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Diabetologia. 2018 Jun;61(6):1333-1343. doi: 10.1007/s00125-018-4596-0. Epub 2018 Mar 27.

Overweight, obesity and the risk of LADA: results from a Swedish case-control study and the Norwegian HUNT Study.

Author information

1
Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden. rebecka.hjort@ki.se.
2
Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Malmö, Sweden.
3
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
4
Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
5
Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
6
Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland.
7
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
8
Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.
9
Division of Endocrinology, Abdominal Center, Helsinki University Hospital, Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
10
Folkhälsan Research Center, Helsinki, Finland.
11
K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

AIMS/HYPOTHESIS:

Excessive weight is a risk factor for type 2 diabetes, but its role in the promotion of autoimmune diabetes is not clear. We investigated the risk of latent autoimmune diabetes in adults (LADA) in relation to overweight/obesity in two large population-based studies.

METHODS:

Analyses were based on incident cases of LADA (n = 425) and type 2 diabetes (n = 1420), and 1704 randomly selected control participants from a Swedish case-control study and prospective data from the Norwegian HUNT Study including 147 people with LADA and 1,012,957 person-years of follow-up (1984-2008). We present adjusted ORs and HRs with 95% CI.

RESULTS:

In the Swedish data, obesity was associated with an increased risk of LADA (OR 2.93, 95% CI 2.17, 3.97), which was even stronger for type 2 diabetes (OR 18.88, 95% CI 14.29, 24.94). The association was stronger in LADA with low GAD antibody (GADA; <median) (OR 4.25; 95% CI 2.76, 6.52) but present also in LADA with high GADA (OR 2.14; 95% CI 1.42, 3.24). In the Swedish data, obese vs normal weight LADA patients had lower GADA levels, better beta cell function, and were more likely to have low-risk HLA-genotypes. The combination of overweight and family history of diabetes (FHD) conferred an OR of 4.57 (95% CI 3.27, 6.39) for LADA and 24.51 (95% CI 17.82, 33.71) for type 2 diabetes. Prospective data from HUNT indicated even stronger associations; HR for LADA was 6.07 (95% CI 3.76, 9.78) for obesity and 7.45 (95% CI 4.02, 13.82) for overweight and FHD.

CONCLUSIONS/INTERPRETATION:

Overweight/obesity is associated with increased risk of LADA, particularly when in combination with FHD. These findings support the hypothesis that, even in the presence of autoimmunity, factors linked to insulin resistance, such as excessive weight, could promote onset of diabetes.

KEYWORDS:

ANDIS; ANDiU; Body mass index; Case–control study; ESTRID; HUNT Study; LADA; Latent autoimmune diabetes in adults; Prospective study; Type 2 diabetes

PMID:
29589073
DOI:
10.1007/s00125-018-4596-0
[Indexed for MEDLINE]

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