Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.

<h4>Background</h4>Patients with type 2 diabetes vary greatly with respect to degree of obesity at time of diagnosis. To address the heterogeneity of type 2 diabetes, we characterised patterns of change in body mass index (BMI) and other cardiometabolic risk factors before type 2 diabete...

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Autores principales:	Dorte Vistisen, Daniel R Witte, Adam G Tabák, Christian Herder, Eric J Brunner, Mika Kivimäki, Kristine Færch
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/2ad7d18df0dd4c3b80de43e80e6f7ecb
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spelling	oai:doaj.org-article:2ad7d18df0dd4c3b80de43e80e6f7ecb2021-11-18T05:42:57ZPatterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.1549-12771549-167610.1371/journal.pmed.1001602https://doaj.org/article/2ad7d18df0dd4c3b80de43e80e6f7ecb2014-02-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24523667/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Patients with type 2 diabetes vary greatly with respect to degree of obesity at time of diagnosis. To address the heterogeneity of type 2 diabetes, we characterised patterns of change in body mass index (BMI) and other cardiometabolic risk factors before type 2 diabetes diagnosis.<h4>Methods and findings</h4>We studied 6,705 participants from the Whitehall II study, an observational prospective cohort study of civil servants based in London. White men and women, initially free of diabetes, were followed with 5-yearly clinical examinations from 1991-2009 for a median of 14.1 years (interquartile range [IQR]: 8.7-16.2 years). Type 2 diabetes developed in 645 (1,209 person-examinations) and 6,060 remained free of diabetes during follow-up (14,060 person-examinations). Latent class trajectory analysis of incident diabetes cases was used to identify patterns of pre-disease BMI. Associated trajectories of cardiometabolic risk factors were studied using adjusted mixed-effects models. Three patterns of BMI changes were identified. Most participants belonged to the "stable overweight" group (n = 604, 94%) with a relatively constant BMI level within the overweight category throughout follow-up. They experienced slightly worsening of beta cell function and insulin sensitivity from 5 years prior to diagnosis. A small group of "progressive weight gainers" (n = 15) exhibited a pattern of consistent weight gain before diagnosis. Linear increases in blood pressure and an exponential increase in insulin resistance a few years before diagnosis accompanied the weight gain. The "persistently obese" (n = 26) were severely obese throughout the whole 18 years before diabetes diagnosis. They experienced an initial beta cell compensation followed by loss of beta cell function, whereas insulin sensitivity was relatively stable. Since the generalizability of these findings is limited, the results need confirmation in other study populations.<h4>Conclusions</h4>Three patterns of obesity changes prior to diabetes diagnosis were accompanied by distinct trajectories of insulin resistance and other cardiometabolic risk factors in a white, British population. While these results should be verified independently, the great majority of patients had modest weight gain prior to diagnosis. These results suggest that strategies focusing on small weight reductions for the entire population may be more beneficial than predominantly focusing on weight loss for high-risk individuals.Dorte VistisenDaniel R WitteAdam G TabákChristian HerderEric J BrunnerMika KivimäkiKristine FærchPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 11, Iss 2, p e1001602 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Dorte Vistisen Daniel R Witte Adam G Tabák Christian Herder Eric J Brunner Mika Kivimäki Kristine Færch Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.
description	<h4>Background</h4>Patients with type 2 diabetes vary greatly with respect to degree of obesity at time of diagnosis. To address the heterogeneity of type 2 diabetes, we characterised patterns of change in body mass index (BMI) and other cardiometabolic risk factors before type 2 diabetes diagnosis.<h4>Methods and findings</h4>We studied 6,705 participants from the Whitehall II study, an observational prospective cohort study of civil servants based in London. White men and women, initially free of diabetes, were followed with 5-yearly clinical examinations from 1991-2009 for a median of 14.1 years (interquartile range [IQR]: 8.7-16.2 years). Type 2 diabetes developed in 645 (1,209 person-examinations) and 6,060 remained free of diabetes during follow-up (14,060 person-examinations). Latent class trajectory analysis of incident diabetes cases was used to identify patterns of pre-disease BMI. Associated trajectories of cardiometabolic risk factors were studied using adjusted mixed-effects models. Three patterns of BMI changes were identified. Most participants belonged to the "stable overweight" group (n = 604, 94%) with a relatively constant BMI level within the overweight category throughout follow-up. They experienced slightly worsening of beta cell function and insulin sensitivity from 5 years prior to diagnosis. A small group of "progressive weight gainers" (n = 15) exhibited a pattern of consistent weight gain before diagnosis. Linear increases in blood pressure and an exponential increase in insulin resistance a few years before diagnosis accompanied the weight gain. The "persistently obese" (n = 26) were severely obese throughout the whole 18 years before diabetes diagnosis. They experienced an initial beta cell compensation followed by loss of beta cell function, whereas insulin sensitivity was relatively stable. Since the generalizability of these findings is limited, the results need confirmation in other study populations.<h4>Conclusions</h4>Three patterns of obesity changes prior to diabetes diagnosis were accompanied by distinct trajectories of insulin resistance and other cardiometabolic risk factors in a white, British population. While these results should be verified independently, the great majority of patients had modest weight gain prior to diagnosis. These results suggest that strategies focusing on small weight reductions for the entire population may be more beneficial than predominantly focusing on weight loss for high-risk individuals.
format	article
author	Dorte Vistisen Daniel R Witte Adam G Tabák Christian Herder Eric J Brunner Mika Kivimäki Kristine Færch
author_facet	Dorte Vistisen Daniel R Witte Adam G Tabák Christian Herder Eric J Brunner Mika Kivimäki Kristine Færch
author_sort	Dorte Vistisen
title	Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.
title_short	Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.
title_full	Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.
title_fullStr	Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.
title_full_unstemmed	Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.
title_sort	patterns of obesity development before the diagnosis of type 2 diabetes: the whitehall ii cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/2ad7d18df0dd4c3b80de43e80e6f7ecb
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Patterns of obesity development before the diagnosis of type 2 diabetes: the Whitehall II cohort study.

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