Estimating the risk of type-2 diabetes using obese-years in a contemporary population of the Framingham Study

Asnawi Abdullah, Fauzi Ali Amin, Farida Hanum, Johannes Stoelwinder, Stephanie Tanamas, Rory Wolf, Evelyn Wong, Anna Peeters

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Background: We have recently demonstrated that an obese-years construct is a better predictor of the risk of diabetes than the severity of body weight alone. However, these risk estimates were derived from a population cohort study initiated in 1948 that might not apply to the current population. Objective: To validate an obese-years construct in estimating the risk of type-2 diabetes in a more contemporary cohort study. Design: A total of 5,132 participants of the Framingham Offspring Study, initiated in 1972, were followed up for 45 years. Body mass index (BMI) above 29 kg/m2 was multiplied by the number of years lived with obesity at that BMI to define the number of obese-years. Time-dependent Cox regression was used to explore the association. Results: The risk of type-2 diabetes increased significantly with increase in obese-years. Adjusted hazard ratios increased by 6% (95% CI: 5-7%) per additional 10 points of obese-years. This ratio was observed to be similar in both men and women, but was 4% higher in current smokers than in never/ex-smokers. The Akaike Information Criterion confirmed that the Cox regression model with the obese-years construct was a stronger predictor of the risk of diabetes than a model including either BMI or the duration of obesity alone. Conclusions: In a contemporary cohort population, it was confirmed that the obese-years construct is strongly associated with an increased risk of type-2 diabetes. This suggests that both severity and the duration of obesity should be considered in future estimations of the burden of disease associated with obesity.

Original languageEnglish
Article number30421
Number of pages8
JournalGlobal Health Action
Publication statusPublished - 30 Jun 2016


  • BMI
  • Obese-years
  • Obesity
  • Offspring Framingham
  • Type-2 diabetes

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