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Weight Gain as a Risk Factor for Clinical Diabetes Mellitus in Women

Graham A. Colditz, MBBS, DrPH; Walter C. Willett, MD; Andrea Rotnitzky, PhD; and JoAnn E. Manson, MD
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From Harvard School of Public Health; Channing Laboratory; and Harvard Medical School, Boston, Massachusetts. Requests for Reprints: Graham A. Colditz, MBBS, DrPH, Harvard Medical School, Channing Laboratory, 180 Longwood Avenue, Boston, MA 02115. Acknowledgments: The authors thank the participants in the Nurses' Health Study; Maureen Ireland, Mark Shneyder, Carol Leighton, and Anne Wolf for their assistance; and Frank E. Speizer, MD, principal investigator of the Nurses' Health Study, for his support. Grant Support: By P30-DK-46200 and by DK36798 and CA40935 from the National Institutes of Health, Washington, D.C. Dr. Manson is a recipient of a Merck/Society for Epidemiologic Research Grant Award.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(7):481-486. doi:10.7326/0003-4819-122-7-199504010-00001
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Objective: To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women.

Design: Prospective cohort study with follow-up from 1976 to 1990.

Setting: 11 U.S. states.

Participants: 114 281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976.

Outcome Measures: Non-insulin-dependent diabetes mellitus.

Results: 2204 cases of diabetes were diagnosed during 1.49 million person-years of follow-up. After adjustment for age, body mass index was the dominant predictor of risk for diabetes mellitus. Risk increased with greater body mass index, and even women with average weight (body mass index, 24.0 kg/m2) had an elevated risk. Compared with women with stable weight (those who gained or lost less than 5 kg between age 18 years and 1976) and after adjustment for age and body mass index at age 18 years, the relative risk for diabetes mellitus among women who had a weight gain of 5.0 to 7.9 kg was 1.9 (95% CI, 1.5 to 2.3). The corresponding relative risk for women who gained 8.0 to 10.9 kg was 2.7 (CI, 2.1 to 3.3). In contrast, women who lost more than 5.0 kg reduced their risk for diabetes mellitus by 50% or more. These results were independent of family history of diabetes.

Conclusion: The excess risk for diabetes with even modest and typical adult weight gain is substantial. These findings support the importance of maintaining a constant body weight throughout adult life and suggest that the 1990 U.S. Department of Agriculture guidelines that allow a substantial weight gain after 35 years of age are misleading.





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