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TOPLINE:

Men with low birth weight who go on to be overweight in young adulthood have a nearly 10-fold increased risk of developing type 2 diabetes, reveals Swedish research that indicates the risks can nevertheless be reduced if overweight in young adulthood is avoided.

METHODOLOGY:

• The researchers gathered data on birth weight and height and weight measurements for men from the population-based body mass index (BMI) Epidemiology Study Gothenburg cohort born between 1945 and 1961.
• School healthcare records were accessed, alongside records for military conscription, which was mandatory for all Swedish men until 2010.
• The main exposures were birth weight, childhood overweight at 8 years of age, and young adult overweight at 20 years of age, from which age-adjusted BMI estimates were calculated.
• The individuals were then linked to the Swedish National Patient Register to identify diagnoses of type 2 diabetes after 30 years of age to avoid misclassification with type 1 diabetes.

TAKEAWAY:

• The team included 34,321 men, who were followed up from 30 years of age to December 31, 2019, yielding 1,100,000 person-years of follow-up.
• Over a median follow-up of 34.3 years, 2733 cases of type 2 diabetes were diagnosed, at a median age of 59.4 years.
• Birth weight below the median of 3.6 kg and overweight at age 20, but not overweight at age 8, were associated with an increased risk for both early (≤ 59.4 years) and late type 2 diabetes (> 59.4 years).
• A birth weight below the median plus overweight at age 20 years was associated with a marked increased risk for early diabetes, at a hazard ratio of 6.07, rising to 9.94 among men with low birth weight (≤ 2.5 kg) and overweight at 20 years.

IN PRACTICE:

The team noted: "Importantly, we observed a 21% absolute risk reduction for early type 2 diabetes if an individual with a low birth weight avoided overweight in young adulthood."

"We therefore propose that particular efforts should be directed at children with low birth weight to prevent the subsequent development of young adult overweight and the associated massive risk of type 2 diabetes."

Coauthor Jenny M. Kindblom, MD, PhD, from Sahlgrenska University Hospital, Gothenburg, Sweden, suggested in a release: "It's possible that the metabolic consequences of fetal growth restriction…when combined with a detrimental BMI trajectory during puberty, when the insulin resistance is at a lifetime peak due to the surge of growth and sex hormones, result in an additive excess risk for later type 2 diabetes."

SOURCE:

The research was led by Jimmy Célind, MD, Department of Paediatrics, Institute of Clinical Studies, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. It was published by Diabetologia on February 22, 2024, and will be presented at the European Congress on Obesity in Venice, Italy, 12-15 May.

LIMITATIONS:

The authors highlight that BMI measurements for women were not available, and the cohort mainly consists of White individuals, so the results may have limited generalizability. Data on gestational age, alongside information on possible mediators, such as BMI in middle age, smoking status, physical exercise, and dietary habits, were also not available.

DISCLOSURES:

The study was supported by the Swedish Research Council and by grants from the Swedish state under the Agreement for Medical Education and Research between the Swedish Government and the County Councils, the Swedish Heart Lung Foundation, the Lundberg Foundation, the Torsten Söderberg Foundation, the Novo Nordisk Foundation, the Gothenburg Medical Society, and the Knut and Alice Wallenberg Foundation. Open-access funding was provided by the University of Gothenburg.

No relevant financial relationships were declared.