Sociodemographic associations of longitudinal adiposity in youth with type 1 diabetes

Abstract

Excess adiposity is common in youth with type 1 diabetes, yet little is known about the sociodemographic factors that predict longitudinal trajectories of body fat. We analyzed data from 363 females and 379 males with type 1 diabetes over ~9 years of follow-up (mean baseline age 12.8 ± 2.3 years in females, 13.2 ± 2.4 years in males). Estimated body fat percentage (eBFP) was calculated with validated sex- and race/ethnicity-specific equations. Group-based modeling identified three eBFP trajectories for each sex. All female trajectories showed gradual increases, while male trajectories showed gradual decreases (<5% in eBFP) that plateaued around 7 years of diabetes duration. Female trajectories showed differences in baseline eBFP: Group F1 (38.0%), mean eBFP 27.8 ± 3.0%: Group F2 (47.9%), mean eBFP 33.9 ± 3.0%: and Group F3 (14.1%), mean eBFP 41.7 ± 4.1%. Male trajectories also showed differences in baseline eBFP: Group M1 (57.2%), mean eBFP 22.0 ± 3.0%: Group M2 (30.9%), mean eBFP 33.9 ± 3.0%: and Group M3 (12.9%), mean eBFP 36.1 ± 3.7%. In multinomial models, adjusted for clinical factors (eg, insulin regimen, insulin dose, and hemoglobin A1c), females who reported a single-parent household (adjusted odds ratio [aOR] = 3.34, 95% confidence interval [CI]: 1.49, 7.47), parental education of less than a college degree (aOR = 3.79, 95% CI: 1.60, 9.60), and a lack of private health insurance (aOR = 3.74, 95% CI: 1.45, 9.60), and a household income of less than $75 000 per year (aOR = 3.13, 95% CI: 1.27, 7.70) were approximately three to four times more likely to be in the highest eBFP trajectory group relative to the lowest eBFP trajectory group. Males who reported a household income of <$75 000/year were almost twice as likely to be in the Group M3 than the Group M1 in the unadjusted model only (aOR = 1.79, 95% CI: 0.91, 4.01 vs unadjusted OR: 2.48, 95% CI: 1.22, 5.06). Lower socioeconomic status may be associated with excess body fat throughout adolescence in type 1 diabetes, particularly among females.

Keywords: adiposity; adolescent; diabetes mellitus; type 1.

Figure 1:. Recruitment/Inclusion Criteria.

Panel A: Study design of the SEARCH Cohort Study. Of note, the 06 and 08 incident years were not invited for the 12, 24, 60-month follow-ups, only the Cohort visit. Panel B: Flow chart depicting participants in this report, including reasons for exclusion. The final sample included 363 females and 376 males >10 years old with type 1 diabetes.

Figure 2:. Trajectories of Estimated Body Fat Percentage (eBFP) in Youth Ages 10+ with Type1 Diabetes in the SEARCH for Diabetes in Youth Study (n=363 females, n=376 males) over a mean follow-up of 107 months (with 95% confidence intervals).

Group-based trajectory modeling identified three distinct eBFP trajectories over a mean type 1 diabetes duration of 108 months in females (2A) and males (2B). All female trajectories showed gradual increases in eBFP (<5%) that plateaued by approximately 7 years of diabetes duration. Three distinct trajectories were defined by differences in baseline eBFP, including Group F1: lowest eBFP (38.0%; mean baseline eBFP: 27.8±3.0%); Group F2: moderate eBFP (47.9%; mean baseline eBFP: 33.9±3.0%), and Group F3: highest eBFP (14.1%; mean baseline eBFP: 41.7±4.1%). All male trajectories showed gradual decreases in eBFP (<5%) that plateaued by approximately 7 years of diabetes duration. Distinct trajectories were defined by differences in baseline eBFP. Including Group M1: Lowest eBFP (57.2%; mean baseline eBFP: 22.0±3.0%), Group M2: Moderate eBFP (30.9%; mean baseline eBFP), and Group M3: highest ebFP (12.0%; mean baseline eBFP: 36.1±3.7%).