Life-Course Trajectories of Body Mass Index, Insulin Resistance, and Incident Diabetes in Chinese Adults.

Zhi Yuan NING; Jing Lan ZHANG; Bing Bing FAN; Yan Lin QU; Chang SU; Tao ZHANG

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Life-Course Trajectories of Body Mass Index, Insulin Resistance, and Incident Diabetes in Chinese Adults.

Author: Zhi Yuan NING ¹ ; Jing Lan ZHANG ² ; Bing Bing FAN ³ ; Yan Lin QU ⁴ ; Chang SU ⁵ ; Tao ZHANG ⁶
Author Information

1. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China.
2. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;School of Life Science, Shandong University, Qingdao 266237, Shandong, China.
3. Food is Medicine Institute, Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA 02148, USA.
4. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
5. National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
6. Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China;Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, Tianjin Medical University, Tianjin 300070, China.
Publication Type:Journal Article
Keywords: Body mass index; Diabetes Mellitus; Homeostasis model assessment of insulin resistance; Longitudinal studies
MeSH: Humans; Insulin Resistance; Body Mass Index; Male; Female; Middle Aged; China/epidemiology*; Adult; Longitudinal Studies; Incidence; Diabetes Mellitus/epidemiology*; Aged; Obesity/epidemiology*; Diabetes Mellitus, Type 2/epidemiology*; East Asian People
From: Biomedical and Environmental Sciences 2025;38(6):706-715
CountryChina
Language:English
Abstract: OBJECTIVE:This study aimed to explore the interplay between the life-course body mass index (BMI) trajectories and insulin resistance (IR) on incident diabetes.
METHODS:This longitudinal cohort included 2,336 participants who had BMI repeatedly measured 3-8 times between 1989 and 2009, as well as glucose and insulin measured in 2009. BMI trajectories were identified using a latent class growth mixed model. The interplay between BMI trajectories and IR on diabetes was explored using the four-way effect decomposition method. Logistic regression and mediation models were used to estimate the interaction and mediation effects, respectively.
RESULTS:Three distinct BMI trajectory groups were identified: low-stable ( n = 1,625), medium-increasing ( n = 613), and high-increasing ( n = 98). Both interaction and mediation effects of BMI trajectories and IR on incident diabetes were significant ( P < 0.05). The proportion of incident diabetes was higher in the IR-obesity than in the insulin-sensitivity (IS) obesity group (18.9% vs. 5.8%, P < 0.001). After adjusting for covariates, the odds ratios (95% confidence intervals) of the IR, IS-obesity, and IR-obesity groups vs. the normal group were 3.22 (2.05, 5.16), 2.05 (1.00, 3.97), and 7.98 (5.19, 12.62), respectively. IR mediated 10.7% of the total effect of BMI trajectories on incident diabetes ( P < 0.001).
CONCLUSION:We found strong interactions and weak mediation effects of IR on the relationship between life-course BMI trajectories and incident diabetes. IS-obesity is associated with a lower risk of incident diabetes than IR-obesity.