October 4, 2018

Approximately 36 percent of adolescents with Type 1 diabetes are overweight or obese. A recent study found that, especially among females in this population, lower socioeconomic status may be associated with higher body fat in the first decade following diagnosis with Type 1 diabetes.

Dr. Jamie Crandell

Dr. Jamie Crandell

Dr. Elizabeth Mayer-Davis

Dr. Elizabeth Mayer-Davis

Anna Kahkoska

Anna Kahkoska

Researchers involved in this study include lead author Anna Kahkoska, a dual doctor of medicine and doctor of philosophy student in the Department of Nutrition at the UNC-Chapel Hill Gillings School of Global Public Health; senior author Elizabeth Mayer-Davis, PhD, Cary C. Boshamer Distinguished Professor of Nutrition and Medicine and chair of the Department of Nutrition; and Jamie Crandell, PhD, an assistant professor in UNC Gillings’ Department of Biostatistics.

The full study, titled “Sociodemographic associations of longitudinal adiposity in youth with type 1 diabetes,” was published online September 14 by Pediatric Diabetes.

“As the prevalence of overweight and obesity has increased among youth with Type 1 diabetes over the past two decades, weight management has emerged as a major clinical issue,” Kahkoska said. “Youth with Type 1 diabetes are now at the same risk of being obese as youth without diabetes, and even more likely to be overweight. This population already has up to a 10-times higher risk of heart disease later in life compared to individuals without Type 1 diabetes, and being overweight or obese can further increase this risk. To inform effective clinical strategies to prevent weight gain and help with weight loss in this population, I wanted to learn more about the subgroups within it who are at the highest risk for becoming overweight or obese over time.”

Weight status represents a complex interaction of biological, behavioral and cultural factors. Previous studies have showed that the prevalence of pediatric obesity in the general population can be predicted by race and ethnicity, as well as by socioeconomic factors like household income and parental education level. However, there also are factors specific to Type 1 diabetes and its management that drive weight gain.

To better understand how these factors influence weight gain over time, the researchers analyzed data from the SEARCH for Diabetes in Youth Study. After identifying 363 females and 379 males with Type 1 diabetes, who averaged between 12 and 14 years of age when SEARCH began to track them, the researchers delved into data from baseline assessments and nearly nine years of follow-up visits. Although direct measures of body fat were not available, the researchers used equations previously developed in the Gillings School Department of Nutrition by June Stevens, PhD, AICR/WCRF Distinguished Professor of nutrition and epidemiology, to estimate body fat percentage from the data they had.

They found three distinct trajectories (lowest, middle and highest) for estimated body fat in each sex group. In females, all three trajectories led to higher final body fat levels, relative to the starting point, as the girls aged. In males, every trajectory led to a relative decline in body fat over time. To explain these sex-specific differences, the authors noted that these trends reflect normal changes in body composition associated with puberty, wherein sex hormones lead to increased body fat in females and decreased body fat in males. Another finding, however, had to do with which trajectory each adolescent fell into.

“After accounting for aspects of Type 1 diabetes management that are known to drive weight gain, we found that several markers of lower socioeconomic status – such as a single-parent household, lack of private health insurance, lower parental education levels and lower household income – predicted higher levels of body fat throughout adolescence in females with Type 1 diabetes,” Kahkoska explained.

In males tracked by the study, however, household income level was the only socioeconomic factor associated with increased rates of obesity.

Ultimately, the co-authors concluded, the findings reinforce that young people with Type 1 diabetes are susceptible to unfavorable body composition based on the same sociodemographic aspects as the general pediatric population. There likely are additional financial barriers as well as specific aspects of Type 1 diabetes clinical care that impact weight control in these teens, and future interventions should attempt to address health inequity to aid young individuals with Type 1 diabetes maintain healthy body fat levels throughout adolescence and into adulthood.


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