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Association of body mass index and age with incident diabetes in Chinese adults: a population-based cohort study
  1. Ying Chen1,2,
  2. Xiao-Ping Zhang3,
  3. Jie Yuan1,
  4. Bo Cai4,
  5. Xiao-Li Wang3,
  6. Xiao-Li Wu3,
  7. Yue-Hua Zhang3,
  8. Xiao-Yi Zhang1,
  9. Tong Yin1,
  10. Xiao-Hui Zhu1,
  11. Yun-Juan Gu1,
  12. Shi-Wei Cui1,
  13. Zhi-Qiang Lu2,
  14. Xiao-Ying Li2
  1. 1 Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
  2. 2 Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
  3. 3 Department of Health Examination, Rich Healthcare Group, Shanghai, China
  4. 4 Nantong Center for Chronic and Noncommunicable Disease Control and Prevention, Center for Disease Control and Prevention, Nantong, China
  1. Correspondence to Professor Xiao-Ying Li; lixy{at}


Objective Type 2 diabetes mellitus is increasing in young adults, and greater adiposity is considered a major risk factor. However, whether there is an association between obesity and diabetes and how this might be impacted by age is not clear. Therefore, we investigated the association between body mass index (BMI) and diabetes across a wide range of age groups (20–30, 30–40, 40–50, 50–60, 60–70 and ≥70 years old).

Design We performed a retrospective cohort study using healthy screening programme data.

Setting A total of 211 833 adult Chinese persons >20 years old across 32 sites and 11 cities in China (Shanghai, Beijing, Nanjing, Suzhou, Shenzhen, Changzhou, Chengdu, Guangzhou, Hefei, Wuhan, Nantong) were selected for the study; these persons were free of diabetes at baseline.

Primary and secondary outcome measures Fasting plasma glucose levels were measured and information regarding the history of diabetes was collected at each visit. Diabetes was diagnosed as fasting plasma glucose ≥7.00 mmol/L and/or self-reported diabetes. Patients were censored at the date of diagnosis or the final visit, whichever came first.

Results With a median follow-up of 3.1 years, 4174 of the 211 833 participants developed diabetes, with an age-adjusted incidence rate of 7.35 per 1000 persons. The risk of incident diabetes increased proportionally with increasing baseline BMI values, with a 23% increased risk of incident diabetes with each kg/m2 increase in BMI (95% CI 1.22 to 1.24). Across all age groups, there was a linear association between BMI and the risk of incident diabetes, although there was a stronger association between BMI and incident diabetes in the younger age groups (age×BMI interaction, p<0.0001).

Conclusions An increased BMI is also independently associated with a higher risk of developing diabetes in young adults and the effects of BMI on incident diabetes were accentuated in younger adults.

  • type 2 diabetes
  • body mass index
  • young onset diabetes
  • ageing

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  • YC, X-PZ and JY contributed equally.

  • S-WC, Z-QL and X-YL contributed equally.

  • Contributors All authors approved thefinal version of the manuscript.

  • Funding This work is supported by grants from the National KeyResearch and Development Program of China (No.2016YFC1304801), Science andtechnology project of Nantong City (MS32016021).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Rich Healthcare Group Review Board, and the information was retrieved retrospectively.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at