BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach.

TitleBMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach.
Publication TypeJournal Article
Year of Publication2013
AuthorsChiu, C-J, Wray, LA, Lu, F-hwa, Beverly, EA
JournalJ Gen Intern Med
Date Published2013 Sep
ISSN Number1525-1497
KeywordsActivities of Daily Living, Body Mass Index, Diabetes Mellitus, Type 2, Disability Evaluation, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Obesity, Obesity, Morbid, Overweight, Retrospective Studies, United States, Weight Gain, Weight Loss

BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability.

OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes.

DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories.

PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064).

MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined.

RESULTS: Four distinct weight trajectories (stable normal weight, 28.7 %; stable overweight, 46.2 %; loss and regain obese, 18.0 %; weight cumulating morbidly obese, 7.1 %) and three disability trajectories (little or low increase, 34.4 %; moderate increase, 45.4 %; chronic high increase, 20.2 %) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group.

CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study.


Copyright - Society of General Internal Medicine 2013 Last updated - 2013-09-09 Bowman, Robert L.; DeLucia, Janice L. Accuracy of self-reported weight: A meta-analysis. Behavior Therapy, 23. 4 (1992): 637-655. Association for Advancement of Behavior Therapy; Elsevier Science Carnethon, Mercedes R, and De Chavez, Peter John D, and Biggs, Mary L, and Lewis, Cora E, and Pankow, James S, and Bertoni, Alain G, and Golden, Sherita H, and Liu, Kiang , and Mukamal, Kenneth J, and Campbell-Jenkins, Brenda , and Dyer, Alan R. Association of Weight Status With Mortality in Adults With Incident Diabetes. JAMA 308:6 Aug 8, 2012 Chaudhry, Z W; Gannon, M C; Nuttall, F Q. Stability of body weight in type 2 diabetes. DIABETES CARE, 29. 3 (2006): 493-497. AMER DIABETES ASSOC COLDITZ, G. A.; MARTIN, P.; STAMPFER, M. J.; WILLETT, W. C.; et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. American journal of epidemiology, 123. 5 (1986): 894-900. Oxford University Press D'Unger, Amy V; D'Unger, Amy V; Land, Kenneth C; McCall, Patricia L. How many latent classes of delinquent/criminal careers? Results from mixed Poisson regression analyses. American Journal of Sociology, 103. 6 (1998): 1593-1630 de Fine Olivarius, N.; Andreasen, A. H.; Siersma, V.; Richelsen, B.; et al. Changes in patient weight and the impact of antidiabetic therapy during the first 5 years after diagnosis of diabetes mellitus. DIABETOLOGIA, 49. 9 (2006): 2058-2067. SPRINGER FELDSTEIN, Adrianne C.; NICHOLS, Gregory A.; SMITH, David H.; STEVENS, Victorj.; et al. Weight Change in Diabetes and Glycemic and Blood Pressure Control. Diabetes care, 31. 10 (2008): 1960-1965. American Diabetes Association Feldstein, Adrianne C.; Nichols, Gregory A.; Smith, David H.; Rosales, A. Gabriela; et al. Weight change and glycemic control after diagnosis of type 2 diabetes. JOURNAL OF GENERAL INTERNAL MEDICINE, 23. 9 (2008): 1339-1345. SPRINGER Ferraro, Kenneth F.; Su, Ya-Ping; Gretebeck, Randall J.; Black, David R.; et al. Body mass index and disability in adulthood: A 20-year panel study. American Journal of Public Health, 92. 5 (2002): 834-840. American Public Health Association Inc Goldman, N; Lin, I F; Weinstein, M; Lin, Y H. Evaluating the quality of self-reports of hypertension and diabetes. JOURNAL OF CLINICAL EPIDEMIOLOGY, 56. 2 (2003): 148-154. PERGAMON-ELSEVIER SCIENCE LTD Gorber, S C; Tremblay, M; Moher, D; Gorber, B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obesity Reviews, 8. 4 (2007): 307-326. Blackwell Publishing Guare, J.C.; Wing, R.R.; Grant, A. Comparison of obese NIDDM and nondiabetic women: short- and long-term weight loss. Obesity research, 3. 4 (1995): 329-335 Hensrud, D D; Hensrud, D D. Dietary treatment and long-term weight loss and maintenance in type 2 diabetes. Obesity Research, 9. Suppl. 4 (2001): 348S-353S Wray LA, Blaum C, Ofstedal MB, Herzog R. Diabetes dianosis and weight loss in middle-aged adults. Res Aging. 2004;26(1):62 81. Hoeymans, N; Feskens, EJM; vandenBos, GAM; Kromhout, D. Measuring functional status: Cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993) JOURNAL OF CLINICAL EPIDEMIOLOGY, 49. 10 (1996): 1103-1110. PERGAMON-ELSEVIER SCIENCE LTD Bobby L Jones, and Daniel S Nagin. Advances in Group-Based Trajectory Modeling and an SAS Procedure for Estimating Them. Sociological Methods and Research 35:4 May 2007: 542-571 Juster, F Thomas; Suzman, Richard. An overview of the Health and Retirement Study. Journal of Human Resources, v30. n1 (1995): pS7(50). University of Wisconsin Press Kahng, Sang Kyoung; Dunkle, Ruth E.; Jackson, James S. The Relationship between the Trajectory of Body Mass Index and Health Trajectory among Older Adults: Multilevel Modeling Analyses. Research on Aging, 26. 1 (2004): 31-61. SAGE Publications Inc LANGLOIS, J. A.; MAGGI, S.; HARRIS, T.; SIMONSICK, E. M.; et al. Self-report of difficulty in performing functional activities identifies a broad range of disability in old age. Journal of the American Geriatrics Society, 44. 12 (1996): 1421-1428. Blackwell LOOKER, Helen C.; KNOWLER, William C.; HANSON, Robert L. Changes in BMI and weight before and after the development of type 2 diabetes. Diabetes care, 24. 11 (2001): 1917-1922. American Diabetes Association McAdams, Mara A.; Hu, Frank B.; Van Dam, Rob M. Comparison of self-reported and measured BMI as correlates of disease markers in U.S. adults. Obesity, 15. 1 (2007): 188-196. Nature Publishing Group NAGIN, Daniel S.; TREMBLAY, Richard E. Analyzing developmental trajectories of distinct but related behaviors : A group-based method. Psychological methods, 6. 1 (2001): 18-34. American Psychological Association NIH-NHLBI. Clinical guidelines on the identification. Evaluation, and treatment of overweight and obesity in adults. Clinical guidelines on the identification. Evaluation, and treatment of overweight and obesity in adults (1998) Jacob AN, Salinas K, Adams-Huet B, Raskin P. Weight gain in type 2 diabetes mellitus. Diabetes Obes Metabol. 2007;9(3):386 93. Jones BL, Nagin DS, Roeder K. A SAS procedure based on mixture models for estimating developmental trajectories. Socio Meth Res. 2001;29(3):374 93. Russell-Jones, David; Russell-Jones, David; Khan, Rehman. Insulin-associated weight gain in diabetes - causes, effects and coping strategies. Diabetes, obesity and metabolism., 9. 6 (2007): 799-812 Sairenchi, Toshimi , and Iso, Hiroyasu , and Irie, Fujiko , and Fukasawa, Nobuko , and Ota, Hitoshi , and Muto, Takashi . Underweight as a Predictor of Diabetes in Older Adults: A large cohort study. Diabetes Care 31:3 Mar 2008: 583-4 Suzanne M Shoff, Ronald Klein, Scot E Moss, Barbara E K Klein, and Karen J Cruickshanks. Weight change and glycemic control in a population-based sample of adults with older-onset diabetes. The Journals of Gerontology 53A:1 Jan 1998: M27-32 Turner, R C; Holman, R R; Cull, CA; Stratton, I M; et al. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) LANCET, 352. 9131 (1998): 837-853. ELSEVIER SCIENCE INC Tuthill, A.; McKenna, M. J.; O'Shea, D.; McKenna, T. J. Weight changes in type 2 diabetes and the impact of gender. DIABETES OBESITY and METABOLISM, 10. 9 (2008): 726-732. BLACKWELL PUBLISHING Wang, Ching-Yi; Sheu, Ching-Fan; Protas, Elizabeth. Construct validity and physical performance of older adults in different hierarchical physical-disability levels. JOURNAL OF AGING AND PHYSICAL ACTIVITY, 15. 1 (2007): 75-89. HUMAN KINETICS PUBL INC WRAY, L. A.; HERZOG, A. R.; WILLIS, R. J.; WALLACE, R. B. The impact of education and heart attack on smoking cessation among middle-aged adults. Journal of health and social behavior, 39. 4 (1998): 271-294. American Sociological Association Zamboni, M.; Mazzali, G.; Zoico, E.; Di Francesco, V.; et al. Health consequences of obesity in the elderly: A review of four unresolved questions. International Journal of Obesity, 29. 9 (2005): 1011-1029. Nature Publishing Group

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Endnote Keywords

Medical Sciences/Body fat/Disability/Disability/Middle age/Diabetes/Models

Endnote ID


Alternate JournalJ Gen Intern Med
Citation Key7844
PubMed ID23463456
PubMed Central IDPMC3744313
Grant ListR24 HD041025 / HD / NICHD NIH HHS / United States