Weight gain raises diabetes risk for adults with prediabetes despite normal BMI
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Among Japanese adults with prediabetes who had normal weight, overweight or obesity, those who progressed to diabetes during an 8-year period had greater increases in BMI and waist circumference than those who maintained their prediabetes status or converted to normal glycemic levels, according to findings published in Clinical Nutrition.
“Although major clinical trials have consistently shown the effect of weight loss with lifestyle intervention on reducing the risk of diabetes among prediabetic people, it is unclear how weight varies during the natural history of progression from prediabetes to diabetes or during the reversion from prediabetes to normoglycemia,” Huan Hu, PhD, senior researcher in the department of epidemiology and prevention at the National Center for Global Health and Medicine in Tokyo, and colleagues wrote. “Exploring longitudinal changes in BMI could provide insight into the heterogeneity of prediabetes, inform monitoring practices for physicians and prediabetic people, and improve risk stratification for targeted diabetes prevention programs.”
Detecting the transitions
Hu and colleagues evaluated HbA1c, fasting glucose, BMI and waist circumference each year from 2008 to 2016 among 22,945 adults with prediabetes at study onset who were aged 20 to 64 years and took part in the Japan Epidemiology Collaboration on Occupational Health study.
The researchers used a HbA1c threshold of 6.5% or greater to established diabetes, with ranges of 5.7% to 6.4% indicating prediabetes and less than 5.7% indicating normal glycemic levels. At the study’s conclusion (8 years), diabetes had been diagnosed in 2,972 participants (mean age, 48.2 years; 7.1% women), 4,706 participants (mean age, 45.2 years; 14.8% women) had achieved normal glycemic levels, and 15,267 participants still had prediabetes (mean age, 47.8 years; 10.2% women).
BMI rose by 0.2 kg/m2 per year on average for those who were diagnosed with diabetes and by 0.06 kg/m2 for those who continued to have prediabetes (P < .001). The researchers noted that when comparing those who achieved normal glycemic levels with those who continued to have prediabetes, “the annual change rate was not statistically significant among people who returned to normoglycemia.”
Different BMI statuses
For those with a baseline BMI of less than 23 kg/m2, which was considered normal weight by the researchers, BMI rose by 0.2 kg/m2 per year on average for those who were diagnosed with diabetes and by 0.09 kg/m2 for those who continued to have prediabetes (P = .018). For those with a baseline BMI between 23 kg/m2 and less than 27.5 kg/m2, which was considered the threshold for overweight by the researchers, BMI rose by 0.13 kg/m2 per year on average for those who were diagnosed with diabetes and by 0.05 kg/m2 for those who continued to have prediabetes (P = .016). For those with a baseline BMI of 27.5 kg/m2 or more, which was considered the threshold for obesity, BMI rose by 0.25 kg/m2 per year on average for those who were diagnosed with diabetes and by 0.05 kg/m2 for those who continued to have prediabetes (P < .001).
The researchers also found that BMI fell by 0.16 kg/m2 per year on average for those who had obesity and achieved normal glycemic levels and was unchanged for those with overweight who achieved normal glycemic levels.
Waist circumference rose by 0.38 cm per year on average for those who were diagnosed with diabetes and by 0.05 cm per year for those who continued to have prediabetes (P < .001). For those who achieved normal glycemic levels, waist circumference remained constant for those who did not have obesity and fell by 0.4 cm per year on average for those who had obesity. Those who continued to have prediabetes, waist circumference fell by 0.02 cm per year on average.
“We observed distinct trajectories of BMI and waist circumference among prediabetic people who progressed to diabetes, people who remained with prediabetes,” the researchers wrote. “This suggests that monitoring BMI and/or waist circumference over time can help to identify people at high risk of developing diabetes.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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