The Association of Maximum Body Weight on the Development of Type 2 Diabetes and Microvascular Complications: MAXWEL Study

Background

Obesity precedes the development of type 2 diabetes (T2D). However, the relationship between the magnitude and rate of weight gain to T2D development and complications, especially in non-White populations, has received less attention.

Methods and Findings

We determined the association of rate and magnitude of weight gain to age at T2D diagnosis (Age_T2D), HbA1c at T2D diagnosis (HbA1c_T2D), microalbuminuria, and diabetic retinopathy after adjusting for sex, BMI at age 20 years, lifestyles, family history of T2D and/or blood pressure and lipids in 2164 Korean subjects aged ≥30 years and newly diagnosed with diabetes. Body weight at age 20 years (Wt_20y) was obtained by recall or from participants’ medical, school, or military records. Participants recalled their maximum weight (Wt_max) prior to T2D diagnosis and age at maximum weight (Age_{max_wt}). The rate of weight gain (Rate_{max_wt}) was calculated from magnitude of weight gain (ΔWt = Wt_max–Wt_20y) divided by ΔTime (Age_{max_wt} –20 years). The mean Age_{max_wt} and Age_T2D were 41.5±10.9 years and 50.1±10.5 years, respectively. The Wt_20y and Wt_max were 59.9±10.5 kg and 72.9±11.4 kg, respectively. The Rate_{max_wt} was 0.56±0.50 kg/year. After adjusting for risk factors, greater ΔWt and higher Rate_{max_wt} were significantly associated with earlier Age_T2D, higher HbA1c_T2D after additional adjusting for Age_T2D, and microalbuminuria after further adjusting for HbA1c_T2D and lipid profiles. Greater ΔWt and higher Rate_{max_wt} were also significantly associated with diabetic retinopathy.

Conclusions

This finding supports public health recommendations to reduce the risk of T2D and its complications by preventing weight gain from early adulthood.