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Duration of obesity exposure between ages 10 and 40 years and its relationship with cardiometabolic disease risk factors: a cohort study

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posted on 07.01.2021, 15:19 by Tom Norris, Tim J Cole, David Bann, Mark Hamer, Rebecca Hardy, Leah Li, Ken K Ong, George B Ploubidis, Russell Viner, Will JohnsonWill Johnson
Background
Individuals with obesity do not represent a homogeneous group in terms of cardiometabolic risk. Using 3 nationally representative British birth cohorts, we investigated whether the duration of obesity was related to heterogeneity in cardiometabolic risk.

Methods and findings
We used harmonised body mass index (BMI) and cardiometabolic disease risk factor data from 20,746 participants (49.1% male and 97.2% white British) enrolled in 3 British birth cohort studies: the 1946 National Survey of Health and Development (NSHD), the 1958 National Child Development Study (NCDS), and the 1970 British Cohort Study (BCS70). Within each cohort, individual life course BMI trajectories were created between 10 and 40 years of age, and from these, age of obesity onset, duration spent obese (range 0 to 30 years), and cumulative obesity severity were derived. Obesity duration was examined in relation to a number of cardiometabolic disease risk factors collected in mid-adulthood: systolic (SBP) and diastolic blood pressure (DBP), high-density-lipoprotein cholesterol (HDL-C), and glycated haemoglobin (HbA1c).

A greater obesity duration was associated with worse values for all cardiometabolic disease risk factors. The strongest association with obesity duration was for HbA1c: HbA1c levels in those with obesity for <5 years were relatively higher by 5% (95% CI: 4, 6), compared with never obese, increasing to 20% (95% CI: 17, 23) higher in those with obesity for 20 to 30 years. When adjustment was made for obesity severity, the association with obesity duration was largely attenuated for SBP, DBP, and HDL-C. For HbA1c, however, the association with obesity duration persisted, independent of obesity severity. Due to pooling of 3 cohorts and thus the availability of only a limited number harmonised variables across cohorts, our models included adjustment for only a small number of potential confounding variables, meaning there is a possibility of residual confounding.

Conclusions
Given that the obesity epidemic is characterised by a much earlier onset of obesity and consequently a greater lifetime exposure, our findings suggest that health policy recommendations aimed at preventing early obesity onset, and therefore reducing lifetime exposure, may help reduce the risk of diabetes, independently of obesity severity. However, to test the robustness of our observed associations, triangulation of evidence from different epidemiological approaches (e.g., mendelian randomization and negative control studies) should be obtained.

Funding

Body size trajectories and cardio-metabolic resilience to obesity in three United Kingdom birth cohorts

Medical Research Council

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National Institute for Health Research (NIHR) Leicester Biomedical Research Centre

Centre for Longitudinal Studies, Resource Centre 2015-20

Economic and Social Research Council

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Socioeconomic inequalities in health: how have they changed in response to changing policy decisions and economic factors, and how may they be reduced?

Academy of Medical Sciences

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Cohort and Longitudinal Studies Enhancement Resources (CLOSER)

Economic and Social Research Council

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Statistical methods and applications in growth and development - SITAR, LMS and IOTF

Medical Research Council

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History

School

  • Sport, Exercise and Health Sciences

Published in

PLoS Medicine

Volume

17

Issue

12

Publisher

Public Library of Science (PLoS)

Version

VoR (Version of Record)

Rights holder

© The Authors

Publisher statement

This is an Open Access Article. It is published by Public Library of Science under the Creative Commons Attribution 4.0 International Licence (CC BY). Full details of this licence are available at: https://creativecommons.org/licenses/by/4.0/

Acceptance date

01/10/2020

Publication date

2020-12-08

Copyright date

2020

ISSN

1549-1277

eISSN

1549-1676

Language

en

Depositor

Dr Will Johnson. Deposit date: 2 October 2020

Article number

e1003387