Obesity and Diabetes: Your Age Matters
Obesity and Diabetes: Your Age Matters
The NS, Richardson AS, Gordon-Larsen P
Diabetes Care. 2013;36:865-872
The National Longitudinal Study of Adolescent Health enrolled a cohort of adolescents 11-21 years of age who were representative of the US school population in grades 7-12 in 1994-1995 (wave 1). The current study focused on respondents from waves 3 and 4, which were conducted in 2001-2002 and 2008-2009, respectively. The young adults were 24-33 years of age and were also wave 1 respondents.
Height, weight, and A1c data were collected during in-home surveys. Participants with an A1c ≥ 6.5% but who responded "no" to having ever been told that they have diabetes were considered undiagnosed.
Obesity was defined as the age- and sex-specific 95th percentile of body mass index (BMI) or as a BMI ≥ 30 kg/m. Duration of obesity was classified as never obese, incident obesity (nonobese at baseline but became and remained obese), fluctuating obesity, and persistent obesity (obese at all waves).
Obesity timing was determined using the individual's age at initial obesity classification. It was categorized as never obese, young adolescent obesity (onset before age 16 years), adolescent obesity (onset at 16-18 years of age), and adult obesity (onset at 18 years of age or older).
Among participants 24-33 years of age, 4.4% had diabetes, approximately one half of whom had undiagnosed disease. However, this varied dramatically by race. Among white patients, about 21% of cases were undiagnosed. Among black patients, who had the highest rates of diabetes, 77% had undiagnosed disease, and 43% of Hispanic persons with diabetes had undiagnosed disease.
The aims of the current study were to assess the influence of timing and duration of obesity on diabetes. The finding that diabetes is undiagnosed in at least one half of young adults with this disease is cause for concern.
Data from the National Health and Nutrition Examination Survey (NHANES) previously suggested that about one third of cases of diabetes in young adults are undiagnosed; therefore, the present findings are not too alarming. However, the large racial and ethnic disparities that were found cannot be overlooked. NHANES estimates that about 24% of diabetes is undiagnosed in non-Hispanic black persons, but the current results are more than 3 times greater than that. Of note, the proportions of undiagnosed cases in the current study among Hispanic persons and in NHANES among Mexican-American persons were nearly identical.
The other important finding was that persistent obesity more than doubled the risk for diabetes compared with recent-onset obesity, probably because beta-cell production can compensate for obesity-related insulin resistance for only so long. This has ramifications for the allocation of diabetes prevention and treatment efforts. We know that lifestyle interventions can reduce diabetes risk, but the current findings suggest that such interventions may be most effective if started earlier in the course of obesity. More aggressive and invasive treatments, such as bariatric surgery, could then be reserved for patients with long-term obesity.
Abstract
Timing and Duration of Obesity in Relation to Diabetes: Findings From an Ethnically Diverse, Nationally Representative Sample
The NS, Richardson AS, Gordon-Larsen P
Diabetes Care. 2013;36:865-872
Study Summary
The National Longitudinal Study of Adolescent Health enrolled a cohort of adolescents 11-21 years of age who were representative of the US school population in grades 7-12 in 1994-1995 (wave 1). The current study focused on respondents from waves 3 and 4, which were conducted in 2001-2002 and 2008-2009, respectively. The young adults were 24-33 years of age and were also wave 1 respondents.
Height, weight, and A1c data were collected during in-home surveys. Participants with an A1c ≥ 6.5% but who responded "no" to having ever been told that they have diabetes were considered undiagnosed.
Obesity was defined as the age- and sex-specific 95th percentile of body mass index (BMI) or as a BMI ≥ 30 kg/m. Duration of obesity was classified as never obese, incident obesity (nonobese at baseline but became and remained obese), fluctuating obesity, and persistent obesity (obese at all waves).
Obesity timing was determined using the individual's age at initial obesity classification. It was categorized as never obese, young adolescent obesity (onset before age 16 years), adolescent obesity (onset at 16-18 years of age), and adult obesity (onset at 18 years of age or older).
Among participants 24-33 years of age, 4.4% had diabetes, approximately one half of whom had undiagnosed disease. However, this varied dramatically by race. Among white patients, about 21% of cases were undiagnosed. Among black patients, who had the highest rates of diabetes, 77% had undiagnosed disease, and 43% of Hispanic persons with diabetes had undiagnosed disease.
Viewpoint
The aims of the current study were to assess the influence of timing and duration of obesity on diabetes. The finding that diabetes is undiagnosed in at least one half of young adults with this disease is cause for concern.
Data from the National Health and Nutrition Examination Survey (NHANES) previously suggested that about one third of cases of diabetes in young adults are undiagnosed; therefore, the present findings are not too alarming. However, the large racial and ethnic disparities that were found cannot be overlooked. NHANES estimates that about 24% of diabetes is undiagnosed in non-Hispanic black persons, but the current results are more than 3 times greater than that. Of note, the proportions of undiagnosed cases in the current study among Hispanic persons and in NHANES among Mexican-American persons were nearly identical.
The other important finding was that persistent obesity more than doubled the risk for diabetes compared with recent-onset obesity, probably because beta-cell production can compensate for obesity-related insulin resistance for only so long. This has ramifications for the allocation of diabetes prevention and treatment efforts. We know that lifestyle interventions can reduce diabetes risk, but the current findings suggest that such interventions may be most effective if started earlier in the course of obesity. More aggressive and invasive treatments, such as bariatric surgery, could then be reserved for patients with long-term obesity.
Abstract
Source...