Impact of weight and weight change on normalization of prediabetes and on persistence of normal glucose tolerance in an older population: the KORA S4/F4 study

Abstract

Background and aims: In a population-based cohort study with older subjects and without specific interventions, we investigated the impact of body mass index (BMI) and BMI change (as well as waist circumference and change of waist circumference) on reversion from prediabetes to normal glucose tolerance (NGT) and on long-term persistence of NGT. Materials and methods: Oral glucose tolerance tests were conducted at baseline and at follow-up in a cohort study in Southern Germany (KORA S4/F4; 1223 subjects without diabetes aged 55-74 years at baseline in 1999-2001; 887 subjects (73%), of whom 436 had prediabetes at baseline, participated in the follow-up 7 years later). Results: BMI reduction, but not initial BMI, predicted reversion from prediabetes to NGT. The odds ratio (OR) for returning to NGT was 1.43 (95% CI: 1.18-1.73) for a BMI decrease of 1 kg m À2 , after adjustment for age, sex, baseline glucose values and lifestyle factors. Initial BMI had no effect on reversion to NGT (OR ¼ 0.98, 95% CI: 0.91-1.06, per kg m À2 ). Persistence of NGT was associated with baseline BMI (OR ¼ 0.94, 95% CI: 0.88-0.998) and BMI reduction (OR ¼ 1.16, 95% CI: 1.02-1.33, per decrease by 1 kg m À2 ). For waist circumference and change of waist circumference similar results were obtained. Conclusion: In older adults, weight loss strongly increased the chances of returning from prediabetes to NGT irrespective of initial BMI. Long-term persistence of NGT depended both on initial BMI and on BMI change.

Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study

“…Our hypothesis was that consequences of CD start with increased BMI and later influence glucose, insulin, and consequently HOMA-IR and QUICKI regulation. Other studies have shown that metabolic disorders are preceded by BMI increases (38,39). This effect might explain why, in this population of young adults, we showed that CD was associated with increased BMI but not with other metabolic risk factors.…”

Natural history of prediabetes in older adults from a population‐based longitudinal study

“…We observed an approximately 22% reversion rate in older adults over 12 years. The only other longitudinal population-based study of older adults to examine the reversion rate to normoglycaemia, the KORA S4/F4 study of 55-to 74-yearolds in Germany, found a reversion rate of 16.3% over 7 years of follow-up, using oral glucose tolerance test (OGTT) as diagnostic criterion [24]. We reported a slightly higher reversion rate of 16% during the first 6-year follow-up, which may be explained by a larger proportion of prediabetes diagnosed by HbA1c, as the sensitivity of HbA1c test in diagnosing prediabetes is inferior to the OGTT [25].…”

“…Heavy To our knowledge, only one observational study in older adults has investigated the association between weight change and normalization of glycaemia [24]. This study showed that weight loss, but not initial BMI, strongly increased the likelihood of reverting from prediabetes to normoglycaemia.…”

Comparison of different aspects of BMI history to identify undiagnosed diabetes in Japanese men and women: Toranomon Hospital Health Management Center Study 12 (TOPICS 12)

“…The present results showed that combinations of current or maximum BMI and BMI changes greatly enhanced the identification of individuals with a high probability of having undiagnosed diabetes who could then be referred for further diagnostic testing. A prospective cohort study in Germany reported that reversion from pre-diabetes to normal glucose tolerance in older subjects was predicted by BMI reduction, but not by the initial BMI [27]. Further investigations are warranted to determine whether adding information on these BMI histories into common risk factors [26] of diabetes might refine the accuracy of screening for undiagnosed diabetes.…”

“…Importantly, we observed that individuals with a relatively low current BMI, but having a higher BMI max or DBMI 20y-max , had a significantly lower prevalence of undiagnosed diabetes compared with individuals with high past BMI and high current BMI. A prospective cohort study in Germany reported that reversion from pre-diabetes to normal glucose tolerance in older subjects was predicted by BMI reduction, but not by the initial BMI [27]. Additionally, a clinical review has shown that changes in lifestyle are effective in preventing both diabetes and obesity in adults in the high-risk group who have impaired glucose tolerance [4].…”