Childhood fat mass more strongly associated with adult-onset type 2 diabetes risk than childhood weight

1. An increase in childhood fat mass was more strongly associated with the risk of adult onset type 2 diabetes than childhood weight, independent of childhood height

Evidence Rating Level: 2 (Good)

Study Rundown: Approximately 422 million people live with diabetes worldwide, among whom more than 90% have type 2 diabetes. Childhood obesity has been linked to long-term type 2 diabetes risk. This population-based retrospective cohort study in Denmark sought to characterize the link between childhood fat mass (FM) and weight with the development of adult type 2 diabetes (T2D). Over 260 000 school-aged participants were registered between January 1930 and December 1985 and followed up through adulthood until 2015.The hazard ratio of adult-onset type 2 diabetes was higher for an increase in fat mass than weight. Independent of height, an increase in childhood fat mass had a stronger association with increased type 2 diabetes in adulthood than an equivalent increase in childhood body weight. One strength of this study is the precise measurements of adult-onset diabetes with a very large sample size and more than 85 years of follow-up for type 2 diabetes which allows robust quantifications of association. One limitation of the study, however, is that diabetes tends to be underdiagnosed, and might have skewered results in this study. Only patients who were referred to a hospital-based clinic diagnosed with type 2 diabetes were included in the study. Additionally, the Danish population during the time period of the study is predominantly of the White race, decreasing the external validity of the study.

Click to read the study in JAMA Network Open

Relevant Reading: Establishing a standard definition for child overweight and obesity worldwide: international survey

In-Depth [retrospective cohort study]: In this retrospective population-based cohort study of more than 260 000 schoolchildren, a 1-kg increase in fat mass at 10 years old was linked to a significantly increased risk of T2D at age 50 when compared to a 1-kg increase in body weight at age 10 years. Risks of T2D associated with a 1-kg increase in fat mass at 10 years old were 12% for boys and 15% for girls. In comparison, the risks of T2D associated with a 1-kg increase in weight at 10 years old were 7% for boys and 10% for girls. The HR of T2D as a function of 1-kg increase in fat mass vs. weight at 10 years old are 1.12 vs. 1.07 for boys and 1.15 vs 1.10 for girls, respectively.

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