Abstract
Childhood obesity, defined by cutoffs based on the weight-based marker of body mass index, is associated with adult type 2 diabetes (T2D) risk. Whether childhood fat mass (FM) is the driver of these associations is currently unknown. To quantify and compare height-independent associations between childhood FM and weight with adult T2D risk in a historic Danish cohort. This population-based retrospective cohort study included schoolchildren from The Copenhagen School Health Records Register born between January 1930 and December 1985 with follow-up to adulthood through December 31, 2015. Analyses were based on 269 913 schoolchildren aged 10 years with 21 896 established adult T2D cases and 261 192 children aged 13 years with 21 530 established adult T2D cases for whom childhood height and weight measurements, as well as predicted FM, were available. Statistical analyses were performed between April 2019 to August 2020. Childhood FM and weight at ages 10 and 13 years. Diagnoses of T2D were established by linkage to national disease registers for adults aged at least 30 years. Sex-specific Cox regression quantified associations, adjusted for childhood height, which were evaluated within 5 birth-cohort groups. Group-specific results were pooled using random-effects meta-analyses accounting for heterogeneity across group-specific associations. This cohort study analyzed data from 269 913 children aged 10 years (135 940 boys [50.4%]) with 21 896 established adult T2D cases and 261 192 children aged 13 years (131 025 boys [50.2%]) with 21 530 established adult T2D cases. After adjusting for childhood height, increases in FM and weight (per kilogram) among boys aged 10 years were associated with elevated T2D risks at age 50 years of 12% (hazard ratio [HR], 1.12; 95% CI, 1.10-1.14) and 7% (HR, 1.07; 95% CI, 1.05-1.09), respectively, and among girls aged 10 years of 15% (HR, 1.15; 95% CI, 1.13-1.17) and 10% (HR, 1.10; 95% CI, 1.08-1.11), respectively. Among children aged 13 years, increases in FM and weight (per kilogram) were associated with increased T2D risks at age 50 years of 10% (HR, 1.10; 95% CI, 1.09-1.10) and 6% (HR, 1.06; 95% CI, 1.05-1.07) for boys, respectively, and of 10% (HR, 1.10; 95% CI, 1.10-1.11) and 7% (HR, 1.07; 95% CI, 1.06-1.08), respectively, for girls. This cohort study found that a 1-kg increase in childhood FM was more strongly associated with increased adult T2D risk than a 1-kg increase in weight, independent of childhood height. Information on FM, rather than weight-based measures, focuses on a modifiable component of weight that may be associated with adult T2D risk. These findings support the assessment of childhood FM in adiposity surveillance initiatives in an effort to reduce long-term T2D risk.
Highlights
Obesity is a substantial global public health issue in both childhood and adulthood
After adjusting for childhood height, increases in fat mass (FM) and weight among boys aged 10 years were associated with elevated type 2 diabetes (T2D) risks at age 50 years of 12% and 7% (HR, 1.07; 95% CI, 1.05-1.09), respectively, and among girls aged 10 years of 15% (HR, 1.15; 95% CI, 1.13-1.17) and 10% (HR, 1.10; 95% CI, 1.08-1.11), respectively
This cohort study found that a 1-kg increase in childhood FM was more strongly associated with increased adult T2D risk than a 1-kg increase in weight, independent of childhood height
Summary
Obesity is a substantial global public health issue in both childhood and adulthood. The World Health Organization estimated that in 2016 there were more than 340 million children and adolescents aged 5 to 191 years worldwide affected by overweight (including obesity) and a further 41 million younger than age 5 years.[1]. Previous studies in children and adolescents have shown significant cross-sectional associations between FM and cardiometabolic risk factors,[14,15] which have been of comparable magnitude to those of BMI,[14] there is little or no information, to our knowledge, on the long-term associations between fat-based measures in childhood and their associations with incident T2D in adulthood. This lack of data reflects the limited number of long-term cohort studies with information on childhood FM as well as established adult T2D diagnoses. We examined the height-independent associations between childhood FM and weight with adult T2D risk among a large Danish cohort of schoolchildren born between 1930 and 1985, measured in childhood and followed up for T2D incidence in adulthood.[17]
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