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Short, tall stature associated with risk for type 2 diabetes
Tall stature is associated with lower risk for developing type 2 diabetes, with each 10 cm increase in height associated with a 41% decreased risk for diabetes among men and a 33% decreased risk among women, according to findings published in Diabetologia.
In an analysis of more than 2,600 German adults, researchers also found that short stature was associated with higher risk for developing incident type 2 diabetes during follow-up, noting that the increased risk among shorter individuals may be due to higher liver fat content and a less favorable profile of cardiometabolic risk factors.
“The mechanisms of how height is associated with diabetes risk are largely unknown,” Matthias Schulze, DrPH, head of the department of molecular epidemiology at the German Institute of Human Nutrition Potsdam-Rehbruecke, Germany, and colleagues wrote in the study background. “Supporting a role for diabetes, it has been reported that taller people are more insulin sensitive and have better beta-cell function, which might partly be a result of less ectopic fat storage (eg, in the liver). Recent Mendelian randomization studies support that height is associated with cardiovascular risk and that this risk might at least in part be mediated by cardiometabolic risk factors relevant for type 2 diabetes, namely [blood pressure], blood lipids and inflammation. However, the relevance of liver fat and cardiometabolic risk factors as potential mediating factors linking height and its components to diabetes risk remains largely unknown.”
Greater height, less risk
Schulze and colleagues analyzed data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study on 2,662 adults without diabetes at baseline recruited from Potsdam, Germany, between 1994 and 1998 (1,264 women; mean age of women, 53 years; mean age of men, 56 years). Researchers measured body weight, total body height and sitting height (with leg length calculated as the difference between the two), waist circumference and BP. Participants completed follow-up questionnaires every 2 to 3 years regarding diabetes status; potential cases were verified by the treating clinician. Researchers modeled height, leg length and sitting height as continuous variables, with relative leg length calculated as the leg length to height ratio expressed as a percentage. Researchers used Cox proportional hazards regression models with age as an underlying time scale to evaluate the association between height and its components and diabetes risk.
Within the cohort, 698 developed incident type 2 diabetes during follow-up.
Researchers found that height was inversely associated with diabetes risk among men and women. For each 10 cm greater height, risk for type 2 diabetes was 41% lower for men (HR = 0.59; 95% CI, 0.47-0.75) and 33% lower for women (HR = 0.67; 95% CI, 0.51-0.88), with results persisting after adjustment for leg length to height ratio.
Researchers found that the association of height with diabetes risk was stronger among normal-weight individuals. For each 10 cm greater height, risk was 86% lower for normal-weight men (HR = 0.14) and 67% lower for women (HR = 0.33), when compared with participants who had overweight or obesity.
Cardiometabolic considerations
“This may indicate that a higher diabetes risk with larger waist circumference counteracts beneficial effects related to height, irrespective of whether larger waist circumference is due to growth or due to an energy imbalance,” the researchers wrote.
In analyses adjusting for fatty liver index, the association between tall stature and diabetes risk was attenuated for men (19%) and women (63%). Adjustment for HbA1c further attenuated diabetes risk with tall stature by 10% for men, whereas adjustment for adiponectin and C-reactive protein further attenuated risk by 30% and 13%, respectively. The findings suggest that a large proportion of the reduced risk attributable to increased height is related to a healthier cardiometabolic profile, according to researchers.
“Our findings suggest that short people might present with higher cardiometabolic risk factor levels and have higher diabetes risk compared with tall people,” the authors said in a press release. “These observations corroborate that height is a useful predictive marker for diabetes risk and suggest that monitoring of cardiometabolic risk factors may be more frequently indicated among shorter persons, independent of their body size and composition. Specifically, liver fat contributes to the higher risk among shorter individuals, and because height appears to be largely unmodifiable during adulthood, interventions to reduce liver fat may provide alternative approaches to reduce risk associated with shorter height.”
The researchers noted that the findings also suggest that early interventions to reduce height-related metabolic risk throughout life likely need to focus on determinants of growth during sensitive periods, such as pregnancy, early childhood, puberty and early adulthood, with sex differences also taken into account. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.