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Obesity increases diabetes risk independent of genetics, lifestyle habits
A person with obesity is nearly six times more likely to develop type 2 diabetes over a decade when compared with a person of normal weight, independent of lifestyle factors and genetic risk for the disease, according to study data presented at the European Association for the Study of Diabetes annual meeting.
“We found that individuals with an unfavorable lifestyle and obesity are at greater risk of incident type 2 diabetes regardless of their genetic risk,” Hermina Jakupovic, PhD, a fellow at the Center for Basic Metabolic Research at the University of Copenhagen, Denmark, told Endocrine Today. “Furthermore, we found that the effect of obesity on type 2 diabetes risk is dominant over other risk factors, highlighting the importance of weight management in type 2 diabetes prevention.”
In a case-control study, Jakupovic and colleagues analyzed data from 9,556 adults using data from the Danish Diet, Cancer and Health cohort (49.6% women; mean age, 56 years; 43% with overweight; 22.8% with obesity). During 14.7 years of follow-up, 49.5% of participants developed type 2 diabetes. Researchers defined a favorable lifestyle as having at least three of the following healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity and a healthy diet. An unfavorable lifestyle was defined as no or only one healthy lifestyle factor; the remaining participants were considered to have an intermediate lifestyle. Genetic risk was assessed by a risk score comprising 213 genetic loci associated with type 2 diabetes. Researchers stratified participants by level of genetic risk score (lowest 25%, middle 50% and top 25%).
Researchers found that adherence to a favorable lifestyle and normal weight decreased type 2 diabetes risk independent of genetic predisposition for the disease (P > .05 for genetic risk score for lifestyle and genetic risk score for obesity interaction).
Obesity, defined as a BMI of at least 30 kg/m², was associated with a 5.8-fold increased risk for developing type 2 diabetes (95% CI, 5.2-6.6) when compared with normal-weight participants, whereas the independent effects of high vs. low genetic risk and unfavorable vs. favorable lifestyle habits were “relatively modest,” according to the researchers, with HRs of 1.8 (95% CI, 1.6-2) and 1.2 (95% CI, 1.1-1.3), respectively.
“Individuals with poor lifestyle and obesity are at greater risk of incident type 2 diabetes regardless of their genetic risk,” the researchers wrote. – by Regina Schaffer
Reference:
Jakupovic H, et al. Abstract 376. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Type 2 diabetes is a common and complex disease that is the result of the interplay between genes, lifestyle and environment. Over the past three decades, the prevalence of type 2 diabetes has more than tripled, fueled by increasingly unhealthy lifestyles and a steep rise in the prevalence of obesity. Besides lifestyle and environment, people’s genetic backgrounds also determine part of their susceptibility to type 2 diabetes.
In this study of nearly 10,000 Danish men and women, researchers assessed the contribution of body weight, lifestyle and genetic susceptibility to the risk for type 2 diabetes. Over the course of a 12-year follow-up, half of all participants developed type 2 diabetes. In particular, participants who were obese at baseline were almost 6 times more likely to develop diabetes than those who were not obese. An unfavorable lifestyle and a high genetic risk further increased the risk of developing type 2 diabetes, but the effects were less pronounced than that of body weight.
These findings confirm that, irrespective of an individual’s genetic susceptibility, controlling body weight and adhering to a healthy lifestyle are key in the prevention of type 2 diabetes. While these preventive measures seem straightforward and are assumed to be changeable and under a person’s own control, unlike genetic susceptibility, anyone who has ever tried to lose weight with diet and exercise knows that this is extremely hard. After all, body weight itself is, at least in part, due to genetic factors that make preventing weight gain — and type 2 diabetes — a major challenge.
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