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Investigators followed 5076 American Indian children and adolescents for up to 25 years. Participants were classified as pre-adolescent (birth–8 years), early adolescent (8–13 years), and late adolescent (13–18 years). Z scores for weight—standardized for age, sex, and height—and for weight velocity (change/year) were calculated during each period. Incident diabetes developed in 13.8% of pre-adolescents, 20.2% of early adolescents, and 26.8% of late adolescents. In the first 10 years of follow-up, the Z score for weight was associated most strongly with incidence of diabetes in early adolescence. The Z score for weight velocity was associated most strongly with incidence of diabetes in pre-adolescence. In all growth periods, higher weight and faster weight gain were associated with increased risk of type 2 diabetes.
During pre-adolescence, higher weight and faster weight gain were associated jointly with the highest risk of type 2 diabetes.
This abstract is available on the publisher's site.
The aim of this work was to examine the associations of average weight and weight velocity in three growth periods from birth through adolescence with type 2 diabetes incidence.
Child participants were selected from a 43 year longitudinal study of American Indians to represent three growth periods: pre-adolescence (birth to ~8 years); early adolescence (~8 to ~13 years); and late adolescence (~13 to ~18 years). Age-, sex- and height-standardised weight z score mean and weight z score velocity (change/year) were computed for each period. Participants were followed for up to 25 years from the end of each growth period until they developed diabetes. Associations of weight z score mean or weight z score velocity with diabetes incidence were determined with sex-, birth date- and maternal diabetes-adjusted Poisson regression models.
Among 2100 participants representing the pre-adolescence growth period, 1558 representing the early adolescence period and 1418 representing the late adolescence period, there were 290, 315 and 380 incident diabetes cases, respectively. During the first 10 years of follow-up, the diabetes incidence rate ratio (95% CI) was 1.72 (1.40, 2.11)/SD of log10 weight z score mean in pre-adolescence, 2.09 (1.68, 2.60)/SD of log10 weight z score mean in early adolescence and 1.85 (1.58, 2.17)/SD of log10 weight z score mean in late adolescence. The diabetes incidence rate ratio (95% CI) was 1.79 (1.49, 2.17)/SD of log10 weight z score velocity in pre-adolescence, 1.13 (0.91, 1.41)/SD of log10 weight z score velocity in early adolescence and 1.29 (1.09, 1.51)/SD of log10 weight z score velocity in late adolescence. There were strong correlations in the weight z score means and weak correlations in the weight z score velocities between successive periods.
Higher weight and accelerated weight gain in all growth periods associate with increased type 2 diabetes risk. Importantly, higher weight and greater weight velocity during pre-adolescence jointly associate with the highest type 2 diabetes risk. Graphical abstract.