Background: Increases in the prevalence of overweight and obesity states, and in their associated adverse health outcomes, have been well described in the general population. However, in type 1 diabetes (T1D), a disease traditionally characterized by a lean phenotype, time trends in overweight and obesity and the role of adiposity on complications in TID have not been well investigated. We therefore investigated time trends in overweight and obesity and the association of adiposity with mortality and coronary artery calcification (CAC), a subclinical marker of coronary artery disease in the Pittsburgh Epidemiology of Diabetes Complications cohort of childhood onset T1D.
Methods: Participants were first seen in 1986-1988 and followed biennially thereafter. Mortality was censored at January 1, 2007. Body mass index (BMI) was defined as kg/m² and Waist circumference (WC) was measured. CAC, visceral adiposity (VAT) and subcutaneous adiposity (SAT) by electron beam tomography. Free fatty acids (FFA) were determined by in vitro colorimetry.
Results: After 18 years of follow-up, the prevalence of overweight increased by 47%; the prevalence of obesity increased 7-fold. BMI demonstrated a quadratic relationship with mortality. Adjustment for waist circumference eliminated the increased risk in the obese. Weight gain was positively related to intensive insulin therapy and inversely with mortality. There was a positive relationship between the presence of CAC and adiposity measures, however the degree of CAC was not associated with any adiposity measure, except negatively with SAT in women. Finally, FFA were not associated with any adiposity measure and showed no association with CAC.
Conclusion: Adiposity is increasing in T1D and shows a complex association with coronary artery disease and mortality. These results have great public health significance by suggesting that avoidance of overweight, per se, in type 1 diabetes should not be a major priority; rather attention should focus on maximizing glucose control even though it may result in weight gain.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12042008-145604 |
| Date | 29 January 2009 |
| Creators | Conway, Baqiyyah Nilija |
| Contributors | Rhobert Evans, Sheryl Kelsey, Trevor Orchard, Linda Fried |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12042008-145604/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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