Age of obesity onset, cumulative obesity exposure over early adulthood and risk of type 2 diabetes



Obesity is a risk factor for type 2 diabetes, yet little is known about how timing and cumulative exposure of obesity are related to disease risk. The aim of this study was to examine the associations between BMI trajectories, age of onset of obesity and obese-years (a product of degree and duration of obesity) over early adulthood and subsequent risk of type 2 diabetes.


Women aged 18–23 years at baseline (n = 11,192) enrolled in the Australian Longitudinal Study on Women’s Health (ALSWH) in 1996 were followed up about every 3 years via surveys for up to 19 years. Self-reported weights were collected up to seven times. Incident type 2 diabetes was self-reported. A growth mixture model was used to identify distinct BMI trajectories over the early adult life course. Cox proportional hazards regression models were used to examine the associations between trajectories and risk of diabetes.


One hundred and sixty-two (1.5%) women were newly diagnosed with type 2 diabetes during a mean of 16 years of follow-up. Six distinct BMI trajectories were identified, varying by different initial BMI and different slopes of increase. Initial BMI was positively associated with risk of diabetes. We also observed that age at onset of obesity was negatively associated with risk of diabetes (HR 0.87 [95% CI 0.79, 0.96] per 1 year increment), and number of obese-years was positively associated with diabetes (p for trend <0.0001).


Our data revealed the importance of timing of obesity, and cumulative exposure to obesity in the development of type 2 diabetes in young women, suggesting that preventing or delaying the onset of obesity and reducing cumulative exposure to obesity may substantially lower the risk of developing diabetes.

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Fig. 1

Data availability

Data may be made available to collaborating researchers where there is a formal request to make use of the material. Permission to use the data must be obtained from the Data Access Committee of ALSWH (



Bayesian information criterion


Growth mixture model


Metabolic equivalents


High-sensitivity C-reactive protein


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We are grateful to the women who provided the survey data. The authors also thank G. Giles of the Cancer Epidemiology Division, Cancer Council Victoria, for permission to use the Dietary Questionnaire for Epidemiological Studies (Version 2), Melbourne: Cancer Council Victoria, 1996.


The research on which this paper is based was conducted as part of the ALSWH by the University of Queensland and the University of Newcastle. We are grateful to the Australian Government Department of Health for funding. This study was also supported by a Pilot and Feasibility Award within the Center for Diabetes and Metabolic Diseases (CDMD) at Indiana University School of Medicine, NIH/NIDDK Grant Number P30 DK097512.

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All the people listed as authors fulfil all the following three criteria: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. JL designed the study and drafted the manuscript. JEB acquired the data. JL is the guarantor of this work.

Correspondence to Juhua Luo.

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Luo, J., Hodge, A., Hendryx, M. et al. Age of obesity onset, cumulative obesity exposure over early adulthood and risk of type 2 diabetes. Diabetologia (2019) doi:10.1007/s00125-019-05058-7

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  • Age of obesity onset
  • Cumulative obesity
  • Diabetes
  • Obese-years
  • Obesity
  • Type 2 diabetes
  • Weight trajectory