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Possible Modifiers of the Association Between Change in Weight Status

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Possible Modifiers of the Association Between Change in Weight Status 1000 Diabetes Care Volume 43, May 2020 fi Lise G. Bjerregaard,1 Niko Wasenius,2,3 Possible Modi ers of the Rozenn Nedelec,4,5 Line K. Gjærde,1 Lars Angquist,¨ 1,6 Karl-Heinz Herzig,7,8 Association Between Change Gorm B. Jensen,9 Erik L. Mortensen,10 Merete Osler,1,11 Kim Overvad,12 in Weight Status From Child Tea Skaaby,1 Anne Tjønneland,13,14 Thorkild I.A. Sørensen,6,11 Through Adult Ages and Later Marjo-Riitta Jarvelin,¨ 4,5,15,16 Johan G. Eriksson,2,3,17,18 Risk of Type 2 Diabetes Sylvain Sebert,4,5,19 and Jennifer L. Baker1,6 Diabetes Care 2020;43:1000–1007 | https://doi.org/10.2337/dc19-1726 1Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark 2Department of General Practice and Primary OBJECTIVE Health Care, University of Helsinki and Helsinki We investigated the association between changes in weight status from childhood University Hospital, Helsinki, Finland through adulthood and subsequent type 2 diabetes risks and whether educa- 3Folkhalsan¨ Research Center, Helsinki, Finland 4 tional attainment, smoking, and leisure time physical activity (LTPA) modify this Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland association. 5 EPIDEMIOLOGY/HEALTH SERVICES RESEARCH Biocenter Oulu, University of Oulu, Oulu, Finland 6Novo Nordisk Foundation Center for Basic RESEARCH DESIGN AND METHODS Metabolic Research, Human Genomics and Using data from 10 Danish and Finnish cohorts including 25,283 individuals, Metagenomics in Metabolism, University of childhood BMI at 7 and 12 years was categorized as normal or high using age- and Copenhagen, Copenhagen, Denmark 7Research Unit of Biomedicine, Department of sex-specific cutoffs (<85th or ‡85th percentile). Adult BMI (20–71 years) was Physiology and Biocenter Oulu, Medical Research categorized asnonobese or obese (<30.0 or ‡30.0 kg/m2,respectively). Associations Center, University of Oulu, Oulu University Hos- between BMI patterns and type 2 diabetes (989 women and 1,370 men) were pital, Oulu, Finland 8Department of Gastroenterology and Metab- analyzed using Cox proportional hazards regressions and meta-analysis techniques. olism, Poznan University of Medical Sciences, Poznan, Poland RESULTS 9The Copenhagen City Heart Study, Bispebjerg and Compared with individuals with a normal BMI at 7 years and without adult obesity, Frederiksberg Hospital, Frederiksberg, Denmark 10 those with a high BMI at 7 years and adult obesity had higher type 2 diabetes risks Department of Public Health and Center for – – Healthy Aging, University of Copenhagen, Co- (hazard ratio [HR]girls 5.04 [95% CI 3.92 6.48]; HRboys 3.78 [95% CI 2.68 5.33]). penhagen, Denmark Individuals with a high BMI at 7 years but without adult obesity did not have a higher 11Section of Epidemiology, Department of Public risk (HRgirls 0.74 [95% CI 0.52–1.06]; HRboys 0.93 [95% CI 0.65–1.33]). Education, Health, Faculty of Health and Medical Sciences, smoking, and LTPA were associated with diabetes risks but did not modify or University of Copenhagen, Copenhagen, Denmark 12Section for Epidemiology, Department of Public confound the associations with BMI changes. Results for 12 years of age were Health, Aarhus University, Aarhus, Denmark similar. 13Danish Cancer Society Research Center, Copen- hagen, Denmark CONCLUSIONS 14Section of Environmental Health, Department A high BMI in childhood was associated with higher type 2 diabetes risks only if of Public Health, Faculty of Health and Medical fl Sciences, University of Copenhagen, Copenha- individuals also had obesity in adulthood. These associations were not in uenced by gen, Denmark educational and lifestyle factors, indicating that BMI is similarly related to the risk 15Department of Epidemiology and Biostatistics, across all levels of these factors. MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, U.K. Even though child and adult BMI (in kilograms per meters squared) are positively 16Department of Life Sciences, College of Health associated with the risk of developing type 2 diabetes, the effects of changes in weight and Life Sciences, Brunel University London, London, U.K. status between childhood and adulthood are not well understood. Previous studies 17Department of Obstetrics and Gynaecology, indicate that children with overweight who remit from it before adulthood may re- Yong Loo Lin School of Medicine, National Uni- duce their risk of type 2 diabetes (1–6). Further, some studies find being persistently versity of Singapore, Singapore care.diabetesjournals.org Bjerregaard and Associates 1001 overweight from childhood to adulthood and in adulthood (.18 years), as well as If individuals participated in more than carries higher risk of type 2 diabetes information on educational attainment, one examination, we preferentially chose than being overweight only in adulthood smoking,andLTPA(Supplementary Table the one at the youngest adult age. (1,2,4). 1). Among the cohorts included in the High BMI in childhood was defined The development of childhood obesity DynaHEALTH consortium, 10 cohorts were as $85th BMI percentile at 7 or 12 years has a strong social gradient (7), and in eligible. Eight were subsamples of adult based on sex- and age-specific BMI per- adult life, inverse associations between research studies (16–22), among whom centiles for the Copenhagen cohorts, the socioeconomic status and educational at- the participants, who were born from NFBC1966 and HBCS, respectively (Sup- tainment and risks of obesity and type 2 1930 to 1981, were included in a Danish plementary Table 2). Obesity in adult- diabetes are well established (8,9). It may school cohort from Copenhagen (23) hood was defined in accordance with the be hypothesized that individuals of low (N 5 19,717) (Supplementary Table 1). World Health Organization criteria (BMI socioeconomic status are more vulner- Additionally, the Northern Finland Birth $30 kg/m2) (30). Patterns of high BMI able to health risks associated with over- Cohort 1966 (NFBC1966) was included. were defined as combinations of high weight. Yet, there is sparse evidence in It includes individuals born in the two BMI in childhood at 7 or 12 years of age this research area (10–12). Only one of northernmost provinces of Finland in and obesity in adulthood. Moreover, a the previous studies focusing on changes 1966 who participated in a clinical exam- BMI pattern with eight categories was in weight status and type 2 diabetes ination in adulthood (N 5 3,985 included) defined accordingtocombinations ofhigh evaluated a potential multiplicative in- (24–26). Finally, the Helsinki Birth Cohort BMIs at 7 years (yes/no) and/or 12 years teractionwith educational attainment on Study (HBCS) contributed with individuals (yes/no) and/or adult obesity (yes/no). these associations (4). Moreover, pre- who were born between 1934 and 1944 At the time of the adult BMI assess- viousstudies are limited byincluding only at the Helsinki University Central Hospi- ment, information on educational attain- one sex (1,4,5), having a low number of tal, attended child welfare clinics in the ment, current smoking (yes/no), and LTPA diabetes case subjects (n , 237) (2,3,6), city, went to school in the city of Helsinki, was obtained by questionnaire. Educa- or ending follow-up in middle adulthood and attended a clinical examination in tional attainment was categorized into (3,6). Further, smoking and lower levels adulthood (N 5 1,581 included) (27). The 0–7 (short), 8–10 (medium), or .10 (long) of leisure time physical activity (LTPA) are cohorts are described in detail elsewhere years of schooling. One cohort used cat- associated with higher risks of develop- (16–24,27). egorizations of 7–9, 10, and .10 years ing type 2 diabetes (13,14), but these All studies were performed in accor- due to the definition in the questionnaire were not investigated as modifying fac- dance with the Helsinki 2 Declaration. The (17). The available information in each tors in the studies on changes in weight project was conducted on anonymous cohort consisted of three to six levels of status and type 2 diabetes. data, and it was approved by the Danish either LTPA or energy expenditure, and it The aim of this study was toinvestigate Data Protection Agency (Datatilsynet). was categorized into three groups cor- the association between changes in weight responding to low (,2 h/week), medium status from childhood to adulthood and Assessment of Variables (light physical activity 2–4 h/week), and the risk of developing type 2 diabetes in Body height and weight were used for high (light physical activity $4 h/week Danish and Finnish cohorts and whether calculation of BMI (weight in kilograms or moderate activity $2 h/week) (HBCS: this association is modified by socioeco- divided by height in meters squared) and less than two times per week, two to four nomic and lifestyle factors. It was hypoth- prospectively measured at school health times per week, and greater than four esized that high BMI at child and adult ages examinations and recorded in health re- times per week). has stronger associations with type 2 di- cords. In the Danish cohorts, BMI at the abetes among individuals with short edu- exact ages of 7 and 12 years were ob- Assessment of Type 2 Diabetes cational attainment, those who smoked, tained by interpolation between succes- Information on type 2 diabetes was ob- and individuals with low levels of LTPA. sive measurements around that age or by tained by linking unique personal identi- extrapolation always within 612 months fication numbers (27,31) of the cohort RESEARCH DESIGN AND METHODS (28). In the Finnish cohorts, BMIs from participants to computerized and com- Study Population $6.0 to ,8 years of age and from $11.0 prehensive health registers. During the The study population was drawn from to ,13 years of age were included as follow-upperiod,,0.6%oftheindividuals cohorts participating in the DynaHEALTH 7-year or 12-year measurements, respec- emigrated, they were censored on this consortiumthat aimstobuild an empirical tively (29).
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