Underweight men who become obese face higher risk of serious condition
Underweight male babies who pile on the pounds in their 20s are at a far higher risk of developing diabetes, warns a new study.
Swedish researchers found that men born with lower than average birthweights who became overweight by the age of 20 were up to ten times more at risk of developing early type 2 diabetes - which can lead to premature death if uncontrolled. Adversely, they discovered that men born with low birthweights who avoided becoming overweight in young adulthood could reduce their risk of developing early type 2 diabetes by over a fifth.
The researchers concluded that their study, to be presented at the European Congress on Obesity (ECO) later this year, highlighted the added importance for men born with low birthweights to avoid becoming overweight or obese in their 20s. Type 2 diabetes is being diagnosed at progressively younger ages, suggesting significant risks may accumulate during the developmental period of sufferers' lives.
The association between low birthweight and being overweight in childhood and/or young adulthood with type 2 diabetes in adults is already known, though it has until now remained unclear how much influence the combination of these two factors exerts. The new study, published in the journal Diabetologia, analysed data from nearly 35,000 men born between 1945 and 1961 involved in the BMI Epidemiology Study (BEST) in Gothenburg, Sweden - a population-based cohort examining the associations between growth and BMI development in early life and the risk of disease in later life.
The researchers, from the University of Gothenburg and Sahlgrenska University Hospital, analysed the birthweights and BMIs of participants from school health care records, at the age of eight, and from medical examinations on enrolment in the military at the age of 20 - which remained mandatory in Sweden until 2010. Participants were followed from the age of 30 until they were either diagnosed with type 2 diabetes, died, emigrated, or until 31st December 2019.
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Information on type 2 diabetes diagnoses was retrieved from Swedish national registers to estimate the risk of early - before 60 years - and late, after 60 years, type 2 diabetes. They also examined whether these associations were independent of, or modified by, socioeconomic factors such as level of education.
During an average 34-year follow-up after the age of 30, 2,733 cases of type 2 diabetes were diagnosed: 1,367 cases of early and 1,366 cases of late diabetes. The analyses found that men who had birthweights below an average of 3.6kg (7lbs 9oz) and who were also overweight at the age of 20 - but not at the age of eight - were associated with an increased risk of both early and late type 2 diabetes.
The researchers calculated that having a below-average birthweight followed by being overweight at 20 was associated with a six times greater risk of developing early type 2 diabetes. However, those with lower birthweights of around 2.5kg (5lbs 8oz) who turned out to be overweight at 20 were linked with a ten-times greater risk of developing early type 2 diabetes.
Adjusting for education - a known risk factor for type 2 diabetes - did little to change the results, the researchers found. The researchers also found that babies with a low birthweight who were overweight at age 20 years had a 27 per cent absolute risk of developing early type 2 diabetes, compared with an absolute risk of just six per cent for those with a birthweight in the normal range who were also normal weight at aged 20 years.
This suggests that preventing excess weight gain during young adulthood in boys born with low birthweights could reduce the absolute risk of early type 2 diabetes by 21 per cent.
Lead author Dr Jimmy Celind, a researcher at Sahlgrenska Academy's Institute of Medicine at the University of Gothenburg, said: "Our findings establish low birthweight and overweight in young adulthood as the main developmental determinants, whereas being overweight in childhood is of lesser importance for type 2 diabetes in adult men.
"The combination of low birthweight followed by being overweight at age 20 years is associated with a massive excess risk for early type 2 diabetes, which is substantially higher than the risk associated with low birthweight or being overweight as a young adult separately."
Co-author Dr Jenny Kindblom, from Sahlgrenska University Hospital, added that public health initiatives should warn against boys born with low birthweights becoming overweight as young adults.
She explained: "It's possible that the metabolic consequences of foetal growth restriction, which promotes resilience against starvation through fat storage and insulin resistance, 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.
"Public health initiatives should target boys born with low birthweight to work on prevention of overweight as young adults, to reduce this huge excess risk for early type 2 diabetes."
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The authors of the study, which will be presented at ECO 2024 in Venice between May 12 and 15, acknowledged did acknowledge that their findings are associations only and was not designed to measure direct cause and effect. They also admitted to several limitations, including that participants were mainly white men, which may limit the generalisability of the findings to other ethnicities and women.
The analyses were also unable to account for the influence of other known risk factors for type 2 diabetes such as smoking, dietary habits, and physical activity which could have influenced the results.
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