Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and the Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Diabetes Care. 2020 Jul;43(7):1487-1495. doi: 10.2337/dc19-1988. Epub 2020 Apr 22.
Type 2 diabetes (T2D) is increasingly diagnosed at younger ages. We investigated the association of adolescent obesity with incident T2D at early adulthood.
A nationwide, population-based study evaluated 1,462,362 adolescents (59% men, mean age 17.4 years) during 1996-2016. Data were linked to the Israeli National Diabetes Registry. Weight and height were measured at study entry. Cox proportional models were applied.
During 15,810,751 person-years, 2,177 people (69% men) developed T2D (mean age at diagnosis 27 years). There was an interaction among BMI, sex, and incident T2D ( = 0.023). In a model adjusted for sociodemographic variables, the hazard ratios for diabetes diagnosis were 1.7 (95% CI 1.4-2.0), 2.8 (2.3-3.5), 5.8 (4.9-6.9), 13.4 (11.5-15.7), and 25.8 (21.0-31.6) among men in the 50th-74th percentile, 75th-84th percentile, overweight, mild obesity, and severe obesity groups, respectively, and 2.2 (1.6-2.9), 3.4 (2.5-4.6), 10.6 (8.3-13.6), 21.1 (16.0-27.8), and 44.7 (32.4-61.5), respectively, in women. An inverse graded relationship was observed between baseline BMI and mean age of T2D diagnosis: 27.8 and 25.9 years among men and women with severe obesity, respectively, and 29.5 and 28.5 years among low-normal BMI (5th-49th percentile; reference), respectively. The projected fractions of adult-onset T2D that were attributed to high BMI (≥85th percentile) at adolescence were 56.9% (53.8-59.9%) and 61.1% (56.8-65.2%) in men and women, respectively.
Severe obesity significantly increases the risk for incidence of T2D in early adulthood in both sexes. The rise in adolescent severe obesity is likely to increase diabetes incidence in young adults in coming decades.
2 型糖尿病（T2D）的诊断年龄越来越小。本研究旨在探讨青少年肥胖与成年早期 2 型糖尿病发病的相关性。
这是一项全国性的基于人群的研究，共纳入了 1462362 名青少年（59%为男性，平均年龄为 17.4 岁），随访时间为 1996 年至 2016 年。研究数据与以色列国家糖尿病登记处相关联。在研究入组时测量了体重和身高。应用 Cox 比例风险模型进行分析。
在 15810751 人年中，有 2177 人（69%为男性）被诊断为 T2D（平均发病年龄为 27 岁）。BMI、性别与 T2D 发病之间存在交互作用（ = 0.023）。在调整了社会人口统计学变量后，男性中 T2D 诊断的风险比分别为 1.7（95%CI 1.4-2.0）、2.8（2.3-3.5）、5.8（4.9-6.9）、13.4（11.5-15.7）和 25.8（21.0-31.6），分别对应于 BMI 第 50-74 百分位、第 75-84 百分位、超重、轻度肥胖和重度肥胖组；女性中 T2D 诊断的风险比分别为 2.2（1.6-2.9）、3.4（2.5-4.6）、10.6（8.3-13.6）、21.1（16.0-27.8）和 44.7（32.4-61.5），分别对应于 BMI 第 50-74 百分位、第 75-84 百分位、超重、轻度肥胖和重度肥胖组。基线 BMI 与 T2D 诊断的平均年龄之间呈负相关：男性重度肥胖组的平均年龄为 27.8 岁，女性为 25.9 岁，而低正常 BMI（第 5-49 百分位；参考）组的平均年龄分别为 29.5 岁和 28.5 岁。青少年时期 BMI 较高（≥第 85 百分位）导致成年期 2 型糖尿病发病的比例分别为男性 56.9%（53.8-59.9%）和女性 61.1%（56.8-65.2%）。
重度肥胖显著增加了两性成年早期 2 型糖尿病的发病风险。青少年重度肥胖的增加可能会导致未来几十年年轻人中糖尿病发病率的上升。
