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Living With Family Obesity Raises Risk for Type 2 Diabetes

Jan 26, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Annahita Forghan, Pharm.D. Candidate 2019, LECOM College of Pharmacy

Increased awareness of nontraditional risk factors may decrease disease diagnosis.

It is important for healthcare professionals to evaluate patients’ health overall instead of only their immediate problem in order to prevent diseases, progression of disease, and complications. Being able to predict chronic diseases like type 2 diabetes may become easier with increased knowledge of diabetes risk factors, such as living with a family member who has obesity.1

Two non-genetic risk factors have already been looked at for type 2 diabetes — obesity (in the patients themselves) and phys­ical inactivity. It has been demonstrated that the environment plays a much greater role than genetics for type 2 diabetes and for obesity. After accounting for all traditional risk factors for type 2 diabetes, a Clinical Diabetes study found that a person residing in the same household as even one (or more) biologically related family member who has obesity will be at risk of acquiring type 2 diabetes.1

The Medical Expenditure Panel Survey (MEPS) was used in this study to obtain health status, health care expenditures, and health insurance coverage information for each household. In the first-year interview, people were included if they did not have diabetes yet and they were living with at least one blood relative in the same home. In the second-year interview, people under 30 years of age and people who were already using insulin were excluded so that the study could ensure that only recently diagnosed patients with type 2 diabetes cases were included. After the exclusion criteria was met, there were 40,707 U.S. residents remaining.1

The participants who were included in the final sample were analyzed to find a correlation between obesity in the family members with whom the participants were living and the incidence of diabetes. A new occurrence of diabetes in a study case was a category for any participant who did not have diabetes in the first year of the study’s MEPS collection, but who reported a diagnosis of diabetes the second year. To categorize obesity in the participants, reported body mass index (BMI) was collected in the survey’s first year. An increase of ≥5% in BMI from the first year to the second was used as an indicator to be further analyzed. Family obesity was defined as over three-fourths of the oth­er family members being obese (BMI ≥30 kg/m2).1

The effect of family obesity was isolated from the ef­fect of family diabetes on the chance of being newly diag­nosed with diabetes. Poverty, consultation on intake of high-fat or high-cholesterol food, sex, hypertension, smoking status, and race/ethnicity were all accounted for.1  Stata SE 14.1 (StataCorp, College Station, Tex.) and a logistic regression model were used to analyze the probability of onset of diabetes. In the survey’s second year, 0.89% of the total study sample had a diagnosed onset of diabetes.1

This study went on to show that “living in a household in which at least three-fourths of an individual’s biological family members had obesity was positively and independently related to diabetes incidence (P <0.05)” was also true in the absence of diabetes in these family members. “If an individual was liv­ing in a household without diabetes but where at least 75% of the family had obesity, then that individual’s risk of diabetes increased by 0.24 percent­age points (P <0.05) from 0.75% to 0.99%. Nationally, this last estimate amounts to ~238,000 people per year in the United States who can be predicted to be newly diagnosed with type 2 diabetes based solely on family obesity.”1

With this kind of association, family obesity is a serious risk factor that individuals should be made aware of. A notified individual can take more care in monitoring risk-related habits and preventing the disease. This study had a large and diverse sample, which makes its conclusions stronger. However, there were some limitations in the study such as complete family histories not being collected, which could have skewed results.

Practice Pearls:

  • More non-traditional risk factors for predicting onset of type 2 diabetes are needed in order to prevent diabetes for a large portion of the American population.
  • The study excluded people who had type 1 diabetes. Onset of type 2 diabetes was examined over a 2-year survey on the participants’ household information.
  • If an individual is living in a household where at least ¾ of the family members have obesity, this individual is at risk of developing type 2 diabetes, regardless of if the family members have diabetes or not.

References:

Encinosa, William; Kumar, Virender; Thakur, Hena; Thakur, Kisha. “Just Living With Obese Family Members Increases Your Risk of Type 2 Diabetes.” Clinical Diabetes 2018 Oct; 36(4): 305-311. http://clinical.diabetesjournals.org/content/36/4/305.full-text.pdf. 8 January 2019.

Annahita Forghan, Pharm.D. Candidate 2019, LECOM College of Pharmacy