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T2DM risk

Young people can avoid T2DM risk if they lose weight early

(Credit: Victovoi)
BMI in early adult life was independently associated with later diabetes risk, but not with MI and stroke risks
Men who were obese when they were 50 had increased chances of suffering a heart attack, stroke or diabetes

A study examining the BMI of people when they were young and compared it to when they were middle aged to see whether it affected their risk of heart attack, stroke or diabetes, has found that they can reduce their chances of developing life threatening illness around if they change before middle age. The outcomes from The British Regional Heart Study (BRHS), published in BMJ Open in the paper, ‘Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study’, reported that males who had high BMI levels at 21, but had lowered their BMI by the time they were 50, had similar or lower rates of diabetes as people who were normal weight when younger.

"Even in men who carried out UK National Service and were relatively thin in early life compared to more recent men, higher levels of fatness in early adult life appear to be associated with later diabetes," said lead researcher, Professor Christopher Owen from St George's University of London, UK. "However, effects of early body mass appear to be reversible by subsequent weight loss. These findings have important implications for Type 2 diabetes prevention, especially in more recent adults with high levels of obesity."

However, men who were obese when they were 50 had increased chances of suffering a heart attack, stroke or diabetes.

The British Regional Heart Study (BRHS) is a prospective study of cardiovascular disease, and type 2 diabetes among middle-aged and older British men. It is based on 7,735 men born between 1919 and 1939 who were recruited in 1978–1980 aged 40–59 years from a single general practice in 24 British towns (78% response rate), and were followed up until the present. Study men completed a detailed questionnaire on entry to the study (including information on pre-existing cardiovascular disease, type 2 diabetes and other medical conditions, smoking status, physical activity, alcohol intake and social class) and had measurements of weight and height, measured with participants in light clothing without shoes. Weight was measured to the last 0.1kg using regularly calibrated scales and height to the last complete 0.1cm using a Harpenden stadiometer. Participants then completed periodic postal questionnaires about their health in 1983–1985, 1992 and 1996; in 1996, they were asked to recall their weight at age 21 years. Men have been followed up over a 30-year period for mortality, morbidity and disability with <2% loss to follow-up.

Outcomes

In all, 4,842 men (63% of the original cohort) had data on height and weight at both ages (ie, BMI-21 and BMI-50), smoking at BRHS baseline and 30 years of follow-up data for type 2 diabetes, MI and stroke. Weight data at 21 years of age were based on military records for 2,205 (44%) men; measured weight at age 20–22 years was obtained directly for 1,258 men and imputed from weights between 17 and 19 years or between 23 and 25 years of age for 947 men. Weight at age 21 years was recalled from middle age for the remaining 2,832 men. A subset of 694 men with both recalled and measured weight in early adult life allowed bias in recalled weight to be quantified; modest overestimation of true weight among thinner men was observed.

Similar numbers were obtained for height at 21 years of age, with 1,244 men measured between 20 and 22 years of age, 963 measured between 17 and 19 or 23 and 25 years and with 2,830 imputed from middle age (allowing for a very small amount of shrinkage). Mean BMI50 was only marginally higher among the 2,890 men excluded from analysis compared with those included (BMI25.6 vs 25.4, p=0.025).

Among 4,846 (63%) men with complete data, a 1kg/m2 higher BMI at 21 years was associated with a 6% (95% CI 4% to 9%) higher type 2 diabetes risk, compared with a 21% (95% CI 18% to 24%) higher diabetes risk for a 1 kg/m2 higher BMI in middle age (hazard ratio (HR) 1.21, 95% CI 1.18 to 1.24). Higher BMI in middle age was associated with a 6% (95% CI 4% to 8%) increase in MI and a 4% (95% CI 1% to 7%) increase in stroke; BMI at 21 years showed no associations with MI or stroke risk.

Therefore, the authors report that BMI in early adult life was independently associated with later diabetes risk, but not with MI and stroke risks. BMI in middle age was more strongly associated with type 2 diabetes, and was also associated with MI and stroke risks.

“The results suggest that BMI in early adult life may have an independent influence on later type 2 diabetes risk rather than on cardiovascular disease,” the authors conclude. “However, the results of the life course analyses presented here suggest that the increase in diabetes risk associated with high early adult BMI may be particularly important among men who have an elevated BMI in middle age; the absence of an increase in diabetes risk among men who had a high early BMI but a normal BMI in middle age suggests that the effects of high early BMI on diabetes may be reversible at least in part.”

To access this paper, please click here

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