Disclosures: The authors report no relevant financial disclosures.
February 10, 2021
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Obesity plays major role in new-onset diabetes; relationship varies by race, sex

Disclosures: The authors report no relevant financial disclosures.
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The prevalence of obesity was associated with a significant uptick in incident diabetes among U.S. adults, with a disparate impact among white women, according to data published in the Journal of the American Heart Association.

Sadiya S. Khan

“In the past 2 decades, we have seen a significant increase in cases of diabetes. We identified that nearly one-third to one-half of these new cases of diabetes are attributed to obesity between 2001 and 2016. Monitoring for weight optimization is an important early step to focus on prevention of diabetes,” Sadiya S. Khan, MD, MSc, assistant professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine, told Healio. “For the first time, this study reports the stagnant burden of diabetes related to obesity over time between 2001 and 2016.”

Diabetes Words 2019
Source: Adobe Stock

MESA and NHANES data

This study included 4,200 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; median age, 61 years; 47% men; median BMI, 27.9 kg/m2) without diabetes at baseline, of whom 54% were white, 33% were Black and 13% were Mexican American. Researchers used these data to calculate risk for diabetes associated with obesity.

In addition, using data from the National Health and Nutrition Examination Survey, researchers calculated national age-adjusted prevalence of obesity among adults with similar characteristics to those included in MESA.

Population-attributable fractions from the race/ethnic and sex-specific HRs and prevalence estimates were also calculated.

Overall, the incidence of diabetes was 11.6% during an average follow-up of 9.2 years.

The overall risk for incident diabetes among participants with obesity was nearly threefold higher compared with participants of normal weight (HR = 2.7; 95% CI, 2.2-3.3).

Among men, those who were Mexican American experienced the greatest risk for diabetes associated with obesity (HR = 3.4; 95% CI, 1.9-6.3) compared with white men (HR = 2.5; 95% CI, 1.7-3.7) and Black men (HR = 2.4; 95% CI, 1.6-3.7).

Among women, white participants experienced the greatest risk for diabetes associated with obesity (HR = 3.6; 95% CI, 2.4-5.6) compared with Mexican American women (HR = 2.4; 95% CI, 1.3-4.5) and Black women (HR = 2.1; 95% CI, 1.4-3.2).

From the 2001-2004 to the 2013-2016 NHANES survey cycles, the overall prevalence of obesity increased from 34% (95% CI, 32-37) to 41% (95% CI, 39-44) and was consistently higher among those with diabetes, the researchers wrote.

According to the study, the prevalence of obesity was lower among white women compared with Black and Mexican women for each survey cycle, and the prevalence among men and those with diabetes at baseline were similar among race/ethnicity subgroups.

Moreover, the adjusted population-attributable fractions for incident diabetes associated with obesity in the entire cohort ranged from 0.35 (95% CI, 0.29-0.4) to 0.41 (95% CI, 0.36-0.46).

In addition, researchers observed no significant linear trends during the study period overall or within sex-race/ethnicity subgroups.

“These data help us define the scope and contemporary extent of this major public health problem,” Khan told Healio. “Gaps remain in understanding how to support communities and individuals in their journey for weight loss or maintenance of a healthy weight. This will require multilevel approaches to ensure there is access to safe green spaces, access to healthy foods and access to health care for ongoing preventive services.”

Obesity and COVID-19

“Additionally, the obesity epidemic has collided with the COVID-19 pandemic,” Khan said in a press release. “The greater severity of COVID-19 infection in individuals with obesity is concerning because of the growing burden of adverse health consequences they could experience in the coming years; therefore, further efforts are needed to help more adults adopt healthier lifestyles and hopefully reduce the prevalence of obesity.”

For more information:

Sadiya S. Khan, MD, MSc, can be reached at s-khan-1@northwestern.edu.