Abstract
BackgroundWe assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin.MethodsNormoglycemic adolescents (range 16–20 years old), including 93,806 native Israelis (≥ 3rd generation in Israel) and 27,684 Israelis of Ethiopian origin, were medically assessed for military service between 1996 and 2011. Weight and height were measured. Data were linked to the Israeli National Diabetes Registry. Incident type 2 diabetes by December 31, 2016 was the outcome. Cox regression models stratified by sex and BMI categories were applied.Results226 (0.29%) men and 79 (0.18%) women developed diabetes during 992,980 and 530,814 person-years follow-up, respectively, at a mean age of 30.4 and 27.4 years, respectively. Among native Israeli men with normal and high (overweight and obese) BMI, diabetes incidence was 9.5 and 62.0 (per 105 person-years), respectively. The respective incidences were 46.9 and 112.3 among men of Ethiopian origin. After adjustment for sociodemographic confounders, the hazard ratios for type 2 diabetes among Ethiopian men with normal and high BMI were 3.4 (2.3–5.1) and 15.8 (8.3–30.3) respectively, compared to third-generation Israelis with normal BMI. When this analysis was limited to Israeli-born Ethiopian men, the hazard ratios were 4.4 (1.7–11.4) and 29.1 (12.9–70.6), respectively. Results persisted when immigrants of other white Caucasian origin were the reference; and among women with normal, but not high, BMI.ConclusionsEthiopian origin is a risk factor for early-onset type 2 diabetes among young men at any BMI, and may require selective interventions.
Highlights
We assessed in a nationwide cohort the association between adolescent body-mass index (BMI) and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin
Our goal was to assess whether the incidence of early-onset type 2 diabetes is higher in Israelis of Ethiopian origin than among native Israelis, and to assess whether this relation differs according to adolescent BMI, sex, and immigration status
Data of an additional 121,997 male adolescents who immigrated to Israel from former countries of the Union of Soviet Socialist Republics (USSR) during the same years as the immigration from Ethiopia were analyzed as part of sensitivity analyses
Summary
We assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin. Immigrants from low- and middle-income countries including those of African and other ancestries have been shown to have a disproportionately high risk for type 2 diabetes, which may be evident at a lower body-mass index (BMI) [8]. Among African immigrants to the US [8, 9] and to Europe [10] significantly higher risk for prediabetes and diabetes have been shown, compared to the native populations. Evidence among adolescent immigrants from Africa is limited, as this population is underrepresented in epidemiological studies and is frequently considered a homogenous group despite large ethnic variability [11, 12]
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