Boone-Heinonen Janne, Sacks Rebecca M, Takemoto Erin E, Hooker Elizabeth R, Dieckmann Nathan F, Harrod Curtis S, Thornburg Kent L
1 Oregon Health & Science University-Portland State University, School of Public Health , Portland, OR.
2 Oregon Health & Science University, School of Nursing and School of Medicine , Portland, OR.
Child Obes. 2018 Apr;14(3):173-181. doi: 10.1089/chi.2017.0290. Epub 2018 Apr 6.
Higher body-mass index (BMI) and lower birth weight (BW) are associated with elevated risk of diabetes in adulthood, but the extent to which they compose two distinct pathways is unclear.
We used data from the National Longitudinal Study of Adolescent to Adult Health, a cohort of adolescents (1994-1995) followed for 14 years over four waves into adulthood (n = 13,413). Sex-stratified path analysis was used to examine pathways from BW [kg; linear (BW) and quadratic (BW)] to latent trajectories in BMI from adolescence to adulthood to prevalent diabetes or prediabetes (pre/diabetes) in adulthood, adjusting for sociodemographic characteristics.
Two pathways from BW to pre/diabetes were characterized: one from higher BW to elevated BMI and pre/diabetes and a second from lower BW, independent of BMI. In the BMI-independent pathway, greater BW was associated with marginally lower odds of pre/diabetes in women, but not men. Girls born at lower and higher BW exhibited elevated BMI in adolescence [coeff (95% CI): BW: -2.1 (-4.1, -0.05); BW: 0.43 (0.09, 0.76)]; higher BW predicted marginally faster BMI gain and higher adolescent BMI and faster BMI gain were associated with pre/diabetes [coeff (95% CI): BMI intercept: 0.09 (0.06, 0.11); BMI slope: 0.11 (0.07, 0.15)]. In boys, BW was weakly associated with BMI intercept and slope; BMI slope, but not BMI intercept, was positively associated with pre/diabetes [coeff (95% CI): 0.29 (0.19, 0.39)].
Findings suggest that in girls, slowing BMI gain is critical for diabetes prevention, yet it may not address distinct pathology stemming from early life.
较高的体重指数（BMI）和较低的出生体重（BW）与成年后患糖尿病的风险升高有关，但它们构成两种不同途径的程度尚不清楚。
我们使用了青少年到成人健康纵向研究的数据，该队列中的青少年（1994 - 1995年）经过14年的四次随访进入成年期（n = 13413）。采用性别分层路径分析来研究从BW[千克；线性（BW）和二次方（BW）]到青少年到成年期BMI的潜在轨迹再到成年期糖尿病或糖尿病前期（糖尿病前期/糖尿病）的途径，并对社会人口学特征进行了调整。
确定了两条从BW到糖尿病前期/糖尿病的途径：一条是从较高的BW到BMI升高和糖尿病前期/糖尿病，另一条是从较低的BW，与BMI无关。在与BMI无关的途径中，较高的BW与女性患糖尿病前期/糖尿病的几率略低有关，但与男性无关。出生时BW较低和较高的女孩在青春期BMI升高[系数（95%置信区间）：BW：-2.1（-4.1，-0.05）；BW：0.43（0.09，0.76）]；较高的BW预示着BMI增长略快，较高的青少年BMI和较快的BMI增长与糖尿病前期/糖尿病有关[系数（95%置信区间）：BMI截距：0.09（0.06，0.11）；BMI斜率：0.11（0.07，0.15）]。在男孩中，BW与BMI截距和斜率的关联较弱；BMI斜率而非BMI截距与糖尿病前期/糖尿病呈正相关[系数（95%置信区间）：0.29（0.19，0.39）]。
研究结果表明，对于女孩来说，减缓BMI增长对预防糖尿病至关重要，但这可能无法解决源于早年的独特病理问题。
