Testing the ‘accelerator hypothesis’: Weight, body mass index and age at diagnosis of type 1 diabetes in a large cohort of 10,985 German and Austrian children and young adults

Aim: The purpose of the present study was to investigate whether increased weight gain is associated with an earlier manifestation of type 1 diabetes in children and young adults ('accelerator hypothesis'). We therefore analyzed the relationship between weight, body mass index (BMI) and age at onset of type 1 diabetes in a large cohort of Caucasoid patients along with time courses and age-related effects.

Methods: We evaluated anthropometric measurements in a large cohort of 10,985 patients diagnosed in the years 1990 to 2005 in 137 hospitals throughout Germany and Austria. Data were collected by the Diabetes Register for Prospective Follow-Up and Survey, designated as DPV. Patients were classified into six age groups: 0–4.9 yr., 5–9.9 yr., 10–14.9 yr., 15–19.9 yr., 20–24.9 yr., 25–29.9 yr. and compared with actual reference data. Statistical analysis was performed using Kruskal-Wallis test, Wilcoxon test, multivariate analysis and Bonferroni stepdown correction.

Results: A significantly higher standard deviation score (SDS) for weight and BMI at diabetes onset was found in all age groups for both females and males (p<0.01 to p<0.000001) compared with controls. BMI and weight SDS at onset, highest in the age-group 0–4.9 yr., gradually decreased with increasing age at manifestation (p<0.0001). Over the 15-year study period, there was a continuous rise in weight and BMI SDS in the cohort (p<0.0001). There was a significant influence of male gender and of calendar year of manifestation on BMI SDS (p<0.0001).

Conclusion: A higher BMI was associated with a younger age at diagnosis in Caucasoid patients. Increased weight gain in childhood should be considered a risk factor for early manifestation of type 1 diabetes.