TY - JOUR

T1 - Association of Childhood Fat Mass and Weight With Adult-Onset Type 2 Diabetes in Denmark

AU - Hudda, Mohammed T.

AU - Aarestrup, Julie

AU - Owen, Christopher G.

AU - Cook, Derek G.

AU - Sorensen, Thorkild I. A.

AU - Rudnicka, Alicja R.

AU - Baker, Jennifer L.

AU - Whincup, Peter H.

AU - Nightingale, Claire M.

PY - 2021

Y1 - 2021

N2 - Importance Childhood obesity, defined by cutoffs based on the weight-based marker of body mass index, is associated with adult type 2 diabetes (T2D) risk. Whether childhood fat mass (FM) is the driver of these associations is currently unknown. Objective To quantify and compare height-independent associations between childhood FM and weight with adult T2D risk in a historic Danish cohort. Design, Setting, and Participants This population-based retrospective cohort study included schoolchildren from The Copenhagen School Health Records Register born between January 1930 and December 1985 with follow-up to adulthood through December 31, 2015. Analyses were based on 269 913 schoolchildren aged 10 years with 21 896 established adult T2D cases and 261 192 children aged 13 years with 21 530 established adult T2D cases for whom childhood height and weight measurements, as well as predicted FM, were available. Statistical analyses were performed between April 2019 to August 2020. Exposures Childhood FM and weight at ages 10 and 13 years. Main Outcomes and Measures Diagnoses of T2D were established by linkage to national disease registers for adults aged at least 30 years. Sex-specific Cox regression quantified associations, adjusted for childhood height, which were evaluated within 5 birth-cohort groups. Group-specific results were pooled using random-effects meta-analyses accounting for heterogeneity across group-specific associations. Results This cohort study analyzed data from 269 913 children aged 10 years (135 940 boys [50.4%]) with 21 896 established adult T2D cases and 261 192 children aged 13 years (131 025 boys [50.2%]) with 21 530 established adult T2D cases. After adjusting for childhood height, increases in FM and weight (per kilogram) among boys aged 10 years were associated with elevated T2D risks at age 50 years of 12% (hazard ratio [HR], 1.12; 95% CI, 1.10-1.14) and 7% (HR, 1.07; 95% CI, 1.05-1.09), respectively, and among girls aged 10 years of 15% (HR, 1.15; 95% CI, 1.13-1.17) and 10% (HR, 1.10; 95% CI, 1.08-1.11), respectively. Among children aged 13 years, increases in FM and weight (per kilogram) were associated with increased T2D risks at age 50 years of 10% (HR, 1.10; 95% CI, 1.09-1.10) and 6% (HR, 1.06; 95% CI, 1.05-1.07) for boys, respectively, and of 10% (HR, 1.10; 95% CI, 1.10-1.11) and 7% (HR, 1.07; 95% CI, 1.06-1.08), respectively, for girls. Conclusions and Relevance This cohort study found that a 1-kg increase in childhood FM was more strongly associated with increased adult T2D risk than a 1-kg increase in weight, independent of childhood height. Information on FM, rather than weight-based measures, focuses on a modifiable component of weight that may be associated with adult T2D risk. These findings support the assessment of childhood FM in adiposity surveillance initiatives in an effort to reduce long-term T2D risk.Question Is childhood fat mass (FM) more strongly associated with long-term type 2 diabetes (T2D) risk than childhood weight, independent of height? Findings In a population-based cohort study including more than 260 000 schoolchildren in Denmark, there were stronger associations (per kilogram increase) between childhood FM and adult T2D risk, independent of childhood height, than those observed for childhood weight. Meaning Results suggest that weight-based measures, currently used as the basis for childhood obesity assessment in the form of body mass index, were less strongly associated with adult T2D risk than childhood FM.This cohort study uses data from Copenhagen School Health Records Register to investigate the association of childhood fat mass and weight with adult-onset type 2 diabetes.

AB - Importance Childhood obesity, defined by cutoffs based on the weight-based marker of body mass index, is associated with adult type 2 diabetes (T2D) risk. Whether childhood fat mass (FM) is the driver of these associations is currently unknown. Objective To quantify and compare height-independent associations between childhood FM and weight with adult T2D risk in a historic Danish cohort. Design, Setting, and Participants This population-based retrospective cohort study included schoolchildren from The Copenhagen School Health Records Register born between January 1930 and December 1985 with follow-up to adulthood through December 31, 2015. Analyses were based on 269 913 schoolchildren aged 10 years with 21 896 established adult T2D cases and 261 192 children aged 13 years with 21 530 established adult T2D cases for whom childhood height and weight measurements, as well as predicted FM, were available. Statistical analyses were performed between April 2019 to August 2020. Exposures Childhood FM and weight at ages 10 and 13 years. Main Outcomes and Measures Diagnoses of T2D were established by linkage to national disease registers for adults aged at least 30 years. Sex-specific Cox regression quantified associations, adjusted for childhood height, which were evaluated within 5 birth-cohort groups. Group-specific results were pooled using random-effects meta-analyses accounting for heterogeneity across group-specific associations. Results This cohort study analyzed data from 269 913 children aged 10 years (135 940 boys [50.4%]) with 21 896 established adult T2D cases and 261 192 children aged 13 years (131 025 boys [50.2%]) with 21 530 established adult T2D cases. After adjusting for childhood height, increases in FM and weight (per kilogram) among boys aged 10 years were associated with elevated T2D risks at age 50 years of 12% (hazard ratio [HR], 1.12; 95% CI, 1.10-1.14) and 7% (HR, 1.07; 95% CI, 1.05-1.09), respectively, and among girls aged 10 years of 15% (HR, 1.15; 95% CI, 1.13-1.17) and 10% (HR, 1.10; 95% CI, 1.08-1.11), respectively. Among children aged 13 years, increases in FM and weight (per kilogram) were associated with increased T2D risks at age 50 years of 10% (HR, 1.10; 95% CI, 1.09-1.10) and 6% (HR, 1.06; 95% CI, 1.05-1.07) for boys, respectively, and of 10% (HR, 1.10; 95% CI, 1.10-1.11) and 7% (HR, 1.07; 95% CI, 1.06-1.08), respectively, for girls. Conclusions and Relevance This cohort study found that a 1-kg increase in childhood FM was more strongly associated with increased adult T2D risk than a 1-kg increase in weight, independent of childhood height. Information on FM, rather than weight-based measures, focuses on a modifiable component of weight that may be associated with adult T2D risk. These findings support the assessment of childhood FM in adiposity surveillance initiatives in an effort to reduce long-term T2D risk.Question Is childhood fat mass (FM) more strongly associated with long-term type 2 diabetes (T2D) risk than childhood weight, independent of height? Findings In a population-based cohort study including more than 260 000 schoolchildren in Denmark, there were stronger associations (per kilogram increase) between childhood FM and adult T2D risk, independent of childhood height, than those observed for childhood weight. Meaning Results suggest that weight-based measures, currently used as the basis for childhood obesity assessment in the form of body mass index, were less strongly associated with adult T2D risk than childhood FM.This cohort study uses data from Copenhagen School Health Records Register to investigate the association of childhood fat mass and weight with adult-onset type 2 diabetes.

U2 - 10.1001/jamanetworkopen.2021.8524

DO - 10.1001/jamanetworkopen.2021.8524

M3 - Journal article

C2 - 33929520

VL - 4

JO - JAMA network open

JF - JAMA network open

SN - 2574-3805

IS - 4

M1 - 218524

ER -