Long-term weight change in adulthood and incident diabetes mellitus: MY Health Up Study

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Abstract

Aim

To investigate whether long-term weight/BMI change in adulthood has a significant impact on the incidence of diabetes, independent of attained weight status.

Methods

A number of 13,700 participants (2962 men and 10,738 women) aged 36 to 55 years were followed for up to 5 years using data from annual health checkups. Incident cases of diabetes were identified from self-reports or single fasting plasma glucose measurements (≥7.0 mmol/l). Weight/BMI change was calculated from participants’ weight/BMI values at age 20 years and weight/BMI values at a given point during follow-up and used as a time-dependent variable in age-stratified multivariate Cox proportional hazards models.

Results

During the 5 year follow-up, 408 participants (137 men and 271 women) developed diabetes. Even after adjusting for BMI during follow-up and other possible confounders, weight/BMI gain since age 20 years was significantly associated with an increased risk of developing diabetes. The hazard ratios were: 2.30 (95% confidence interval (CI): 1.31–4.04) for those who gained 6.0 to <10.0 kg and 3.09 (95% CI: 1.79–5.34) for those who gained ≥10.0 kg [reference: <2.0 kg change]; and 2.61 (95% CI: 1.58–4.31) for those who gained 3.0 to <5.0 kg/m2 and 3.70 (95% CI: 2.22–6.16) for those who gained ≥5.0 kg/m2 [reference: <1.0 kg/m2 change].

Conclusions

The results indicate that long-term weight/BMI gain in adulthood is a significant predictor for the development of diabetes, independent of attained weight status. Because weight gain within the normal weight range could increase the risk of diabetes, non-obese people should also be warned against possible weight gain.

Introduction

The worldwide prevalence of diabetes mellitus is rapidly increasing. The total number of people with diabetes worldwide was estimated at 366 million in 2011 and is expected to rise to 552 million by 2030 [1]. Additionally, the total number of deaths attributable to diabetes in 2011 was estimated at 4.6 million, equivalent to 8.2% of global all-cause mortality for that year [1]. Japan was estimated as the country with the sixth highest number of people with diabetes in 2011, with 10.7 million people having the disease [1]. The increasing burden of diabetes in Japan and other countries suggests that prevention of this disease is of great public health significance.

Obesity is a major risk factor for diabetes. Body mass index (BMI) is often used to assess the degree of obesity. In Japan, obesity is defined as BMI  25.0 kg/m2, normal weight as a BMI between 18.5 and 25.0 kg/m2, and underweight as a BMI < 18.5 kg/m2, based on the criteria proposed by the Japan Society for the Study of Obesity [2]. The WHO reported that globally 44% of the diabetes burden in 2004 could be attributed to overweight (i.e. BMI  25.0 kg/m2 by WHO criteria) and obesity (i.e. BMI  30.0 kg/m2 by WHO criteria) [3]. Having a higher BMI has also been shown to increase the risk of diabetes even in non-obese people [4], [5]. Additionally, people of Asian origin have been reported to develop diabetes with lower BMIs than those of European origin [6], [7].

Several studies have indicated that, in addition to weight status assessed at a single point in time, change in weight status during a certain period of time may also be a significant predictor of diabetes [4], [8], [9], [10], [11], [12], [13]. However, the impact of weight change on the incidence of diabetes remains unclear; Jacobs-van der Bruggen et al. [14] noted that many studies have investigated the association between weight change and diabetes incidence with an adjustment for initial weight status assessed at the beginning of the period of weight change. They suggested that to determine whether weight change itself yields a significant effect on diabetes incidence independently of current weight level one should take into account attained weight status assessed at the end of the period of weight change. To date, only three follow-up studies have examined the impact of weight change on diabetes incidence while controlling for attained weight status. Of these, one study revealed a positive relationship [15] while the others did not [14], [16].

The present study investigated the association between weight change since age 20 years and incident diabetes among Japanese workers. The aim of this study was to determine whether long-term weight change had a significant impact on the incidence of diabetes, independent of the effect of attained weight status. We hypothesized that weight change itself would be an independent predictor of diabetes.

Section snippets

Participants and data

Participants in the current study included employees of a large insurance company that has branches throughout Japan. The MY Health Up Study [17], [18], [19] was developed in 2004 as part of a health promotion project within the company. This project aimed to utilize the results of health questionnaires and annual health checkups to improve the overall health status of its workers. In October 2004, self-administered questionnaires were distributed to all company employees. Specifically,

Results

Of 34,300 employees who answered the questionnaire and had a health checkup in 2004, 13,700 employees (2962 men and 10,738 women) were eligible for the present study (Fig. 1). Table 1 summarizes the baseline characteristics of these participants and the results of the bivariate analyses. During the 5-year follow-up, 408 participants (137 men and 271 women) developed diabetes. The crude incidence rate per 1000 person-years was 7.0 (9.9 for men and 6.1 for women). Larger weight/BMI gain was

Discussion

In this 5-year follow-up study of Japanese workers aged 36 to 55 years, we demonstrated that long-term weight/BMI gain since age 20 years was significantly associated with an increased risk of developing diabetes, independent of the effect of attained weight status. Even after adjusting for BMI during follow-up and other possible confounders, weight gain (≥6.0 kg) and BMI gain (≥3.0 kg/m2) still significantly predicted the risk of diabetes.

The impact of weight change itself on the development of

Conflict of Interest

The authors declare that they have no conflict of interest.

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