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1 April 1995 | Volume 122 Issue 7 | Pages 481-486
Objective: To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women.
Design: Prospective cohort study with follow-up from 1976 to 1990.
Setting: 11 U.S. states.
Participants: 114 281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976.
Outcome Measures: Non-insulin-dependent diabetes mellitus.
Results: 2204 cases of diabetes were diagnosed during 1.49 million person-years of follow-up. After adjustment for age, body mass index was the dominant predictor of risk for diabetes mellitus. Risk increased with greater body mass index, and even women with average weight (body mass index, 24.0 kg/m2) had an elevated risk. Compared with women with stable weight (those who gained or lost less than 5 kg between age 18 years and 1976) and after adjustment for age and body mass index at age 18 years, the relative risk for diabetes mellitus among women who had a weight gain of 5.0 to 7.9 kg was 1.9 (95% CI, 1.5 to 2.3). The corresponding relative risk for women who gained 8.0 to 10.9 kg was 2.7 (CI, 2.1 to 3.3). In contrast, women who lost more than 5.0 kg reduced their risk for diabetes mellitus by 50% or more. These results were independent of family history of diabetes.
Conclusion: The excess risk for diabetes with even modest and typical adult weight gain is substantial. These findings support the importance of maintaining a constant body weight throughout adult life and suggest that the 1990 U.S. Department of Agriculture guidelines that allow a substantial weight gain after 35 years of age are misleading.
Author and Article Information
From Harvard School of Public Health; Channing Laboratory; and Harvard Medical School, Boston, Massachusetts.
ARTICLE
Weight Gain as a Risk Factor for Clinical Diabetes Mellitus in Women
Requests for Reprints: Graham A. Colditz, MBBS, DrPH, Harvard Medical School, Channing Laboratory, 180 Longwood Avenue, Boston, MA 02115.
Acknowledgments: The authors thank the participants in the Nurses' Health Study; Maureen Ireland, Mark Shneyder, Carol Leighton, and Anne Wolf for their assistance; and Frank E. Speizer, MD, principal investigator of the Nurses' Health Study, for his support.
Grant Support: By P30-DK-46200 and by DK36798 and CA40935 from the National Institutes of Health, Washington, D.C. Dr. Manson is a recipient of a Merck/Society for Epidemiologic Research Grant Award.
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G. Hu, J. Lindstrom, T. T. Valle, J. G. Eriksson, P. Jousilahti, K. Silventoinen, Q. Qiao, and J. Tuomilehto Physical Activity, Body Mass Index, and Risk of Type 2 Diabetes in Patients With Normal or Impaired Glucose Regulation Arch Intern Med, April 26, 2004; 164(8): 892 - 896. [Abstract] [Full Text] [PDF]
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 R. I. G. Holt Diagnosis, epidemiology and pathogenesis of diabetes mellitus: an update for psychiatrists The British Journal of Psychiatry, April 1, 2004; 184(47): s55 - s63. [Abstract] [Full Text] [PDF]
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P. Cavazzoni, N. Mukhopadhyay, C. Carlson, A. Breier, and J. Buse Retrospective analysis of risk factors in patients with treatment-emergent diabetes during clinical trials of antipsychotic medications The British Journal of Psychiatry, April 1, 2004; 184(47): s94 - s101. [Abstract] [Full Text] [PDF]
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C. L Pelkman, V. K Fishell, D. H Maddox, T. A Pearson, D. T Mauger, and P. M Kris-Etherton Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women Am. J. Clinical Nutrition, February 1, 2004; 79(2): 204 - 212. [Abstract] [Full Text] [PDF]
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C. Arroyo, F. B. Hu, L. M. Ryan, I. Kawachi, G. A. Colditz, F. E. Speizer, and J. Manson Depressive Symptoms and Risk of Type 2 Diabetes in Women Diabetes Care, January 1, 2004; 27(1): 129 - 133. [Abstract] [Full Text] [PDF]
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J. S. Torgerson, J. Hauptman, M. N. Boldrin, and L. Sjostrom XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) Study: A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients Diabetes Care, January 1, 2004; 27(1): 155 - 161. [Abstract] [Full Text] [PDF]
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 K. M. McTigue, R. Harris, B. Hemphill, L. Lux, S. Sutton, A. J. Bunton, and K. N. Lohr Screening and Interventions for Obesity in Adults: Summary of the Evidence for the U.S. Preventive Services Task Force Ann Intern Med, December 2, 2003; 139(11): 933 - 949. [Abstract] [Full Text] [PDF]
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D. E Kelley Sugars and starch in the nutritional management of diabetes mellitus Am. J. Clinical Nutrition, October 1, 2003; 78(4): 858S - 864. [Abstract] [Full Text] [PDF]
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J. W. Anderson, C. W.C. Kendall, and D. J.A. Jenkins Importance of Weight Management in Type 2 Diabetes: Review with Meta-analysis of Clinical Studies J. Am. Coll. Nutr., October 1, 2003; 22(5): 331 - 339. [Abstract] [Full Text] [PDF]
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 M. A. Torsoni, J. B. Carvalheira, M. Pereira-Da-Silva, M. A. de Carvalho-Filho, M. J. A. Saad, and L. A. Velloso Molecular and functional resistance to insulin in hypothalamus of rats exposed to cold Am J Physiol Endocrinol Metab, July 1, 2003; 285(1): E216 - E223. [Abstract] [Full Text] [PDF]
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 D. F. Terry, M. Wilcox, M. A. McCormick, E. Lawler, and T. T. Perls Cardiovascular Advantages Among the Offspring of Centenarians J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2003; 58(5): M425 - 431. [Abstract] [Full Text] [PDF]
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M. Inoue, K. Tajima, T. Takezaki, N. Hamajima, K. Hirose, H. Ito, and S. Tominaga Epidemiology of pancreatic cancer in Japan: a nested case-control study from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC) Int. J. Epidemiol., April 1, 2003; 32(2): 257 - 262. [Abstract] [Full Text] [PDF]
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J. Steinberger and S. R. Daniels Obesity, Insulin Resistance, Diabetes, and Cardiovascular Risk in Children: An American Heart Association Scientific Statement From the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism) Circulation, March 18, 2003; 107(10): 1448 - 1453. [Full Text] [PDF]
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Z. T. Bloomgarden American Association of Clinical Endocrinologists (AACE) Consensus Conference on the Insulin Resistance Syndrome: 25-26 August 2002, Washington, DC Diabetes Care, March 1, 2003; 26(3): 933 - 939. [Full Text] [PDF]
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B. McCulloch, R. McDermott, G. Miller, D. Leonard, M. Elwell, and R. Muller Self-Reported Diabetes and Health Behaviors in Remote Indigenous Communities in Northern Queensland, Australia Diabetes Care, February 1, 2003; 26(2): 397 - 403. [Abstract] [Full Text] [PDF]
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A. D. Mooradian Cardiovascular Disease in Type 2 Diabetes Mellitus: Current Management Guidelines Arch Intern Med, January 13, 2003; 163(1): 33 - 40. [Abstract] [Full Text] [PDF]
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A. Peeters, J. J. Barendregt, F. Willekens, J. P. Mackenbach, A. A. Mamun, L. Bonneux, and for NEDCOM, the Netherlands Epidemiology and Demog Obesity in Adulthood and Its Consequences for Life Expectancy: A Life-Table Analysis Ann Intern Med, January 7, 2003; 138(1): 24 - 32. [Abstract] [Full Text] [PDF]
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N. Nakanishi, K. Suzuki, and K. Tatara Alcohol Consumption and Risk for Development of Impaired Fasting Glucose or Type 2 Diabetes in Middle-Aged Japanese Men Diabetes Care, January 1, 2003; 26(1): 48 - 54. [Abstract] [Full Text] [PDF]
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S. J. McNulty, E. Ur, and G. Williams A Randomized Trial of Sibutramine in the Management of Obese Type 2 Diabetic Patients Treated With Metformin Diabetes Care, January 1, 2003; 26(1): 125 - 131. [Abstract] [Full Text] [PDF]
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 M Labib The investigation and management of obesity J. Clin. Pathol., January 1, 2003; 56(1): 17 - 25. [Abstract] [Full Text] [PDF]
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