Pastorino, S; (2014) The association of adult lifecourse body mass index, waist circumference and dietary patterns with type 2 diabetes incidence in the MRC National Survey of Health and Development. Doctoral thesis , UCL (University College London).

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Abstract

Type 2 diabetes is a major public health problem and its prevalence is increasing worldwide, especially among older people. Overweight and abdominal obesity are known risk factors for the disease, but few studies have analysed their longitudinal pattern. A high glycaemic index (GI), low dietary fibre and high dietary fats have also been linked to type 2 diabetes, but their combined effect has never been studied. Using data from the MRC National Survey of Health and Development this thesis aimed to examine adult life course (from age 26 to 53 years) body mass index (BMI), waist circumference (WC) and dietary patterns in relation to type 2 diabetes incidence between age 53 and 60-64 years. At any stage of the adult life course BMI gain was associated with type 2 diabetes incidence. Early (26-36 years) and late (43-53 years) adulthood BMI gains were more important for men whereas late adulthood gains had stronger associations for women. The risk of type 2 diabetes increased with longer durations of overweight or obesity, probably because of the increasing accumulation of weight across the life course. Long-term WC change (36-53 years), independent of concomitant BMI change, was associated with increased risk of diabetes especially among women and people with an initially normal BMI. A high fat, high GI, low fibre dietary pattern was identified that was characterised by a high consumption of refined grains, processed meat, and animal fats, and a low intake of fruits, vegetables, low-fat dairy and wholegrain cereals. Higher scores for this dietary pattern at age 43 (only among women) and 53 were associated with increased type 2 diabetes incidence, predominantly via pathways that were independent of BMI and WC. Long-term score change (36-53 years) was significantly associated with diabetes only among women. Early interventions to reduce weight and WC gain and improve dietary patterns would be effective public health strategies to prevent type 2 diabetes risk at older ages.

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