Risks for diabetes, cardiometabolic disorders rise with obesity duration
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People who have obesity for longer are at greater risk for diabetes and other cardiometabolic disorders compared with those with no history of obesity or shorter duration, according to study findings published in PLOS Medicine.
“Our results demonstrate the importance of delaying the onset of obesity, but that if you do become obese — it is possible to reduce your cardiometabolic disease risk with weight loss,” Tom Norris, PhD, a senior research associate in epidemiology and biostatistics at Loughborough University in the United Kingdom, told Healio. “However, our results also suggest that the number of years a person lives with their BMI above the obesity threshold increases their diabetes risk, even if their BMI is only just in the obesity range and doesn’t continue to increase.”
Norris and colleagues analyzed data from three British birth cohort studies: the Medical Research Council’s National Survey of Health and Development (NSHD), the National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS70). BMI was calculated from measured or self-reported height and weight collected at specific ages. Data were collected at age 11, 15, 20, 26, 36 and 43 years in NSHD; 11, 16, 23, 33 and 42 years in NCDS; and 10, 16, 26, 30, 34 and 42 years in BCS70. Blood samples measuring HbA1c, systolic and diastolic blood pressure and HDL cholesterol were collected at age 53 years in NSHD, 44 years in NCDS and 46 years in BCS70.
Data from 20,746 participants across all three studies were analyzed (49.1% male). After adjusting for obesity severity, obesity from age 10 to 40 years was associated with a 4.5% increase in HbA1c compared with those who never had obesity (95% CI, 3.5-5.6). For those with obesity for less than 5 years, there was a 2.1 times higher risk for elevated HbA1c compared with those who never had obesity (95% CI, 1.8-2.4). The risk was even higher for those with obesity 20 to 30 years (RR = 4.6; 95% CI, 3.9-5.5). The association was attenuated following adjustments for obesity severity but remained statistically significant (P for trend = .006).
Those with obesity between 10 and 40 years had a 6.1% higher systolic BP (95% CI, 5.6-6.6) and a 7.1% higher diastolic BP (95% CI, 6.6-7.7) compared with those who never had obesity. Unadjusted data showed obesity duration was associated with higher systolic and diastolic BP, but evidence for the association was greatly reduced after adjusting for obesity severity. Obesity between 10 and 40 years was also associated with an increased risk for hypertension (RR = 1.6; 95% CI, 1.5-1.7) independent of obesity severity. The risk for hypertension gradually increased with obesity duration in unadjusted data, but the evidence for the association was weakened after adjusting for obesity severity. Obesity of 10 to 40 years also increased the risk for low HDL cholesterol (RR = 2; 95% CI, 1.8-2.2) independent of obesity severity. Similar to BP and hypertension, the risk increased with obesity duration, but was attenuated with an adjustment for obesity severity.
“We expected to see worse outcomes among people who had been obese for longer,” Norris said. “But we were surprised that the association of obesity duration with HbA1c was still largely present after accounting for obesity severity. This was not what we found for the other outcomes.”
Norris said the associations between worse cardiometabolic outcomes and obesity duration reveal the importance of treating obesity early on.
“We believe a big focus needs to be made on tackling childhood obesity, which in turn will reduce a person’s lifetime duration and thus lower the risk for an adverse cardiometabolic profile in adulthood,” Norris said. “We advocate regular routine BMI measurements to be taken, especially during childhood and adolescence, in order to identify individuals demonstrating patterns of BMI development that are likely to culminate in obesity.”
For more information:
Tom Norris, PhD, can be reached at t.norris@lboro.ac.uk.
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