Do all fat kids become diabetics? If not, who does?
As GPs we often see little kids already carrying extra weight and we know that many of these will go on to become overweight or obese adults. Many overweight kids and overweight adults will go on to develop type 2 diabetes. Interestingly, some obese kids don’t go on to become diabetic. Which subsets of these overweight kids don’t go on to develop diabetes? What if the overweight kid skinny up when they become adults? Are they still at risk? What about normal weight kids that become overweight adolescents and young adults? Are they at risk too?
We know that high BMI at a young adult age is associated with T2D later on in life (1,2). High childhood BMI or low birth weight is also associated with increased risk of adult T2D (3-10). The physiology during childhood and during puberty are actually very different. Is the childhood BMI the risk factor or the adult BMI the risk factor? Does the degree of weight gain matter?
In a study from four populations where BMI was measured both in childhood at 3-19 years of age and later in the same participants at 30-40 years of age, overweight adults had increased risk of adult type 2 diabetes regardless of BMI status during childhood (6). The risk in overweight children was similar to the risk in participants who were never overweight. However, the number of overweight subjects in that study was too underpowered to draw a valid conclusion (10). On the other hand, excessive BMI increase during puberty has been associated with CVD, stroke and heart failure in a number of studies (11-13).
The BMI Epidemiology Study Gothenburg (BEST Gothenburg) studied the impact of birthweight, childhood and adolescent BMI on adult diseases. 36,176 men born between 1945-1961 with information on both childhood BMI at age 8 and BMI change during puberty (BMI at age 20 – BMI at age 8) were included and followed until December 2013. There were 1,777 cases of type 2 diabetes before the end of follow-up and the median age at diagnosis was 55.7 years. When they break down those that developed diabetes, they found:
- High adult BMI and a high childhood BMI are associated with increased risk of T2D
- Overweight kids and a high BMI increase during puberty was associated with increased risk of adult T2D. The risk was more pronounced for early (<55.7 years) compared with late (>55.7 years) onset T2D.
- Overweight adolescents also had a substantially increased risk of T2D compared with men who were never overweight (as kids or as young adults) irrespective of whether they were overweight as a child
- Men who were overweight both at childhood and young adult age had a nearly four-fold increased risk of adult T2D compared with men that were never overweight
- Most interestingly, men who were overweight as kids but skinny up (normalised) during puberty did not have an increased risk of T2D
The authors speculate that a high BMI increase during puberty might result in increased risk of type 2 diabetes via expansion of visceral fat mass, resulting in low-grade inflammation and insulin resistance.
It would appear that childhood and adult BMI are independent risk factor for the development of T2D. From this study, the BMI change during puberty is an important determinant of adult T2D risk. As these overweight kids frequent our practices during that period, we could reduce their adult T2D risk.
Access the abstract here.
- de Mutsert R, Sun Q, Willett WC, Hu FB, van Dam RM. Overweight in early adulthood, adult weight change, and risk of type 2 diabetes, cardiovascular diseases, and certain cancers in men: a cohort study. Am J Epidemiol 2014; 179:1353-1365
- Tirosh A, Shai I, Afek A, Dubnov-Raz G, Ayalon N, Gordon B, Derazne E, Tzur D, Shamis A, Vinker S, Rudich A. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med 2011; 364:1315-1325
- Zimmermann E, Bjerregaard LG, Gamborg M, Vaag AA, Sorensen TIA, Baker JL. Childhood body mass index and development of type 2 diabetes throughout adult life-A large-scale danish cohort study. Obesity (Silver Spring) 2017; 25:965-971
- Eriksson JG, Kajantie E, Lampl M, Osmond C. Trajectories of body mass index amongst children who develop type 2 diabetes as adults. J Intern Med 2015; 278:219-226
- Charakida M, Khan T, Johnson W, Finer N, Woodside J, Whincup PH, Sattar N, Kuh D, Hardy R, Deanfield J. Lifelong patterns of BMI and cardiovascular phenotype in individuals aged 60-64 years in the 1946 British birth cohort study: an epidemiological study. Lancet Diabetes Endocrinol 2014; 2:648-654
- Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, Srinivasan SR, Daniels SR, Davis PH, Chen W, Sun C, Cheung M, Viikari JS, Dwyer T, Raitakari OT. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365:1876-1885
- Morrison JA, Glueck CJ, Horn PS, Wang P. Childhood predictors of adult type 2 diabetes at 9- and 26-year follow-ups. Arch Pediatr Adolesc Med 2010; 164:53-60 Sabin MA, Magnussen CG, Juonala M, Shield JP, Kahonen M, Lehtimaki T, Ronnemaa T, Koskinen J, Loo BM, Knip M, Hutri-Kahonen N, Viikari JS, Dwyer T, Raitakari OT. Insulin and BMI as predictors of adult type 2 diabetes mellitus. Pediatrics 2015; 135:e144-151
- Hypponen E, Power C, Smith GD. Prenatal growth, BMI, and risk of type 2 diabetes by early midlife. Diabetes Care 2003; 26:2512-2517
- Park MH, Sovio U, Viner RM, Hardy RJ, Kinra S. Overweight in childhood, adolescence and adulthood and cardiovascular risk in later life: pooled analysis of three british birth cohorts. PLoS One 2013; 8:e70684
- Zimmermann E, Gamborg M, Sorensen TI, Baker JL. Sex Differences in the Association Between Birth Weight and Adult Type 2 Diabetes. Diabetes 2015; 64:4220-4225
- Ohlsson C, Bygdell M, Sonden A, Rosengren A, Kindblom JM. Association between excessive BMI increase during puberty and risk of cardiovascular mortality in adult men: a population-based cohort study. Lancet Diabetes Endocrinol 2016; 4:1017-1024
- Ohlsson C, Bygdell M, Sonden A, Jern C, Rosengren A, Kindblom JM. BMI increase through puberty and adolescence is associated with risk of adult stroke. Neurology 2017; 89:363-369
- Kindblom JM, Bygdell M, Sonden A, Celind J, Rosengren A, Ohlsson C. BMI change during puberty and the risk of heart failure. J Intern Med 2018;
- Claes Ohlsson M.D., Ph.D., Maria Bygdell Pharm.D., Maria Nethander M.Sc., Annika Rosengren M.D., Ph.D., Jenny M Kindblom M.D., Ph.D. BMI change during puberty is an important determinant of adult type 2 diabetes risk in men. The Journal of Clinical Endocrinology & Metabolism. First Online: December 04, 2018. DOI: 10.1210/jc.2018-01339