Редукцията на теглото до 13 годишна възраст намалява риска от развитието на захарен диабет тип 2 в по-късна възраст

  • April 13, 2018
  • In a long-term epidemiologic study in Denmark, men who were overweight or obese as children had a greater risk of developing type 2 diabetes in adulthood than their slim peers — but their risk dropped back down if they lost weight by puberty and kept it off.

    “Our data showed that in this study population, men who had been overweight in childhood had a lower risk of type 2 diabetes if they had had remission of overweight before puberty (before 13 years of age),” Lise G Bjerregaard, PhD, Bispebjerg and Frederiksberg Hospital, in Copenhagen, Denmark, and colleagues write.

    “Since overweight during puberty appears to be a particularly important factor involved in increasing the risk of type 2 diabetes in middle and late adulthood, normalization of body mass index (BMI) before these ages may reduce this risk,” they suggest.

    The lack of data in women is a study limitation, the researchers admit, so “whether there are sex-related differences in the risk of type 2 diabetes after changes in weight status during childhood and adolescence remains to be investigated.”

    The study was published in the April 5 issue of the New England Journal of Medicine (2018;378:1302-1312).

    Childhood Until Puberty a Critical Time for Weight Loss

    Children with higher BMIs, even those below the overweight category, are at increased risk of developing type 2 diabetes as adults, and weight gain during puberty (a time of decrease in insulin sensitivity) may put them at higher risk, according to the researchers.

    It was not clear, however, if weight loss before puberty or early adulthood, or higher education levels might mitigate this risk.

    Bjerregaard and colleagues analyzed data from 62,565 men who were born in Denmark between 1939 and 1959 and had weight and height measured when they were 7 years old, 13 years old, and 17 to 26 years old.

    The researchers also had data for new-onset diabetes in these men from age 30 onwards until study end in 2015.

    As reported earlier, using the same data set researchers previously showed that being overweight at age 7 years but having a normal weight in early adulthood “erased” the increased risk of developing type 2 diabetes.

    Based on Centers for Disease Control and Prevention criteria, researchers defined overweight at ages 7, 13, and in early adulthood as a BMI of ≥ 17, ≥ 22, and ≥ 25 kg/m2, respectively.

    Being obese at ages 7, 13, and in early adulthood was defined as a BMI of ≥ 19, ≥ 25, and ≥ 28 kg/m2, respectively.

    At age 7 (in 1946 to 1966), 5.4% of the children were overweight, and by ages 17 to 26, 8.2% were overweight.

    Men who had been overweight as young boys but had a normal weight at puberty and as young adults had virtually the same risk of developing diabetes in adulthood as if they had never been overweight.

    Men who had been overweight at all three times had the highest risk of developing type 2 diabetes in adulthood, and men who were only overweight at ages 7 and 13 had an intermediate risk.

    Risk of Adult Diabetes, Overweight at Young Age Vs Always Normal Weight

    Age When Overweight, Years HR (95% CI)
    7 0.96 (0.75 – 1.21)
    7 and 13 1.47 (1.10 – 1.98)
    7, 13, and 17–26 4.14 (3.57 – 4.79)
    HR: hazard ratio

    Men who had been obese as children and then lost weight to become overweight young men had a much lower risk of type 2 diabetes than men who were persistently obese.

    “Our results show a graded and reversible effect of child overweight and obesity and indicate that patterns of increases in BMI matter,” the researchers write.

    These findings “support increased vigilance in men with large increases in BMI from childhood onward to mitigate the risk of type 2 diabetes.”

    This risk of developing diabetes was independent of intelligence or education.

    And “unsurprisingly,” being overweight as a child or youth had a stronger effect on risk of diabetes in middle rather than late adulthood, when the risk of diabetes increases as part of normal aging.

    Although the population grew up in a less obesogenic environment than today’s children, according to Bjerregaard and colleagues, “it is likely that our results apply to contemporary children with overweight who have remission of overweight before early adulthood.”

    The authors have disclosed no relevant financial relationships.

    N Engl J Med 2018;378:1302-1312. Abstract

     

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