Being overweight in childhood, persisting into puberty and early adulthood, is associated with an increased risk of subsequent type 2 diabetes.
A study was done to answer the question as to whether remission of overweight before early adulthood reduces this risk for diabetes. Danish men with weight and height data available from childhood and early adulthood were studied to evaluate the association between the risk of type 2 diabetes in adulthood and childhood overweight that remits before adulthood.
The study was done involving 62,565 Danish men whose weights and heights had been measured at 7 and 13 years of age and in early adulthood (17 to 26 years of age). Overweight was defined in accordance with the Centers for Disease Control and Prevention criteria. Data on type 2 diabetes status (at age ≥30 years, 6710 persons) were obtained from a national health registry.
Overweight at 7 years of age (3373 of 62,565 men; 5.4%), 13 years of age (3418 of 62,565; 5.5%), or early adulthood (5108 of 62,565; 8.2%) was positively associated with the risk of type 2 diabetes; associations were stronger at older ages of overweight and at younger ages at diagnosis of type 2 diabetes. Men who had had remission of overweight before the age of 13 years had a risk of having type 2 diabetes diagnosed at 30 to 60 years of age that was similar to that among men who had never been overweight. As compared with men who had never been overweight, men who had been overweight at 7 and 13 years of age but not during early adulthood had a higher risk of type 2 diabetes, but their risk was lower than that among men with persistent overweight. An increase in body-mass index between 7 years of age and early adulthood was associated with an increased risk of type 2 diabetes, even among men whose weight had been normal at 7 years of age.
Lifestyle interventions that are aimed at weight loss in adults have been found to delay the onset of type 2 diabetes in persons who are at high risk for the condition. In children, it is now well established that higher body-mass index (BMI) values, even at levels far below current overweight classifications, are associated with increased risks of type 2 diabetes in adulthood. This raises the question of whether weight loss in children who are overweight or obese can reduce the risk of type 2 diabetes later in life. Not all studies have shown beneficial effects.
Because more than 23% of children worldwide are overweight or have obesity, it is important to know whether the adverse effects of childhood overweight on the risk of type 2 diabetes are reversible if remission to normal weight occurs before adulthood. Moreover, it is important to establish whether increases in weight that occur during the critical period of puberty — a period that is associated with a marked decrease in insulin sensitivity — also play a central role in the later development of type 2 diabetes.
Since the risk of childhood obesity and the risk of diabetes in adulthood are inversely associated with socioeconomic status, it is likely that associations between remission of overweight and the risk of type 2 diabetes are influenced by socioeconomic conditions.
Thus, the data also 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 (i.e., before 13 years of age). Remission of overweight after that age but before early adulthood was associated with a risk of type 2 diabetes that was markedly lower than that among men who had been overweight at every age. Overweight around puberty and early adulthood was associated with higher risks of type 2 diabetes than was overweight only in early adulthood. 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 BMI before these ages may reduce this risk.
- Childhood overweight at 7 and 13 years of age which persists into puberty and early adulthood is associated with an increased risk of subsequent type 2 diabetes.
- Associations between remission of overweight and the risk of type 2 diabetes can be influenced by socioeconomic conditions.
- Men who had been overweight in early adulthood had the highest incidence of type 2 diabetes.
N Engl J Med. 2018 Apr 5;378(14):1302-1312. doi: 10.1056/NEJMoa1713231.