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Observational Study
. 2017 Feb 6;17(1):170.
doi: 10.1186/s12889-017-4081-6.

Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants

Adina L Feldman  1 , Simon J Griffin  1 , Amy L Ahern  1 , Grainne H Long  1 , Lars Weinehall  2 , Eva Fhärm  2 , Margareta Norberg  2 , Patrik Wennberg  3
Affiliations
Observational Study

Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants

Adina L Feldman et al. BMC Public Health. .

Abstract

Background: Weight loss in individuals at high risk of diabetes is an effective prevention method and a major component of the currently prevailing diabetes prevention strategies. The aim of the present study was to investigate the public health potential for diabetes prevention of weight maintenance or moderate weight loss on a population level in an observational cohort with repeated measurements of weight and diabetes status.

Methods: Height, weight and diabetes status were objectively measured at baseline and 10 year follow-up in a population-based cohort of 33,184 participants aged 30-60 years between 1990 and 2013 in Västerbotten County, Sweden. The association between risk of incident diabetes and change in BMI or relative weight was modelled using multivariate logistic regression. Population attributable fractions (PAF) were used to assess population impact of shift in weight.

Results: Mean (SD) BMI at baseline was 25.0 (3.6) kg/m2. Increase in relative weight between baseline and follow-up was linearly associated with incident diabetes risk, odds ratio (OR) 1.05 (95% confidence interval (CI) 1.04-1.06) per 1% change in weight. Compared to weight maintenance (±1.0 kg/m2), weight gain of > +1.0 kg/m2 was associated with an increased risk of incident diabetes, OR 1.52 (95% CI 1.32, 1.74), representing a PAF of 21.9% (95% CI 15.8, 27.6%). For moderate weight loss (-1.0 to -2.0 kg/m2) the OR was 0.72 (95% CI 0.52, 0.99).

Conclusions: Weight maintenance in adulthood is strongly associated with reduced incident diabetes risk and there is considerable potential for diabetes prevention in promoting this as a whole population strategy.

Keywords: Body mass index; Body weight change; Diabetes mellitus; Epidemiology; Public health.

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Figures

Fig. 1
Fig. 1
Crude distribution of BMI at baseline (solid line) and 10 year follow-up (dashed line), by age at baseline. Vӓsterbotten Intervention Programme 1990–2013. Horizontal grey lines indicate cut-off points for BMI categories (25.0; 30.0; 35.0 kg/m2). Mean (SD) BMI at baseline for ages 30, 40 and 50 was 24.2 (3.6), 24.9 (3.6) and 25.5 (3.6) kg/m2, respectively, whereas mean (SD) BMI at 10 year follow-up was 25.9 (4.2), 26.3 (4.2) and 26.5 (4.0) kg/m2, respectively. BMI Body Mass Index
Fig. 2
Fig. 2
Modelled estimated probability and 95% CI of incident diabetes detected at 10 year follow-up by relative weight change between baseline and 10 year follow-up, and BMI category at baseline (model 4). Vӓsterbotten Intervention Programme 1990–2013. The grey vertical bar indicates weight maintenance (±3%). Estimated probabilities adjusted for absolute BMI at baseline (continuous) and the co-variates sex, age at baseline (30, 40 or 50 years), calendar year at baseline (continuous), educational level, marital status, family history of diabetes and tobacco use. BMI Body Mass Index, CI Confidence Interval
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