Rapid Increase in Adolescent BMI Predicts Adult Obesity, Diabetes

November 6, 2018

How can adolescent body mass index influence T2DM risk later in adulthood? A new study offers insight.

Tao Zhang, MD, PhD, and fellow researchers in the US and China have discovered a positive relationship between the rapidity of increasing body mass index (BMI) during adolescence and obesity with diabetes in adulthood. Click through the slides below for details on their study and take home points for clinical practice.

Childhood Body Composition, Diabetes. BMI is closely associated with T2DM and research has shown that obesity early in life is a risk factor for adult T2DM. Authors of this study looked at how steeper increasing slopes of BMI at certain ages influences weight and risk for T2DM later in life and aimed to characterize longitudinal BMI trajectory profile and relate them to future body composition and adult T2DM risk.

The Study. Authors formed a longitudinal cohort consisting of 2449 participants from the Bogalusa Heart Study, which focused on early natural history of CVD and childhood risk factors. Authors recorded data on fasting glucose, self-reported T2DM, medications, and regular examinations for BMI determination. Participants were defined as having T2DM if they had a fasting plasma blood glucose level of ≥7.0 mmol/L or were taking glucose-lowering medication in adulthood; prediabetes was classified as a fasting plasma glucose level between 5.6–6.9 mmol/L.

The Results:

BMI increased faster in black female participants starting at age 10 vs other race-sex groups
Hyperglycemic participants had higher BMI levels and linear slopes at age 20.1 years vs normoglycemic group
BMI slopes were higher in hyperglycemic subjects at age 20.1 years, but ceased to be significant at age 20-35 years
ORs significantly greater than 1.0 between 10–19 yrs (OR 1.17–1.50), with peak (OR 1.50, p<.001) at age 16 yrs
ORs for adjusted linear slopes of BMI significantly greater than 1.0 between age 13-19 years for prediabetes and T2DM

Take Home Points:

Adolescence is a critical period when changes in body composition may lead to serious adulthood health issues
In all patients, be vigilant for body composition changes, weight gain, and poor dietary patterns; in young people focus on early recognition and prevention
Vigorously encourage a healthy diet, active lifestyle, and close monitoring of weight in children and adolescents

Perspective. “This study represents important work toward disease prevention vs the traditional paradigm of symptom treatment after the fact. The majority of allopathic medical effort is placed on the treatment of health conditions while prevention and education have long remained an unfortunate afterthought," stated the slideshow author, Gregory M. Weiss, MD. "More and more we are recognizing the large impact on quality of life, long-term health, and skyrocketing costs that preventing health problems has over treating them. The authors should be commended on their conclusions that recognize the early window of opportunity for preventing obesity and T2DM that may lead to healthier adults and reduced costs of care.”

Reference: Zhang T, Xu J, Li S, et al. Trajectories of childhood BMI and adult diabetes: the Bogalusa Heart Study. Diabetologia. 2018.