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Adiposity in Type 1 Diabetes

Conway, Baqiyyah Nilija (2009) Adiposity in Type 1 Diabetes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Background: Increases in the prevalence of overweight and obesity states, and in their associated adverse health outcomes, have been well described in the general population. However, in type 1 diabetes (T1D), a disease traditionally characterized by a lean phenotype, time trends in overweight and obesity and the role of adiposity on complications in TID have not been well investigated. We therefore investigated time trends in overweight and obesity and the association of adiposity with mortality and coronary artery calcification (CAC), a subclinical marker of coronary artery disease in the Pittsburgh Epidemiology of Diabetes Complications cohort of childhood onset T1D.Methods: Participants were first seen in 1986-1988 and followed biennially thereafter. Mortality was censored at January 1, 2007. Body mass index (BMI) was defined as kg/m² and Waist circumference (WC) was measured. CAC, visceral adiposity (VAT) and subcutaneous adiposity (SAT) by electron beam tomography. Free fatty acids (FFA) were determined by in vitro colorimetry.Results: After 18 years of follow-up, the prevalence of overweight increased by 47%; the prevalence of obesity increased 7-fold. BMI demonstrated a quadratic relationship with mortality. Adjustment for waist circumference eliminated the increased risk in the obese. Weight gain was positively related to intensive insulin therapy and inversely with mortality. There was a positive relationship between the presence of CAC and adiposity measures, however the degree of CAC was not associated with any adiposity measure, except negatively with SAT in women. Finally, FFA were not associated with any adiposity measure and showed no association with CAC.Conclusion: Adiposity is increasing in T1D and shows a complex association with coronary artery disease and mortality. These results have great public health significance by suggesting that avoidance of overweight, per se, in type 1 diabetes should not be a major priority; rather attention should focus on maximizing glucose control even though it may result in weight gain.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Conway, Baqiyyah Nilijabaqiyyah@yahoo.com
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairOrchard, TrevorOrchardT@edc.pitt.eduTJO
Committee MemberFried, LindaLinda.Fried@va.gov
Committee MemberEvans, RhobertEvansR@edc.pitt.eduRWE2
Committee MemberKelsey, Sherylkelsey@edc.pitt.eduKELSEYS
Date: 29 January 2009
Date Type: Completion
Defense Date: 31 October 2008
Approval Date: 29 January 2009
Submission Date: 4 December 2008
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: BMI; adibposity; time trends; type 1 diabetes; coronary artery disease; mortality
Other ID: http://etd.library.pitt.edu/ETD/available/etd-12042008-145604/, etd-12042008-145604
Date Deposited: 10 Nov 2011 20:08
Last Modified: 15 Nov 2016 13:53
URI: http://d-scholarship.pitt.edu/id/eprint/10031

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