Keywords
Diabetes mellitus, Body mass index, Weight
Abstract
Objective: Obesity is a known risk factor for diabetes, but the effect of weight changes on the incidence of diabetes is not yet certain. This study aims to evaluate the long-term effects of weight change [based on body mass index (BMI)] on the incidence of diabetes mellitus (DM) in a middle eastern population.
Method: In the Isfahan Cohort Study (ICS) 6504 adults equal or greater than 35 years of age were recruited at 2001 and were followed until 2013. The absolute BMI changes (ΔBMI) were calculated by subtracting the baseline BMI from the BMI measured at follow-ups. To make a comparison between participants with different baseline BMI easier, relative changes in BMI were quantified as the percentage of changes from baseline. DM was assessed based on standard definitions. Multivariable Cox regression was used to determine the association of ΔBMI and the incidence of diabetes.
Results: During follow-ups, 261 new cases of diabetes were recorded, with an IR of 3401.29 per 100,000 P-Y. Highest number of new cases of type 2 DM belongs to participants with overweight and obesity who had minimal BMI changes (less than 5% of their baseline BMI limits; 42 and 38 new cases, respectively). Participants who were obese at baseline and had lost more than 10% or gained 5-10% of baseline BMI were in the groups with the highest IR [360.05 - 95% CI (239.3-541.8) and 322.39 – 95% CI (178.5-582.1) respectively]. There was no significant association between BMI changes and the incidence of DM in the participants with normal BMI, overweight, and obesity at baseline in cure and adjusted models.
Conclusion: This study showed that there was no significant association between diabetes mellitus incidence and BMI changes.
References
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30. Mi B, Wu C, Gao X, Wu W, Du J, Zhao Y, et al. Long-term BMI change trajectories in Chinese adults and its association with the hazard of type 2 diabetes: evidence from a 20-year China Health and Nutrition Survey. 2020;8(1).
31. Nagaya T, Yoshida H, Takahashi H, Kawai M. Increases in body mass index, even within non-obese levels, raise the risk for Type 2 diabetes mellitus: a follow-up study in a Japanese population. Diabetic medicine : a journal of the British Diabetic Association. 2005;22(8):1107-11.
32. Koh-Banerjee P, Wang Y, Hu FB, Spiegelman D, Willett WC, Rimm EB. Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men. American journal of epidemiology. 2004;159(12):1150-9.
33. Kodama S, Horikawa C, Fujihara K, Yoshizawa S, Yachi Y, Tanaka S, et al. Quantitative relationship between body weight gain in adulthood and incident type 2 diabetes: a meta-analysis. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2014;15(3):202-14.
34. Galaviz KI, Weber MB, Straus A, Haw JS, Narayan KMV, Ali MK. Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose. 2018;41(7):1526-34.
2. Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers. Clinical diabetes : a publication of the American Diabetes Association. 2016;34(1):3-21.
3. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives. Nature reviews Endocrinology. 2011;8(4):228-36.
4. Harati H, Hadaegh F, Saadat N, Azizi F. Population-based incidence of Type 2 diabetes and its associated risk factors: results from a six-year cohort study in Iran. BMC public health. 2009;9:186.
5. Musaiger AO. Overweight and obesity in eastern mediterranean region: prevalence and possible causes. Journal of obesity. 2011;2011.
6. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. The Lancet. 2005;366(9497):1640-9.
7. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes care. 1994;17(9):961-9.
8. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Annals of internal medicine. 1995;122(7):481-6.
9. Djalalinia S, Peykari N, Qorbani M, Moghaddam SS, Larijani B, Farzadfar F. Obesity researches over the past 24 years: A scientometrics study in Middle East countries. International journal of preventive medicine. 2015;6.
10. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine. 2002;346(6):393-403.
11. Penn L, White M, Lindström J, den Boer AT, Blaak E, Eriksson JG, et al. Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT. PloS one. 2013;8(2):e57143.
12. Lindström J, Eriksson JG, Valle TT, Aunola S, Cepaitis Z, Hakumäki M, et al. Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: results from a randomized clinical trial. Journal of the American Society of Nephrology : JASN. 2003;14(7 Suppl 2):S108-13.
13. Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes research and clinical practice. 2005;67(2):152-62.
14. Wing RR, Venditti E, Jakicic JM, Polley BA, Lang W. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes care. 1998;21(3):350-9.
15. Long SD, O'Brien K, MacDonald KG, Jr., Leggett-Frazier N, Swanson MS, Pories WJ, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study. Diabetes care. 1994;17(5):372-5.
16. Schienkiewitz A, Schulze MB, Hoffmann K, Kroke A, Boeing H. Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. The American journal of clinical nutrition. 2006;84(2):427-33.
17. Wannamethee SG, Shaper AG, Walker M. Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes. Journal of epidemiology and community health. 2005;59(2):134-9.
18. Kaneto C, Toyokawa S, Miyoshi Y, Suyama Y, Kobayashi Y. Long-term weight change in adulthood and incident diabetes mellitus: MY Health Up Study. Diabetes research and clinical practice. 2013;102(2):138-46.
19. Higgins M, D'Agostino R, Kannel W, Cobb J, Pinsky J. Benefits and adverse effects of weight loss. Observations from the Framingham Study. Annals of internal medicine. 1993;119(7 Pt 2):758-63.
20. Oguma Y, Sesso HD, Paffenbarger RS, Jr., Lee IM. Weight change and risk of developing type 2 diabetes. Obesity research. 2005;13(5):945-51.
21. French SA, Folsom AR, Jeffery RW, Zheng W, Mink PJ, Baxter JE. Weight variability and incident disease in older women: the Iowa Women's Health Study. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 1997;21(3):217-23.
22. Talaei M, Thomas GN, Marshall T, Sadeghi M, Iranipour R, Oveisgharan S, et al. Appropriate cut-off values of waist circumference to predict cardiovascular outcomes: 7-year follow-up in an Iranian population. Internal medicine (Tokyo, Japan). 2012;51(2):139-46.
23. Lemieux S, Mongeau L, Paquette MC, Laberge S, Lachance B. Health Canada's new guidelines for body weight classification in adults: challenges and concerns. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2004;171(11):1361-3.
24. Sadeghi M, Talaei M, Parvaresh Rizi E, Dianatkhah M, Oveisgharan S, Sarrafzadegan N. Determinants of incident prediabetes and type 2 diabetes in a 7-year cohort in a developing country: The Isfahan Cohort Study. Journal of diabetes. 2015;7(5):633-41.
25. Wild SH, Byrne CD. ABC of obesity. Risk factors for diabetes and coronary heart disease. BMJ (Clinical research ed). 2006;333(7576):1009-11.
26. Sarrafzadegan N, Talaei M, Sadeghi M, Mohammadifard N, Taheri M, Lotfizadeh M, et al. Determinants of weight change in a longitudinal study of Iranian adults: Isfahan Cohort Study. Archives of Iranian medicine. 2014;17(8):539-44.
27. Mohammadifard N, Sajjadi F, Maghroun M, Alikhasi H, Nilforoushzadeh F, Sarrafzadegan N. Validation of a simplified food frequency questionnaire for the assessment of dietary habits in Iranian adults: Isfahan Healthy Heart Program, Iran. ARYA atherosclerosis. 2015;11(2):139-46.
28. Sarrafzadegan N, Gharipour M, Sadeghi M, Nezafati P, Talaie M, Oveisgharan S, et al. Metabolic Syndrome and the Risk of Ischemic Stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2017;26(2):286-94.
29. Ye M, Robson PJ, Eurich DT, Vena JE, Xu JY, Johnson JA. Changes in body mass index and incidence of diabetes: A longitudinal study of Alberta's Tomorrow Project Cohort. Preventive medicine. 2018;106:157-63.
30. Mi B, Wu C, Gao X, Wu W, Du J, Zhao Y, et al. Long-term BMI change trajectories in Chinese adults and its association with the hazard of type 2 diabetes: evidence from a 20-year China Health and Nutrition Survey. 2020;8(1).
31. Nagaya T, Yoshida H, Takahashi H, Kawai M. Increases in body mass index, even within non-obese levels, raise the risk for Type 2 diabetes mellitus: a follow-up study in a Japanese population. Diabetic medicine : a journal of the British Diabetic Association. 2005;22(8):1107-11.
32. Koh-Banerjee P, Wang Y, Hu FB, Spiegelman D, Willett WC, Rimm EB. Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men. American journal of epidemiology. 2004;159(12):1150-9.
33. Kodama S, Horikawa C, Fujihara K, Yoshizawa S, Yachi Y, Tanaka S, et al. Quantitative relationship between body weight gain in adulthood and incident type 2 diabetes: a meta-analysis. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2014;15(3):202-14.
34. Galaviz KI, Weber MB, Straus A, Haw JS, Narayan KMV, Ali MK. Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose. 2018;41(7):1526-34.