, people who remained with prediabetes, and those who returned to normoglycemia. METHODS We used data from 22,945 prediabetic people who received an annual health checkup for up to eight years. The development of diabetes was defined using the American Diabetes Association criteria. People who did not progress to diabetes during the observation period were classified as 'remained with prediabetes' or 'returned to normoglycemia', based on their last health checkup data. Trajectories of BMI and WC were evaluated using linear mixed models for repeated measures, with adjustment for a wide range of covariates. RESULTS During the study period, 2972 people progressed to diabetes, 4706 returned to normoglycemia, and 15,267 remained with prediabetes. People who progressed to diabetes had a larger increase in mean BMI from 7 years to 1 year prior to diagnosis, which was about three times that of people who remained with prediabetes (annual change rate, 0.20 [95% confidence interval; 0.15 to 0.24] vs 0.06 [0.04 to 0.08] kg/m2 per year, P < 0.001), regardless of their BMI levels at the initial health checkup. Among people who returned to normoglycemia, mean BMI remained almost the same over time (-0.04 [-0.09 to 0.002] kg/m2 per year), except for those with obesity (-0.16 [-0.28 to -0.05] kg/m2 per year). As for WC, the annual change rate among people who developed diabetes was about 7 times that of people who remained with prediabetes (0.38 [0.32 to 0.45] vs 0.05 [0.03 to 0.08] cm per year, P < 0.001). We also observed a constant mean WC over time among people who had no central obesity and later returned to normoglycemia (-0.02 [-0.06 to 0.03] cm per year), and an annual decrease in mean WC among those who had central obesity and later returned to normoglycemia (-0.40 [-0.47 to -0.32] cm per year). CONCLUSIONS Our study provides strong evidence that avoiding weight gain could help prediabetic people minimize the risk of developing diabetes, regardless of whether they are obese. Losing weight could help obese people restore normoglycemia from a prediabetic state, whereas maintaining current weight may help nonobese people return to normoglycemia.
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Affiliation(s)
- Huan Hu
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Keisuke Kuwahara
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan; Teikyo University Graduate School of Public Health, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Naoko Sasaki
- Mitsubishi Fuso Truck and Bus Corporation, Kanagawa, Japan
| | - Ai Hori
- Department of Global Public Health, University of Tsukuba, Ibaraki, Japan
| | | | - Makiko Shimizu
- Mizue Medical Clinic, Keihin Occupational Health Center, Kanagawa, Japan
| | - Taizo Murakami
- Mizue Medical Clinic, Keihin Occupational Health Center, Kanagawa, Japan
| | - Sanmei Chen
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Isamu Kabe
- Furukawa Electric Co., Ltd., Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
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20
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Matsui M, Yoshikawa T, Mizushima R, Tanahashi K, Myoenzono K, Tanaka K, Maeda S. Association between duration of excessive weight and arterial stiffness in middle-aged and older adults. Clin Exp Hypertens 2019; 42:213-217. [DOI: 10.1080/10641963.2019.1619752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Masahiro Matsui
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Toru Yoshikawa
- Faculty of Sports and Health Sciences, Ryutsu Keizai University, Ryugasaki, Japan
| | - Ryoko Mizushima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Koichiro Tanahashi
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Kanae Myoenzono
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Kiyoji Tanaka
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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21
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Zhang T, Xu J, Li S, Bazzano LA, He J, Whelton PK, Chen W. Trajectories of childhood BMI and adult diabetes: the Bogalusa Heart Study. Diabetologia 2019; 62:70-77. [PMID: 30343393 PMCID: PMC6365010 DOI: 10.1007/s00125-018-4753-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022]
Abstract
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 .
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Affiliation(s)
- Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shengxu Li
- Cardiovascular Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Paul K Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA.
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22
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Kim ES, Jeong JS, Han K, Kim MK, Lee SH, Park YM, Baek KH, Moon SD, Han JH, Song KH, Kwon HS. Impact of weight changes on the incidence of diabetes mellitus: a Korean nationwide cohort study. Sci Rep 2018; 8:3735. [PMID: 29487293 PMCID: PMC5829255 DOI: 10.1038/s41598-018-21550-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/02/2018] [Indexed: 12/27/2022] Open
Abstract
Obesity is a well-known risk factor for type 2 diabetes, but few data exist on the association between weight changes and diabetes risk in non-obese subjects. This study aimed to investigate the effect of weight changes on the incidence of type 2 diabetes in Korea, using 51,405 non-diabetic subjects. Individuals who developed type 2 diabetes were more likely to be older and male, to have high body mass index (BMI), blood pressure, fasting blood glucose, and total cholesterol, to be current smokers and frequent drinkers, to be hypertensive and hyperlipidemic, and to have a family history of diabetes, compared to those without type 2 diabetes. Compared with the consistently non-obese group, there was a higher hazard ratio for incident diabetes (95% confidence interval) in subjects becoming obese [1.49 (1.26–1.77)] and remaining obese [2.56 (2.34–2.81)] after adjustment for confounding factors. Decreased BMI was significantly associated with lower risks for incident diabetes and the trends were more evident in the non-obese group. However, overall there was no significant association of increased BMI with incident diabetes. In conclusion, weight loss was significantly associated with lower risk for diabetes both in non-obese and obese Koreans, but particularly in the non-obese.
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Affiliation(s)
- Eun Sook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's hospital, Incheon, 21431, Korea
| | - Jee Sun Jeong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Seung-Hwan Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, 06591, Korea
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA
| | - Ki Hyun Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Sung Dae Moon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's hospital, Incheon, 21431, Korea
| | - Je-Ho Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's hospital, Incheon, 21431, Korea
| | - Ki-Ho Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea. .,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea.
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23
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Feng C, Osgood ND, Dyck RF. Low Birth Weight, Cumulative Obesity Dose, and the Risk of Incident Type 2 Diabetes. J Diabetes Res 2018; 2018:8435762. [PMID: 29541643 PMCID: PMC5818910 DOI: 10.1155/2018/8435762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity history may provide a better understanding of the contribution of obesity to T2DM risk. METHODS 17,634 participants from the 1958 National Child Development Study were followed from birth to 50 years. Cumulative obesity dose, a measure of obesity history, was calculated by subtracting the upper cut-off of the normal BMI from the actual BMI at each follow-up and summing the areas under the obesity dose curve. Hazard ratios (HRs) for diabetes were calculated using Cox regression analysis. Three separate models compared the predictive ability of cumulative obesity dose on diabetes risk with the time-varying BMI and last BMI. RESULTS In final models, 341 of 15,043 (2.27%) participants developed diabetes; male sex and low birth weight were significant confounding variables. Adjusted HRs were 1.080 (95% CI: 1.071, 1.088) per 10-unit cumulative obesity dose, 1.098 (95% CI: 1.080, 1.117) per unit of the time-varying BMI, and 1.146 (95% CI: 1.084, 1.212) per unit of the last BMI. Cumulative obesity dose provided the best predictive ability for diabetes. CONCLUSIONS Cumulative obesity dose is an improved method for evaluating the impact of obesity history on diabetes risk. The link between low birth weight and T2DM is strengthened by adjusting for cumulative obesity dose.
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Affiliation(s)
- Cindy Feng
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Roland F. Dyck
- Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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24
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Long-term metabolic risk for the metabolically healthy overweight/obese phenotype. Int J Obes (Lond) 2017; 42:302-309. [PMID: 29064474 PMCID: PMC5867190 DOI: 10.1038/ijo.2017.233] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES The clinical relevance of the metabolically healthy overweight/obese (MHO) phenotype is controversial and the relationships between weight change and the development of cardiometabolic risk factors is unknown. Therefore, we aim to: (1) Assess the long-term risk of developing one or more components of the metabolic syndrome in MHO adults compared with metabolically healthy normal weight (MHNW); (2) Evaluate risk of a composite of death, cardiovascular disease (CVD), and risk of developing type 2 diabetes between adults defined according to baseline body mass index and metabolic health. SUBJECTS/METHODS Retrospective cohort study of adults 18-65 years of age seen at our institution between 1998 and 2000 who lived in Olmsted County. Metabolically healthy was defined as the absence of all components of the metabolic syndrome (except for waist circumference). Main outcome was the development of metabolic risk factors. The secondary outcome was a composite of mortality, CVD and heart failure. RESULTS Of the 18 070 individuals with complete data at baseline, 1805 (10%) were MHO (mean age 38±11 years) and 3047 were MHNW (mean age 35±11 years). After a median follow-up of 15 years, interquartile range 10-17, 80% of MHO vs 68% of MHNW developed at least one cardiometabolic risk factor (P<0.001). In multivariate analysis, MHO individuals who gained ⩾10% of their body weight were more likely to have developed metabolic complications compared to MHO individuals that did not gain weight (P=0.001 for 10-15%, P<0.001 for >15% weight gain). The risk for the secondary composite end point was similar between MHO and MHNW, number of events 218/1805 vs 217/3048 for MHO and MHNW, respectively, (hazard ratio: 1.16, 95% confidence interval: 0.96-1.40). CONCLUSIONS MHO are more likely to develop metabolic complications than MHNW, especially if they gain weight.
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Stokes A, Preston SH. The contribution of rising adiposity to the increasing prevalence of diabetes in the United States. Prev Med 2017; 101:91-95. [PMID: 28579501 PMCID: PMC5540312 DOI: 10.1016/j.ypmed.2017.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/02/2017] [Accepted: 05/28/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We assessed the contribution of increasing adiposity to the rising prevalence of diabetes in the United States over the period 1988-2014. RESEARCH DESIGN AND METHODS Data from NHANES III (1988-1994) and continuous waves (1999-2014) were pooled for the current study. Diabetes status was assessed using data on Hemoglobin A1c. We estimated a multivariable logistic regression model that predicted the odds of having diabetes as a function of age, sex, racial/ethnic group, educational attainment, and period of observation. At a second stage, we introduced measures of general and abdominal adiposity into the model. Changes in coefficients pertaining to period of observation between the first and second models were interpreted as indicating the extent to which adiposity can account for trends in the prevalence of diabetes. Sensitivity analyses were conducted to investigate how alternative definitions of adiposity and diabetes status would affect results. RESULTS The predicted prevalence of diabetes rose by 2.59%/yr between 1988 and 2014 after adjusting for changes in population composition. Increasing adiposity explained 72% of the rise in diabetes. Results were consistent for men and women. CONCLUSIONS Rising levels of adiposity explained the large majority of the rise in diabetes prevalence between 1988 and 2014.
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Affiliation(s)
- Andrew Stokes
- Department of Global Health, Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
| | - Samuel H Preston
- Department of Sociology, Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
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26
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Viner R, White B, Christie D. Type 2 diabetes in adolescents: a severe phenotype posing major clinical challenges and public health burden. Lancet 2017; 389:2252-2260. [PMID: 28589895 DOI: 10.1016/s0140-6736(17)31371-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/27/2017] [Accepted: 05/10/2017] [Indexed: 01/14/2023]
Abstract
Type 2 diabetes in adolescence manifests as a severe progressive form of diabetes that frequently presents with complications, responds poorly to treatment, and results in rapid progression of microvascular and macrovascular complications. Although overall still a rare disease, adolescent type 2 diabetes now poses major challenges to paediatric and adult diabetes services in many countries. Therapeutic options are heavily curtailed by a dearth of knowledge about the condition, with low numbers of participants and poor trial recruitment impeding research. Together with lifestyle modification, metformin remains the first-line therapy for adolescents with type 2 diabetes, although the majority rapidly progress to treatment failure and insulin therapy. Early bariatric surgery is controversial but has great potential to transform outcomes. Health systems must respond by both concentrating patients in specialist clinical services integrated with translational research programmes, but also by joining up with local health and social care services to improve engagement and uptake of services.
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Affiliation(s)
- Russell Viner
- UCL Great Ormond Street Institute of Child Health, London, UK; Child and Adolescent Diabetes Service, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Billy White
- UCL Great Ormond Street Institute of Child Health, London, UK; Child and Adolescent Diabetes Service, UCL Hospitals NHS Foundation Trust, London, UK
| | - Deborah Christie
- Child and Adolescent Diabetes Service, UCL Hospitals NHS Foundation Trust, London, UK; UCL Institute of Epidemiology and Healthcare, London, UK
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27
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Lim S, Dunbar JA, Versace VL, Janus E, Wildey C, Skinner T, O'Reilly S. Comparing a telephone- and a group-delivered diabetes prevention program: Characteristics of engaged and non-engaged postpartum mothers with a history of gestational diabetes. Diabetes Res Clin Pract 2017; 126:254-262. [PMID: 28288435 DOI: 10.1016/j.diabres.2017.02.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/16/2017] [Indexed: 12/30/2022]
Abstract
AIMS To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement. METHODS Postpartum women participated in a lifestyle modification program delivered by telephone (n=33) or group format (n=284). Semi-structured interviews on barriers and enablers to program engagement (defined as completing≥80% sessions) were conducted before (Group) and after (Group and Telephone) interventions. The Health Action Process Approach theory was used as the framework for inquiry. Psychological measures were compared between engagement subgroups before and after group-delivered intervention. RESULTS In the telephone-delivered program 82% participants met the engagement criteria compared with 38% for the group-delivered program. Engaged participants (Group) had significantly higher risk perception, outcome expectancy, and activity self-efficacy at baseline (P<0.05). There was a greater decrease in body weight (-1.45±3.9 vs -0.26±3.5, P=0.024) and waist circumference (-3.56±5.1 vs -1.24±5.3, P=0.002) for engaged vs non-engaged participants following group program completion. CONCLUSIONS Telephone delivery was associated with greater engagement in postpartum women. Engagement was associated with greater reduction in weight and waist circumference. Further studies are required to confirm the effectiveness of telephone-delivered program for diabetes prevention in postpartum women.
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Affiliation(s)
- Siew Lim
- Faculty of Health, School of Medicine, Deakin Rural Health, Warrnambool, Victoria, Australia; Health Systems Improvement Unit, Centre for Population Health, School of Health and Social Development, Deakin University, VIC, Australia.
| | - James A Dunbar
- Centre for Population Health Research, Deakin University, VIC, Australia
| | - Vincent L Versace
- Faculty of Health, School of Medicine, Deakin Rural Health, Warrnambool, Victoria, Australia
| | - Edward Janus
- General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, VIC, Australia; Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia
| | - Carol Wildey
- Health Systems Improvement Unit, Centre for Population Health, School of Health and Social Development, Deakin University, VIC, Australia
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, NT, Australia
| | - Sharleen O'Reilly
- Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia
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Body mass index trajectory patterns and changes in visceral fat and glucose metabolism before the onset of type 2 diabetes. Sci Rep 2017; 7:43521. [PMID: 28266592 PMCID: PMC5339907 DOI: 10.1038/srep43521] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/25/2017] [Indexed: 12/31/2022] Open
Abstract
We investigated BMI trajectory patterns before diabetes diagnosis and examined associated changes in visceral adiposity and glucose metabolism. 23,978 non-diabetic Japanese participants (2,789 women) aged 30–64 years were assessed with a mean follow-up of 7.6 years. Diabetes was diagnosed via fasting glucose, HbA1c, and self-report. Latent-class trajectory analyses were performed to identify BMI trajectories. Longitudinal changes in BMI, visceral adiposity, and glucose metabolism were estimated using mixed models. 1,892 individuals developed diabetes. Three distinct BMI trajectories were identified in adults developing and not developing diabetes, respectively. Among adults developing diabetes, 47.3% were classified as “medium BMI” (n = 895), and had increased mean BMI within the obesity category before diagnosis. The “low BMI” group (38.4%, n = 726) had an initial mean BMI of 21.9 kg/m2, and demonstrated small weight gain. The “high BMI” group (n = 271) were severely obese and showed greater increase in BMI until diagnosis. All groups which developed diabetes showed absolute and/or relative increase in visceral fat and impaired β-cell compensation for insulin resistance. All groups not developing diabetes showed measured variables were relatively stable during observation. These data suggest that visceral fat gain may induce β-cell failure in compensation for insulin resistance, resulting in diabetes regardless of obesity level.
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Duration and degree of weight change and risk of incident diabetes: Japan Epidemiology Collaboration on Occupational Health Study. Prev Med 2017; 96:118-123. [PMID: 28040517 DOI: 10.1016/j.ypmed.2016.12.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 01/25/2023]
Abstract
We prospectively examined diabetes risk in association with a summary measure of degree and duration of weight change. The study participants were 51,777 employees from multiple companies in Japan, who were aged 30-59years, free of diabetes at baseline, and followed up for 7years (2008-2015). Exposure was cumulative body mass index (BMI)-years, which was defined as the area of BMI units above or below baseline BMI during follow-up, and was treated as a time-dependent variable in the Cox proportional hazards regression models. During the 263,539 person-years of follow-up, 3465 participants developed diabetes. The adjusted hazard ratio (HR) of diabetes for a 1-unit increase in cumulative BMI-years was 1.11 (95% confidence interval (CI): 1.09, 1.12). The association was more pronounced among overweight (HR=1.11; 95% CI: 1.08, 1.14) and obese (HR=1.12; 95% CI: 1.08, 1.15) adults compared with normal- and under-weight (HR=1.07; 95% CI: 1.03, 1.11) adults (P for interaction of cumulative BMI-years X baseline BMI-group=0.002). The association of higher cumulative BMI-years with incident diabetes did not substantially differ by metabolic phenotype. The present results emphasize the importance of avoiding additional weight gain over an extended period of time for the prevention of type 2 diabetes, especially among overweight and obese adults, irrespective of metabolic health status.
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Zhang T, Li Y, Zhang H, Sun D, Li S, Fernandez C, Harville E, Bazzano L, He J, Chen W. Insulin-sensitive adiposity is associated with a relatively lower risk of diabetes than insulin-resistant adiposity: the Bogalusa Heart Study. Endocrine 2016; 54:93-100. [PMID: 27060004 PMCID: PMC7502025 DOI: 10.1007/s12020-016-0948-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
Obesity and insulin resistance are both closely associated with type 2 diabetes mellitus (T2DM). It is, however, not clear whether the role of obesity in the development of T2DM is dependent on insulin resistance. This study aims to assess the hypothesis that insulin-sensitive adiposity is associated with a relatively lower risk of T2DM than insulin-resistant adiposity, and the adiposity-T2DM association is modified by insulin resistance in middle-aged black and white adults. The longitudinal study cohort consisted of 1588 middle-aged normoglycemic black and white adults aged 18-44 years at baseline who were followed for 16 years on average. Overweight/obesity at baseline was defined as BMI ≥25, and insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA). The prevalence of incident pre-diabetes and T2DM was compared between the insulin-sensitive and insulin-resistant adiposity groups. The prevalence of both incident pre-diabetes and T2DM was higher in the insulin-resistant adiposity than in the insulin-sensitive adiposity group (11.5 vs. 7.5 %, p = 0.023 for pre-diabetes; 16.7 vs. 2.7 %, p < 0.001 for T2DM). In multivariable logistic analyses, adjusted for baseline age, race, sex, follow-up years, and smoking, baseline insulin-resistant obesity was associated with incident pre-diabetes (odds ratio, OR = 2.07, p = 0.046) and T2DM (OR = 8.19, p < 0.001). ORs did not differ between blacks and whites. The ORs for the association of BMI with pre-diabetes and T2DM significantly increased across increasing quartiles of baseline HOMA (p for trend = 0.032 for pre-diabetes and <0.001 for T2DM). Slopes of increasing follow-up glucose with baseline BMI, measured as regression coefficients (β), were significantly greater in insulin-resistant than in insulin-sensitive individuals (β = 0.86 vs. 0.38, p = 0.009 for difference in slopes). These findings suggest that insulin resistance amplifies the obesity-diabetes association and underscore the importance of preventing both adiposity and insulin resistance in young adults.
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Affiliation(s)
- Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Ying Li
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Huijie Zhang
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
- Department of Endocrinology and Metabolism, The First Hospital of Xiamen, Xiamen University, Xiamen, China
| | - Dianjianyi Sun
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Shengxu Li
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Emily Harville
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Jiang He
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA
| | - Wei Chen
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, 1440 Canal Street, Room 1504G, New Orleans, LA, 70112, USA.
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Navarro-González D, Sánchez-Íñigo L, Fernández-Montero A, Pastrana-Delgado J, Martinez JA. TyG Index Change Is More Determinant for Forecasting Type 2 Diabetes Onset Than Weight Gain. Medicine (Baltimore) 2016; 95:e3646. [PMID: 27175686 PMCID: PMC4902528 DOI: 10.1097/md.0000000000003646] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The risk of type 2 diabetes associated with obesity appears to be influenced by other metabolic abnormalities, and there is controversy about the harmless condition of the metabolically healthy obese (MHO) state. The aim of this study is to assess the risk of diabetes and the impact of changes in weight and in triglyceride-glucose index (TyG index), according to the metabolic health and obesity states.We analyzed prospective data of the Vascular Metabolic CUN cohort, a population-based study among a White European population (mean follow-up, 8.9 years). Incident diabetes was assessed in 1923 women and 3016 men with a mean age at baseline of 55.33 ± 13.68 and 53.78 ± 12.98 years old.A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of diabetes on metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese (MUNO), and metabolically unhealthy obese (MUO). A continuous standardized variable (z-score) was derived to compute the HR for diabetes per 1-SD increment in the body mass index (BMI) and the TyG index.MHO, MUNO, and MUO status were associated with the development of diabetes, HR of 2.26 (95% CI: 1.25-4.07), 3.04 (95% CI: 1.69-5.47), and 4.04 (95% CI: 2.14-7.63), respectively. MUNO individuals had 1.82 greater risk of diabetes compared to MHO subjects (95% CI: 1.04-3.22). The HRs for incident diabetes per 1-SD increment in BMI and TyG indexes were 1.23 (95% CI: 1.04-1.44) and 1.54 (95% CI: 1.40-1.68). The increase in BMI did not raise the risk of developing diabetes among metabolically unhealthy subjects, whereas increasing the TyG index significantly affect the risk in all metabolic health categories.Metabolic health is more important determinant for diabetes onset than weight gain. The increase in weight does not raise the risk of developing diabetes among metabolically unhealthy subjects.
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Affiliation(s)
- David Navarro-González
- From the Garcia-Orcoyen Hospital (DN-G); Burlada Clinic (LS-Í), Navarra Health Service-Osasunbidea; Department of Occupational Medicine (AF-M), Preventive Medicine and Public Health; Department of Internal Medicine (JP-D), University of Navarra Clinic, Pamplona; IdiSNA-Health Research Institute of Navarra (JP-D, JAM); Food Science and Physiology (JAM), University of Navarra, Pamplona; and Centre of Biomedical Research in Pathophysiology of Obesity and Nutrition (CIBERObn) (JAM), Carlos III, Madrid, Spain
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