Adolescent Obesity and Early-onset Type 2 Diabetes

Abstract

<b>OBJECTIVE</b>: Type 2 diabetes (T2D) is increasingly diagnosed at younger ages. We investigated the association of adolescent obesity with incident T2D at early adulthood. <p><b>RESEARCH DESIGN AND METHODS</b>: A nationwide, population-based study of 1,462,362 adolescents (59% men; mean age 17.4 years) evaluated 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. <b></b></p> <p><b>RESULTS</b>: During 15,810,751 person-years, 2,177 people (69% men) developed T2D (mean age at diagnosis, 27 year). There was an interaction between BMI, sex and incident T2D (P<sub>interaction</sub>=0.023). In a model adjusted for socio-demographic variables, the hazard ratios for diabetes diagnosis were 1.7 (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 50<sup>th</sup>-74<sup>th</sup>, 75<sup>th</sup>-84<sup>th</sup>, 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 the low-normal BMI (5<sup>th</sup>-49<sup>th</sup> percentile; reference), respectively. The projected fractions of adult-onset T2D that were attributed to high BMI (≥85<sup>th</sup> percentile) at adolescence were 56.9% (53.8%-59.9%) and 61.1% (56.8%–65.2%), in men and women, respectively.</p> <b>CONCLUSIONS</b>: 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.

Association Between Age at Diagnosis of Type 2 Diabetes and Cardiovascular Diseases: A Nationwide, Population-Based, Cohort Study

“…It was reported that obesity was a more general feature of early-onset type 2 diabetes than it is in later-onset type 2 diabetes ( 3 , 36 ). A prospective study including 1,462,362 adolescents confirmed that severe obesity significantly increased the risk for incidence of type 2 diabetes in young ( 20 ). Importantly, we found that the association of age at diagnosis of diabetes with risk of CVD was more pronounced among patients with obesity or overweight than those with normal weight.…”

“…During the past decades, China has experienced a rapid transition to western lifestyles with more sedentary behavior and a high energy/fat diet ( 19 ), leading to the escalating rates of obesity and related metabolic diseases, including type 2 diabetes. The rise in the prevalence of obesity in early and middle-aged population is likely to increase the incidence of early-onset type 2 diabetes ( 20 ). Previous studies have reported a strong relationship between obesity in youth and subsequent onset of type 2 diabetes ( 20 – 23 ).…”

“…The rise in the prevalence of obesity in early and middle-aged population is likely to increase the incidence of early-onset type 2 diabetes ( 20 ). Previous studies have reported a strong relationship between obesity in youth and subsequent onset of type 2 diabetes ( 20 – 23 ). Obesity was also an independent risk factor for CVD, which is the leading cause of premature death in China ( 24 ).…”

Adolescent cognitive function and incident early-onset type 2 diabetes

“…This includes a detailed interview, review of medical history and a physical examination. Measurement of weight, height, and systolic and diastolic blood pressure were performed for most of the adolescents (98.5%) as described elsewhere [17,18]. Mean arterial pressure was calculated: ðSystolic BP þ 2 Ã Dias tolic BPÞ 3 .…”

“…Residential SES was based on locality of residence at the time of examination and was determined according to a 1-to-10 ordinal scale reflecting SES characteristics of residential areas, as defined by the Israeli Bureau of Statistics [19]. Adolescents were classified into three categories of residential SES: low (1À4), intermediate (5À7), and high (8À10) as reported previously [17]. Data on years of attained education were received from the Israeli Ministry of Education and dichotomized as previously described using a cutoff of 11 years of formal schooling (Supplementary Appendix) [17].…”