A greater obesity duration is associated with worse values for all cardiometabolic disease factors, according to a study from Loughborough University, UK.
People with obesity do not all share the same risk for the development of cardiometabolic disease risk factors. The duration a person has spent with obesity over their lifetime has been hypothesized to affect this variation. In the new study, researchers used data from three British birth cohort studies that collected information on body mass index from age 10 to 40 as well as cardiometabolic disease risk factors – blood pressure, cholesterol and glycated haemoglobin (blood sugar) measurements – in 20,746 participants.
More years of obesity was associated with worse values for all measured cardiometabolic risk factors. The association was particularly strong for glycated haemoglobin, or HbA1c; those with less than five years of obesity had a 5% higher HbA1c (95%Confidence Interval 4-6) compared to people with no years of obesity, while those with 20 to 30 years of obesity had a 20% higher HbA1c (95%CI 17-23) compared to people with no obesity. Importantly, this increased risk persisted when adjustment was made for a robust measure of life course obesity severity. Other measures of cardiometabolic disease risk (systolic and diastolic blood pressure, high density-lipoprotein cholesterol) were also associated with obesity duration, though these were largely attenuated when adjusting for obesity severity.
“Our findings suggest that health policy recommendations aimed at preventing early obesity onset, and therefore reducing lifetime exposure, may help reduce risk of diabetes, independently of obesity severity,” the authors say.
Study Details
Duration of obesity exposure between ages 10 and 40 years and its relationship with cardiometabolic disease risk factors: A cohort study
Tom Norris, Tim J. Cole, David Bann, Mark Hamer, Rebecca Hardy, Leah Li, Ken K. Ong, George B. Ploubidis, Russell Viner, William Johnson
Published in PLOS Medicine 8 December 2020
Abstract
Background
Individuals with obesity do not represent a homogeneous group in terms of cardiometabolic risk. Using 3 nationally representative British birth cohorts, we investigated whether the duration of obesity was related to heterogeneity in cardiometabolic risk.
Methods and findings
We used harmonised body mass index (BMI) and cardiometabolic disease risk factor data from 20,746 participants (49.1% male and 97.2% white British) enrolled in 3 British birth cohort studies: the 1946 National Survey of Health and Development (NSHD), the 1958 National Child Development Study (NCDS), and the 1970 British Cohort Study (BCS70). Within each cohort, individual life course BMI trajectories were created between 10 and 40 years of age, and from these, age of obesity onset, duration spent obese (range 0 to 30 years), and cumulative obesity severity were derived. Obesity duration was examined in relation to a number of cardiometabolic disease risk factors collected in mid-adulthood: systolic (SBP) and diastolic blood pressure (DBP), high-density-lipoprotein cholesterol (HDL-C), and glycated haemoglobin (HbA1c).
A greater obesity duration was associated with worse values for all cardiometabolic disease risk factors. The strongest association with obesity duration was for HbA1c: HbA1c levels in those with obesity for <5 years were relatively higher by 5% (95% CI: 4, 6), compared with never obese, increasing to 20% (95% CI: 17, 23) higher in those with obesity for 20 to 30 years. When adjustment was made for obesity severity, the association with obesity duration was largely attenuated for SBP, DBP, and HDL-C. For HbA1c, however, the association with obesity duration persisted, independent of obesity severity. Due to pooling of 3 cohorts and thus the availability of only a limited number harmonised variables across cohorts, our models included adjustment for only a small number of potential confounding variables, meaning there is a possibility of residual confounding.
Conclusions
Given that the obesity epidemic is characterised by a much earlier onset of obesity and consequently a greater lifetime exposure, our findings suggest that health policy recommendations aimed at preventing early obesity onset, and therefore reducing lifetime exposure, may help reduce the risk of diabetes, independently of obesity severity. However, to test the robustness of our observed associations, triangulation of evidence from different epidemiological approaches (e.g., mendelian randomization and negative control studies) should be obtained.
[link url="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003387"]PLOS Medicine study (Open Access)[/link
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