Youth Overweight and Metabolic Disturbances in Predicting Carotid Intima-Media Thickness, Type 2 Diabetes, and Metabolic Syndrome in Adulthood: The Cardiovascular Risk in Young Finns Study

Koskinen, Juha; Magnussen, Costan G.; Sabin, Matthew A.; Kähönen, Mika; Hutri‐Kähönen, Nina; Laitinen, Tomi; Taittonen, Leena; Jokinen, Eero; Lehtimäki, Terho; Viikari, Jorma; Raitakari, Olli T.; Juonala, Markus

doi:10.2337/dc14-0008

Cited by 63 publications

(56 citation statements)

References 37 publications

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“…Metabolically healthy obesity in young adults, in contrast, may consist of a more heterogeneous population that includes both obese subjects who are likely to develop various metabolic abnormalities in the near future as well as those who will maintain their metabolic health for several decades. In support of this concept, a recent study from the Young Finns cohort describing 34 cases of type 2 diabetes among young adults demonstrated that overweight at youth is a risk factor for diabetes, even in the absence of any metabolic abnormalities (23).…”

Section: Discussionmentioning

confidence: 70%

Diabetes Risk Among Overweight and Obese Metabolically Healthy Young Adults

et al. 2014

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OBJECTIVETo determine diabetes incidence over time among obese young adults without metabolic risk factors. RESEARCH DESIGN AND METHODSIncident diabetes during a median follow-up of 6.1 years was assessed among 33,939 young men (mean age 30.9 6 5.2 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults cohort who were stratified for BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ‡30 kg/m 2 in the presence of normoglycemia, normal blood pressure, and normal levels of fasting triglyceride and HDL-cholesterol levels (n = 631). RESULTSA total of 734 new cases of diabetes were diagnosed during 210,282 person-years of follow-up. The incidence rate of diabetes among participants with no metabolic risk factors was 1.15, 2.10, and 4.34 cases per 1,000 person-years among lean, overweight, and obese participants, respectively. In a multivariable model adjusted for age, region of origin, family history of diabetes, physical activity, fasting plasma glucose, triglyceride level, HDL-cholesterol, systolic blood pressure, and white blood cell count, a higher diabetes risk was observed among MH-overweight (hazard ratio [HR] 1.89 [95% CI 1.25-2.86]; P < 0.001) and MH-obese (HR 3.88 [95% CI 1.94-7.77]; P < 0.001) compared with MH-normal weight subjects. There was no interaction between BMI and the number of metabolic abnormalities at enrollment in predicting diabetes risk. CONCLUSIONSHealthy metabolic profile and the absence of diabetes risk factors do not protect young adults from incident diabetes associated with overweight and obesity.Heterogeneity in the metabolic risk status of individuals with normal weight (NW), overweight, or obesity raised the hypothesis that metabolically healthy (MH)-obese individuals have no additional metabolic risk (1-3). However, there is conflicting evidence regarding the metabolic course of this subpopulation. Adjusted diabetes risk, for example, was reported to be unchanged (1,3), 4-fold higher (4), or 13-fold higher in MH-obese compared with MH-NW individuals (5).While the definition of healthy obesity suffers from inconsistency (6,7), the prevailing defining criteria of MH in most studies assessing diabetes risk include individuals with a BMI $30 kg/m 2 with one (1,4) or even two (3,5,7) metabolic

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Section: Discussionmentioning

confidence: 70%

Diabetes Risk Among Overweight and Obese Metabolically Healthy Young Adults

et al. 2014

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“…Fifth, the mean age of incident diabetes in our cohort was around 40 years; thus it is not clear if our results are valid for other cohorts with an older age of diabetes onset. However, in several recent studies from U.S. and European cohorts, similar incident rates and a similar age of onset were reported (35)(36)(37)(38), thereby likely making our results applicable to a wide population of young adults. Finally, the use of a general intelligence test cannot be used to assess the relationship between specific cognitive domains and diabetes.…”

Section: Discussionmentioning

confidence: 90%

Cognitive Function and the Risk for Diabetes Among Young Men

et al. 2014

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OBJECTIVEDiabetes is a risk factor for an accelerated rate of cognitive decline and dementia. However, the relationship between cognitive function and the subsequent development of diabetes is unclear. RESEARCH DESIGN AND METHODSWe conducted a historical-prospective cohort study merging data collected at premilitary recruitment assessment with information collected at the Staff Periodic Examination Center of the Israeli Army Medical Corps. Included were men aged 25 years or older without a history of diabetes at the beginning of follow-up with available data regarding their general intelligence score (GIS), a comprehensive measure of cognitive function, at age 17 years. RESULTSAmong 35,500 men followed for a median of 5.5 years, 770 new cases of diabetes were diagnosed. After adjustment for age, participants in the lowest GIS category had a 2.6-fold greater risk for developing diabetes compared with those in the highest GIS category. In multivariable analysis adjusted for age, BMI, fasting plasma glucose, sociogenetic variables, and lifestyle risk factors, those in the lowest GIS category had a twofold greater risk for incident diabetes when compared with the highest GIS category (hazard ratio 2.1 [95% CI 1.5-3.1]; P < 0.001). Additionally, participants in the lowest GIS category developed diabetes at a mean age of 39.5 6 4.7 years and those in the highest GIS group at a mean age of 41.5 6 5.1 years (P for comparison 0.042). CONCLUSIONSThis study demonstrates that in addition to a potential causal link between diabetes and enhanced cognitive decline, lower cognitive function at late adolescence is independently associated with an elevated risk for future diabetes.Evidence from the last several years suggests that dysglycemia accelerates the rate of cognitive decline and increases the risk for dementia. Indeed, people with diabetes are about 1.5-fold more likely to experience an accelerated rate of cognitive decline and are twice as likely to develop dementia (1-4). It also has been shown that dysglycemia per se is associated with an increased risk for dementia (5). This relationship is partially explained by cardiovascular risk factors, education, socioeconomic status (SES), and lifestyle factors. However, common mechanistic pathways such as inflammation, microvascular disease, and the effects of insulin sensitivity on the brain and in the periphery have also been hypothesized as an explanation for this relationship.

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“…These data also includes information on reimbursement decisions for hypertension (systolic BP Ն 160 mmHg and/or diastolic BP Ͼ 95 mmHg persistently during a 6-month follow-up period with nonmedical treatment) and type 2 diabetes (fasting plasma glucose Ն 7 mmol/l, nonfasting plasma glucose Ն 11.1 mmol/l and/or GHbA1c Ն 6.5% in two different measurements) made by the Social Insurance Institution of Finland based on applications from medical practitioners. Participants were classified as having type 2 diabetes if they had: (1) a fasting plasma glucose Ն 7.0 mmol/l, (2) GHbA1C Ն 6.5%, (3) reported receiving oral hypoglycemic agents and/or insulin injections and did not have type 1 diabetes, (4) reported a history of physician diagnosed type 2 diabetes, or (5) had a medication reimbursement decision for type 2 diabetes (18). Hypertension was defined by reimbursement decision data and dyslipidemia by purchases of statins or etsetimibe.…”

Section: Classification Of Adulthood Outcomesmentioning

confidence: 99%