(06-07-10) Association between adiposity in midlife and older age and risk of diabetes in older adults.

Biggs ML, Mukamal KJ, Luchsinger JA, Ix JH, Carnethon MR, Newman AB, de Boer IH, Strotmeyer ES, Mozaffarian D, Siscovick DS.

Department of Biostatistics, School of Public Health and Community Medicine,
University of Washington, Seattle, WA, USA. [email protected]
Abstract
CONTEXT: Adiposity is a well-recognized risk factor for type 2 diabetes among
young and middle-aged adults, but the relationship between body composition and
type 2 diabetes is not well described among older adults. OBJECTIVE: To examine
the relationship between adiposity, changes in adiposity, and risk of incident
type 2 diabetes in adults 65 years of age and older. DESIGN, SETTING, AND
PARTICIPANTS: Prospective cohort study (1989-2007) of 4193 men and women 65
years of age and older in the Cardiovascular Health Study. Measures of
adiposity were derived from anthropometry and bioelectrical impedance data at
baseline and anthropometry repeated 3 years later. MAIN OUTCOME MEASURE:
Incident diabetes was ascertained based on use of antidiabetic medication or a
fasting glucose level of 126 mg/dL or greater. RESULTS: Over median follow-up
of 12.4 years (range, 0.9-17.8 years), 339 cases of incident diabetes were
ascertained (7.1/1000 person-years). The adjusted hazard ratio (HR) (95%
confidence interval [CI]) of type 2 diabetes for participants in the highest
quintile of baseline measures compared with those in the lowest was 4.3 (95%
CI, 2.9-6.5) for body mass index (BMI [calculated as weight in kilograms
divided by height in meters squared]), 3.0 (95% CI, 2.0-4.3) for BMI at 50
years of age, 4.2 (95% CI, 2.8-6.4) for weight, 4.0 (95% CI, 2.6-6.0) for fat
mass, 4.2 (95% CI, 2.8-6.2) for waist circumference, 2.4 (95% CI, 1.6-3.5) for
waist-hip ratio, and 3.8 (95% CI, 2.6-5.5) for waist-height ratio. However,
when stratified by age, participants 75 years of age and older had HRs
approximately half as large as those 65 to 74 years of age. Compared with
weight-stable participants (+/-2 kg), those who gained the most weight from 50
years of age to baseline (> or = 9 kg), and from baseline to the third follow-
up visit (> or = 6 kg), had HRs for type 2 diabetes of 2.8 (95% CI, 1.9-4.3)
and 2.0 (95% CI, 1.1-3.7), respectively. Participants with a greater than 10-cm
increase in waist size from baseline to the third follow-up visit had an HR of
type 2 diabetes of 1.7 (95% CI, 1.1-2.8) compared with those who gained or lost
2 cm or less. CONCLUSION: Among older adults, overall and central adiposity,
and weight gain during middle age and after the age of 65 years are associated
with risk of diabetes.

Source: JAMA. 2010 Jun 23;303(24):2504-12.

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