Body Weight Patterns From 20 to 49 Years of Age and Subsequent Risk for Diabetes Mellitus

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Abstract
DIABETES MELLITUS imposes a substantial burden on public health in the United States, contributing annually to more than 300,000 deaths1 and more than $130 billion in direct and indirect costs.2 Overweight in middle age is a well-established, potentially modifiable risk factor for type 2 diabetes mellitus. About 90% of prevalent diabetes cases in the United States are classified as type 2. Since 1970, at least 28 prospective studies have confirmed this relationship.3-30 However, the relationship between weight and weight gain at younger ages and the risk for diabetes is less certain. Of the 28 studies, only 6 presented data regarding weight history before 40 years of age.15,17,25,28-30 The 6 studies were also able to assess longitudinal features of body weight, such as weight gain,15,17,28-30 weight variability,15,29 and duration of overweight,25 in addition to body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) at a single point in time. Unfortunately, these studies used retrospective data collection for body weight at young ages,15,17,28 lacked follow-up of sufficient length to characterize body weight patterns in young adulthood and middle age in the same individuals,30 or were limited to Pima Indians, a group at unusually high risk for obesity and diabetes compared with the general US population.25,29 Furthermore, no single study sought to compare the predictive value of various longitudinal features of body weight. A better understanding of the relationship of body weight in young adulthood with the risk for diabetes in middle age would guide public health and clinical efforts aimed at primary prevention of type 2 diabetes mellitus by weight control. The rising prevalence of overweight in adolescents and adults in the United States heightens the need for such information.31 With this in mind, we conducted a prospective cohort study with the following 2 aims: to determine the relationship between weight patterns from 20 to 49 years of age and the subsequent risk for type 2 diabetes mellitus and to compare the predictive value of these patterns.