Timing and Duration of Obesity in Relation to Diabetes: Findings from an ethnically diverse, nationally representative sample
NATALIE S. THE
PHD
ANDREA S. RICHARDSON
PENNY GORDON-LARSEN
PHD
E p i d e m i o l o g y / H e a l t h OBJECTIVEdThe influence on diabetes of the timing and duration of obesity across the highrisk period of adolescence to young adulthood has not been investigated in a population-based, ethnically diverse sample. RESEARCH DESIGN AND METHODSdA cohort of 10,481 individuals aged 12-21 years enrolled in the U.S. National Longitudinal Study of Adolescent Health (1996) was followed over two visits during young adulthood (18-27 years, 2001-2002; 24-33 years, 2007-2009). Separate logistic regression models were used to examine the associations of diabetes (A1C $6.5% or diagnosis by a health care provider) in young adulthood with 1) obesity timing (never obese, onset ,16 years, onset 16 to ,18 years, onset $18 years) and 2) obesity duration over time (never obese, incident obesity, fluctuating obesity, and persistent obesity), testing differences by sex and race/ethnicity. RESULTSdAmong 24- to 33-year-old participants, 4.4% had diabetes (approximately half were undiagnosed), with a higher prevalence in blacks and Hispanics than whites. In multivariable analyses, women who became obese before age 16 were more likely to have diabetes than women who became obese at or after age 18 (odds ratio 2.77 [95% CI 1.39-5.52]), even after accounting for current BMI, waist circumference, and age at menarche. Persistent (vs. adult onset) obesity was associated with increased likelihood of diabetes in men (2.27 [1.41-3.64]) and women (2.08 [1.34-3.24]). CONCLUSIONSdDiabetes risk is particularly high in individuals who were obese as adolescents relative to those with adult-onset obesity, thus highlighting the need for diabetes prevention efforts to address pediatric obesity.
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D stantially over the last few decades,
iabetes prevalence has risen
subdisproportionately affecting racial/
ethnic minorities (1,2). In 2007, 24
million Americans had diabetes; nearly 6
million were undiagnosed (3). The total
cost of diabetes in 2007 was estimated
to be $174 billion (4), and this economic
burden is likely to escalate over time. The
adverse health and economic
consequences combined with significant racial/
ethnic disparities and high rates of
undiagnosed diabetes emphasize the critical
need to address this disease.
Although the links between current
obesity and type 2 diabetes are clear, some
research suggests that a history of obesity
during childhood (5,6) and young
adulthood (7) increases diabetes risk later in
life. However, the differential and
cumulative effects of obesity during different
periods of the life span on the
development of diabetes are not well
documented. In particular, adolescence may be a
sensitive period for the development of
diabetes given the substantial decreases
in insulin sensitivity associated with
pubertal development (8). This period has
c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c
the potential for alterations in insulin
metabolism, which might increase diabetes
risk later in life, and there is the potential
that a longer duration of obesity might
elicit additional metabolic changes that
increase future diabetes risk (9,10).
With obesity, pancreatic b-cells initially
increase insulin release to overcome the
reduced efficiency of insulin action,
although over time compensation may
become insufficient, ultimately leading to
the development of diabetes (9,10).
Nevertheless, epidemiologic research
specifically examining the relationship between
duration of obesity with diabetes in
adulthood has yielded inconsistent results
(1116). A better understanding of the
relationship of obesity timing and
duration to diabetes in adulthood is needed to
determine important periods for diabetes
intervention, particularly in diverse
ethnic groups.
In this article, we use nationally
representative, longitudinal data to
examine racial/ethnic differences in rates of
diagnosed and undiagnosed diabetes in
young adults. In addition, we capitalize
upon longitudinal data to examine how
adolescent-onset obesity and adult-onset
obesity might differentially relate to
diabetes risk in young adulthood and
whether these associations differ by sex
and race/ethnicity. We hypothesize that
individuals who experienced
adolescent(vs. adult onset) obesity would be more
likely to have diabetes in young adulthood,
independent of current body size, with the
highest risk among those with persistent
obesity from the teen to adult years.
RESEARCH DESIGN AND
METHODS
National Longitudinal Study of
Adolescent Health
The National Longitudinal Study of
Adolescent Health (Add Health) is a cohort of
adolescents (N = 20,745; ages 1121
years), representative of the U.S. school
population in grades 7 to 12 in 1994
1995 (wave I) and followed into young
adulthood. Wave II (1996; n = 14,738;
ages 1222 years) included wave I
adolescents who had not graduated from
high school (including those who had
dropped out o (...truncated)