Age, overweight and physical inactivity increase the risk of latent autoimmune diabetes in adults: results from the Nord-Trøndelag health study

Abstract

Aims/hypothesis Latent autoimmune diabetes (LADA) is a common form of diabetes, yet the risk factors are poorly characterised. The aim of this study was to investigate the influence of age, overweight and physical activity on the risk of LADA. Methods We analysed age, overweight and physical inactivity and the incidence of LADA in 38,800 men and women, observed between 1984 and 1986 and 1995 and 1997 as part of the Nord-Trøndelag Health Survey. We also compared such factors with incident cases of type 2 (n=738) and 'classic' type 1 diabetes (n=18). Patients classified as LADA (n=81) had antibodies against GAD and were insulin independent at diagnosis. Results The proportion of those who were older, overweight and inactive before diagnosis was almost identical in LADA and type 2 diabetes patients. BMI ≥30 kg/m 2 was strongly associated with LADA incidence (relative risk [RR]=15.0, 95% CI 7.51-29.97). The association was similar for type 2 diabetes (RR=15.37, 95% CI 12.07-19.57) but not for type 1 diabetes. Similarly, age (≥60 years) was an important risk factor for LADA (RR= 5.62, 95% CI 2.36-13.4) as well as for type 2 diabetes (RR=6.78, 95% CI 5.07-9.06) in contrast to type 1 diabetes. Physical inactivity was associated with an increased risk of both LADA and type 2 diabetes. Conclusions/interpretation This study suggests that increased age, overweight and physical inactivity are as strong risk factors for LADA as for type 2 diabetes. These findings suggest a role for insulin resistance in the pathogenesis of LADA.Keywords Age . Epidemiology . Incidence . Latent autoimmune diabetes in adults . Overweight . Physical inactivityAbbreviations AP attributable proportion LADA latent autoimmune diabetes in adults RR relative risk Diabetologia (2007) 50:55-58

Metabolic Syndrome and Autoimmune Diabetes: Action LADA 3

“…Therefore, there is no evidence to suggest that autoimmune diabetes is due to decreased insulin sensitivity; instead, decreased insulin sensitivity might predispose to an earlier time of diagnosis. Such decreased insulin sensitivity could explain why age, overweight, and physical inactivity are as strongly predictive of LADA as they are of type 2 diabetes (15,16). These present observations indicate that metabolic syndrome is as common in adults with autoimmune diabetes as it is in normal subjects.…”

Physical activity and incident type 2 diabetes mellitus: a systematic review and dose–response meta-analysis of prospective cohort studies

“…Follow-up time varied from 3 [42] to 23.1 [60] years. Twelve studies were conducted in the USA [12,14,35,38,46,58,[60][61][62][63][64][65], six in Asia [47,57,59,[66][67][68], two in Australia [40,42] and eight across Europe [13,36,37,39,41,[69][70][71]. All cohorts relied on self-reported PA collected using questionnaires or by interview, apart from one study in Hawaiians [58].…”

“…In the context of type 2 diabetes, earlier studies have found that dose-response curves may be different for Asian Ding et al (2015) [42] Burchfiel et al (1995) [58] Magliano et al (2008) [40] Steinbrecher et al (I) (2012) [38] Grøntved et al (2012) [61] Demakakos et al (2010) [71] Haapanen et al (II) (1997) [36] Krishnan et al (2009) [64] Chien et al (2009) [68] Folsom et al (2000) [62] Carlsson et al (2007) [41] Ekelund et al (II) (2012) [39] Nakanishi et al ( 2004) [57] Steinbrecher et al (II) (2012) [38] Meisinger et al (II) (2005) [37] Okada et al (2000) [66] Grøntved et al (II) (2014) [35] Fretts et al (2009) [46] Lynch et al (1996) [13] Meisinger et al (I) (2005) [37] Haapanen et al (I) (1997) [36] Subtotal (I Indians who may require more PA to be protected from their relatively higher susceptibility to develop type 2 diabetes [72,73]. A potential strength of our present analyses is the expression of PA exposure dose in MMET h/week rather than just MET h/week.…”

“…Studies reporting data independently for men and women [35][36][37][38][39] or for multiple cohorts within a study [35] were treated as separate observations. Studies reporting risk estimates relative to the highest category of PA were re-calculated to set the lowest PA [36,[40][41][42] category as the referent [43].…”

Overweight, obesity and the risk of LADA: results from a Swedish case–control study and the Norwegian HUNT Study

“…Hence, the role of overweight in the development of LADA may depend on the severity of the underlying autoimmune process. Only one prospective study based on 11 years follow-up of the Norwegian Nord-Trøndelag Health Study (HUNT Study) estimated the risk of LADA in relation to overweight/obesity [20]. This study was based on only 81 individuals; hence, the influence of excessive weight on more or less autoimmune forms of LADA could not be explored, and confounding control was limited.…”