Excess Body Mass Index: A Modifiable Risk Factor for Type 1 Diabetes Development?

Christine Ferrara, Susan Geyer, Carmella Evans- Molina, Ingrid Libman, Dorothy Becker, Yuk-Fun Liu, Rachel Besser, Lisa Rafkin, Henry Rodriguez, Antoinette Moran, Stephen Gitelman

Research output: Contribution to journalMeeting abstractpeer-review

5 Citations (Scopus)

Abstract

In the past decade, there has been a global rise in incidence of type 1 diabetes (T1D) paralleling the increased incidence of obesity. To determine whether excess body weight is a modifiable risk factor for T1D development, we performed an analysis using longitudinal body mass index (BMI) data in 1150 pediatric antibody positive relatives (age 2-20yo) enrolled in the TrialNet Pathway to Prevention Study. Median baseline BMI%ile was 64.7%ile (IQR:-37.4 to 85.2), with 14% of participants classified as overweight (BMI 85-95%ile) and 12% as obese (BMI >95%ile). Median follow-up for T1D-free subjects was 3.0 years (range: 0.5-10.5), with 224 (19.4%) subjects developing T1D. Dynamic changes in BMI were evaluated as an aggregate measure using interval-based cumulative excess in relation to the reference BMI (85%ile) based on age and gender. The median annual excess BMI was -1.86 (IQR: -3.6 to 0.003) and was further characterized by quartiles, where the upper quartile corresponded to persistent overweight or obese status. Subjects who were on average above the 85%ile BMI threshold over time had a significantly higher rate of T1D (HR=1.61; p=0.028). Subgroup multivariate analysis revealed a significant interaction between excess BMI over time and age. Individuals 8-13 years old at baseline who on average over time were persistently overweight or obese had an increased risk of diabetes (HR=1.69, p=0.017), with a 5-year risk of 40.2% versus 29.7% in individuals of average normal BMI. The effects of excess BMI in relation to diabetes risk were not seen in those <8 years old or 14-20 years old at baseline (p=0.34 and 0.20, respectively). Our longitudinal analysis demonstrates that peripubertal individuals may be uniquely vulnerable to the effects of excess body weight in the progression to T1D. This subset of participants in the TrialNet Pathway to Prevention Study may benefit from lifestyle modifications to delay or prevent T1D.
Original languageEnglish
JournalDiabetes
Volume65
Issue numbersupplement 1
Publication statusPublished - 1 Jun 2016

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