Life-course trajectories of weight and their impact on the incidence of type 2 diabetes

Diego Yacamán-Méndez,Per Tynelius,Anton Lager,Antonio Monteiro Ponce De Leon,Hrafnhildur Gudjonsdottir,Ylva Trolle-Lagerros,Minhao Zhou

doi:10.1038/s41598-021-91910-z

Diego Yacamán-Méndez, Per Tynelius + Show 5 more

Open Access

https://doi.org/10.1038/s41598-021-91910-z

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Abstract

Although exposure to overweight and obesity at different ages is associated to a higher risk of type 2 diabetes, the effect of different patterns of exposure through life remains unclear. We aimed to characterize life-course trajectories of weight categories and estimate their impact on the incidence of type 2 diabetes. We categorized the weight of 7203 participants as lean, normal or overweight at five time-points from ages 7–55 using retrospective data. Participants were followed for an average of 19 years for the development of type 2 diabetes. We used latent class analysis to describe distinctive trajectories and estimated the risk ratio, absolute risk difference and population attributable fraction (PAF) associated to different trajectories using Poisson regression. We found five distinctive life-course trajectories. Using the stable-normal weight trajectory as reference, the stable overweight, lean increasing weight, overweight from early adulthood and overweight from late adulthood trajectories were associated to higher risk of type 2 diabetes. The estimated risk ratios and absolute risk differences were statistically significant for all trajectories, except for the risk ratio of the lean increasing trajectory group among men. Of the 981 incident cases of type 2 diabetes, 47.4% among women and 42.9% among men were attributable to exposure to any life-course trajectory different from stable normal weight. Most of the risk was attributable to trajectories including overweight or obesity at any point of life (36.8% of the cases among women and 36.7% among men). The overweight from early adulthood trajectory had the highest impact (PAF: 23.2% for woman and 28.5% for men). We described five distinctive life-course trajectories of weight that were associated to increased risk of type 2 diabetes over 19 years of follow-up. The variability of the effect of exposure to overweight and obesity on the risk of developing type 2 diabetes was largely explained by exposure to the different life-course trajectories of weight.

Highlights

The prevalence of high body weight, including overweight and obesity, has increased considerably over the last several decades, making it one of the main contributors to the global burden of disease and a pressing public health concern[1, 2]
We found that the variability of the effect of exposure to overweight and obesity on the risk of developing type 2 diabetes can be largely explained by the different life-course trajectories of exposure
Around half of the cases of type 2 diabetes were attributed to exposure to any life-course trajectory other than a stable normal weight though life

Summary

Introduction

The prevalence of high body weight, including overweight and obesity, has increased considerably over the last several decades, making it one of the main contributors to the global burden of disease and a pressing public health concern[1, 2]. There is a strong association between high body weight and increased risk of type. Epidemiological evidence of the association between body weight and type 2 diabetes usually comes from studies linking weight status at a certain point in time or some measure of cumulative exposure to the occurrence of type 2 diabetes, typically several years later in life[10,11,12,13,14]. Studies looking into a single time of exposure ignore the time-varying effects of changes in weight through different stages of life, while measures of cumulative exposure assume a constant effect at different ages, ignoring important physiological changes in metabolism as well as in social and behavioral factors related to age. Longitudinal studies usually ignore the important differences observed between individuals exposed to overweight or obesity by generalizing the effect of exposure across the population. Studies covering the whole life span, from childhood to adulthood, are scarce

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