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New Findings on the Relationship Between Teen BMIs and Diabetes

Jun 20, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Maya Palmer, PharmD. Candidate, Florida A&M University College of Pharmacy

A study of Israeli teen BMIs finds body mass in adolescence affects risk of developing type 2 as an adult.  

Obesity has been a rising epidemic health issue, and specifically among the adolescent population, it has affected over 12.7 million children and teens in the United States alone. As the prevalence of obesity continues to rise, the incidence of type 2 diabetes in early adulthood among teens with severe obesity has been steadily rising. Several studies have analyzed and showed strong evidence for the relationship of obesity in  youth and the advancement of type 2 diabetes. This particular study analyzes the association between body mass index in adolescent males and females with incident diabetes.  

Male and female adolescents (between 16 and 19 years old) who had a medical evaluation in the year before mandatory military service, were the leading focus group of this study. By law, all health medical organizations had to report cases of diabetes to the Israel National Diabetes Registry (INDR) annually, which was established by the Israel Center for Disease Control to assess the state of diabetes morbidity. The primary outcome was type 2 diabetes incidences that were diagnosed during military service or later in life as recorded by the INDR. Data including body mass index (BMI), education, cognitive performance, socioeconomic status (SES), and country of origin were recorded. BMI was classified into subgroups based on the U.S. Centers for Disease Control and Prevention’s percentiles, and Kaplan Meier survival curves were created for the BMI categories. Researchers used Cox proportional hazard models to get the hazard ratios (HRs) and 95% CI for incident diabetes. The population-attributable risk percent (PAR%) of type 2 diabetes, which is the proportion of the incidence of disease in the population due to exposure, was calculated for both overweight and obesity (> 85th BMI percentile) subgroups. 

After a median follow-up of 11.3 years, results exhibited a significant correlation between gender, BMI, and type 2 diabetes incidence (P = 0.023). Cumulatively, the prevalence of type 2 diabetes was seen as more than two folds higher among adolescents with severe obesity than those with mild obesity or a healthy BMI. The HRs among men came to be 1.7 (95% CI 1.4-2.0) in the 50th-70th percentile, 2.8 (2.3-3.5) for the 75th-84th percentile, 5.8 (4.9-6.9) for the overweight group, 13.4 (11.5-15.7) for the mild obesity group, and 25.8 (21.0-31.6) for the severe obesity group. As for women, the HRs were 2.2 (1.6-2.9) for the 50th-70th percentile, 3.4 (2.5-4.6) for the 75th-84th percentile, 10.6 (8.3-13.6) for the overweight group, 21.1 (16.0-27.8) for the mild obesity group, and lastly, 44.7 (32.4-61.5) for the severe obesity group. The hazard ratios remained high for the overweight, mild, and severe obesity subgroups when looking specifically at the group who had an onset of diabetes before the age of 25. When looking at the fractions of incident type 2 diabetes that was caused by being overweight and obesity, results were 51.5% for men and 54.6% for women. As for the PAR%, with 5-year intervals, the projected numbers of overweight and obesity among men and women for the years 2015-2016 were 56.9% and 60.6%, respectively.    

An increase of type 2 diabetes occurrence was proven to be higher in adulthood among adolescent men and women with severe obesity. The study revealed that the women’s teenage group with obesity were at a higher risk than men. This finding aligned with a separate trial conducted in the U.S.; girls who developed obesity before the age of 16 had more than a two-fold higher risk of developing diabetes in adulthood than those who whose obesity happened later. This higher risk in women could be due to the early age in which they experience puberty. It could also be a result of decreased physical activity or due to BMI reflecting fat mass better in women than in men. Ultimately, further studies could be conducted using fasting blood glucose data within adolescent ages, which could allow researchers to better assess the risk of developing type 2 diabetes in adulthood. 

Practice Pearls:  

  • Adolescent men and women with severe obesity are at a higher risk of type 2 diabetes onset in adulthood. 
  • Young women with obesity have the highest risk of developing type 2 diabetes perhaps due to early puberty, decreased physical activity, or BMI reflecting body mass better than with men. 
  • Further studies are needed that include fasting blood glucose level data to assess the risk of type 2 diabetes development in adulthood. 

 

Reference for “New Findings on the Relationship Between Teen BMIs and Diabetes”:
Twig, Gilad, et al.
Adolescent Obesity and Early-Onset Type 2 Diabetes. Diabetes Care, 2020, p.dc191988., doi:10.2337/dc19-1988. 

 

Maya Palmer, PharmD. Candidate, Florida A&M University College of Pharmacy 

 

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