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. 2022 Mar 21:46:101356.
doi: 10.1016/j.eclinm.2022.101356. eCollection 2022 Apr.

Body mass index in adolescence, risk of type 2 diabetes and associated complications: A nationwide cohort study of men

Andréasson Karin  1 , Edqvist Jon  1   2 , Adiels Martin  3 , Björck Lena  1   4 , Lindgren Martin  1   5 , Sattar Naveed  6 , Lind Marcus  1   2   7 , Åberg Maria  8   9 , Rosengren Annika  1   5
Affiliations

Body mass index in adolescence, risk of type 2 diabetes and associated complications: A nationwide cohort study of men

Andréasson Karin et al. EClinicalMedicine. .

Abstract

Background: Obesity is a predominant factor in development of type 2 diabetes but to which extent adolescent obesity influences adult diabetes is unclear. We investigated the association between body mass index (BMI) in young men and subsequent type 2 diabetes and how, in diagnosed diabetes, adolescent BMI relates to glycemic control and diabetes complications.

Methods: Baseline data from the Swedish Conscript Register for men drafted 1968-2005 was combined with data from the National Diabetes and Patient registries. Diabetes risk was estimated through Cox regression and Kaplan-Meier survival estimates. Relationships between BMI, glycemic control and diabetes complications were assessed through multiple linear and logistic regression.

Findings: Among 1,647,826 men, 63,957 (3·88%) developed type 2 diabetes over a median follow-up of 29.0 years (IQR[21.0-37.0]). The risk of diabetes within 40 years after conscription was nearly 40% in individuals with adolescent BMI ≥35 kg/m2. Compared to BMI 18·5-<20 kg/m2 (reference), diabetes risk increased in a linear fashion from HR 1·18(95%CI 1·15-1·21) for BMI 20-<22·5 kg/m2 to HR 15·93(95%CI 14·88-17·05) for BMI ≥35 kg/m2, and a difference in age at onset of 11·4 years was seen. Among men who developed diabetes, higher adolescent BMI was associated with higher HbA1c levels and albuminuria rates.

Interpretation: Rising adolescent BMI was associated with increased risk of type 2 diabetes diagnosed at a younger age, with poorer metabolic control, and a greater prevalence of albuminuria, all suggestive of worse prognosis.

Keywords: obesity; type 2 diabetes.

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Conflict of interest statement

NS has consulted for Affimune, Amgen, Astrazeneca, Boehringer Ingelheim, Eli-Lilly, Novartis, Novo Nordisk, Pfizer and Sanofi and received grant support from Boehringer Ingelheim. MLind has consulted for Astra Zeneca, Boehringer Ingelheim, DexCom, Eli-Lilly, MSD and Novo Nordisk, and received research grants from Eli-Lilly and Novo Nordisk, all outside the submitted work. Remaining authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Kaplan Meier Survival curve for incident type 2 diabetes stratified by body mass index at conscription. Kaplan Meier survival estimates. Individuals at risk by each 10-year period are presented at the bottom of the figure. Regions around lines denote 95% CI. Abbreviations: body mass index (BMI). Log rank test p-value: 2 × 10−16.
Figure 2
Figure 2
Hazard ratio and incidence rates for the risk of incident type 2 diabetes during follow- up, stratified by body mass index at conscription. Analyses were based on Cox regression. Model 1, adjusted for age, year of conscription and center. Model 2, adjusted for age, year of conscription and center, cardiorespiratory fitness, and muscle strength. Rate as events per 10,000 person years. Abbreviations: body mass index (BMI).
Figure 3
Figure 3
Mean adjusted values for continuous risk factors and odds ratio for albuminuria post diagnosis for type 2 diabetes predicted by BMI at conscription and by BMI at first registration in NDR. Linear Model Estimation using Ordinary Least Square (panels A, C, D) and logistic regression (panel B). All models adjusted for age and diabetes duration. BMI tied with 4 equal knots. Abbreviations: body mass index (BMI). Systolic blood pressure adjusted for use of antihypertensive medication. LDL adjusted for use of statins. Number of patients missing due to missing data (outcome or covariates): Panel A = 9809; Panel B = 33,365; Panel C = 12,358, Panel D = 27,593.
Figure 4
Figure 4
Riverplot decribing patterns of weight change among indivuals who were diagnosed with type 2 diabetes between the time of conscription and post diagnosis (registration in the NDR). Abbreviations: body mass index (BMI). Thickness of the lines represent the number of participants at the corresponding level of BMI.
See this image and copyright information in PMC

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