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Long-term type 2 diabetes risk continues to rise with extreme obesity
SAN DIEGO — Among Southwest American Indian children with obesity, the risk for developing type 2 diabetes in young adulthood increases incrementally with increasing BMI, according to results of a longitudinal study presented here.
“There are few studies that have characterized long-term health risks, such as diabetes, associated with different severities of obesity,” Madhumita Sinha, MD, staff clinician in the diabetes epidemiology and clinical research section at the Phoenix Epidemiology and Clinical Research Branch of the National Institute of Diabetes and Digestive and Kidney Diseases, told Endocrine Today. “The prevalence of severe obesity in children is increasing worldwide. Severe obesity greatly increases the risk for youth-onset type 2 diabetes, which leads to development of late-stage diabetes complications earlier in life and contributes to greater premature mortality. Early identification of and timely intervention in these children may assist in preventing or delaying future health risks.”
Sinha and colleagues evaluated data from a longitudinal study on diabetes and related conditions collected between 1965 and 2007 on 2,728 Southwest American Indian children aged between 5 and 10 years and 4,317 aged between 10 and 17 years (groups partially overlapped) without diabetes (median age at baseline, 12.1 years; 53.4% girls); follow-up continued for 20 years or until development of type 2 diabetes. Participants were stratified by BMI percentile based on CDC 2000 growth charts: for the younger group, obesity categories were BMI between 100% and less than 120%, between 120% and less than 140%, and above 140% of the 95th percentile; for the older group, additional categories included BMI between 140% and less than 160% and BMI 160% and greater of the 95th percentile. “Severe obesity” was defined as BMI above 120% of the 95th percentile.
At baseline, 18% of the younger group had obesity and 12% had severe obesity; 21% of the older group had obesity and 17% had severe obesity. Among the younger group, over a mean 10.8 years of follow-up, 98 participants developed type 2 diabetes by age 20 years and 543 by age 45 years (13.7 years’ follow-up); among the older group, over a mean 5.5 years of follow-up, 111 developed type 2 diabetes by age 20 years and 1,014 by age 45 years (mean 12.1 years’ follow-up).
Children and adolescents with BMI greater than 140% of the 95th percentile had incidence rates for diabetes onset before age 20 years that were 10 to 18 times higher compared with those with normal weight, whereas incidence rates of diabetes before age 45 years among the group were 2.9 to 3.7 times higher compared with those with normal weight.
“The incidence of diabetes before age 20 years was much more magnified with greater severity of obesity in young adults with diabetes than it was at 45 years of age,” Sinha said during the presentation. “The rising incidence of diabetes in youth and young adults is related directly with the epidemic of childhood obesity and is largely driven by the increase in more severe forms of obesity.
“Now, since these kids are getting diabetes at a far younger age, their duration of exposure to dysglycemia is higher, and therefore you would expect that the late-stage cardiovascular complications would arise much earlier with a high risk of morbidity and mortality,” she said. – by Jill Rollet
Reference:
Sinha M. 12-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
For more information:
Madhumita Sinha, MD, can be reached at madhumita.sinha@nih.gov.
Disclosures: Sinha reports no relevant financial disclosures.