Public Health Nutrition

Biological and behavioural determinants

The duration of obesity and the risk of type 2 diabetes

Asnawi Abdullaha1a2 c1, Johannes Stoelwindera1, Susan Shortreeda1, Rory Wolfea1, Christopher Stevensona1, Helen Wallsa1, Maximilian de Courtena1 and Anna Peetersa1

a1 Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Victoria 3004, Australia

a2 Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Indonesia


Objective The evidence for the association between obesity and the risk of type 2 diabetes has been derived mainly from the analysis of the degree of obesity. The role of the duration of obesity as an independent risk has not been fully explored. The objective of the present study was to investigate the association between the duration of obesity and the risk of type 2 diabetes.

Design Prospective cohort study.

Setting The Framingham Heart Study (FHS), follow-up from 1948 to 1998.

Subjects A total of 1256 FHS participants who were free from type 2 diabetes at baseline, but were obese on at least two consecutive of the study’s twenty-four biennial examinations, were included. Type 2 diabetes status was collected throughout the 48 years of follow-up of the study. The relationship between duration of obesity and type 2 diabetes was analysed using time-dependent Cox models, adjusting for a number of covariates.

Results The unadjusted hazard ratio (HR) for the risk of type 2 diabetes for men was 1·13 (95 % CI 1·09, 1·17) and for women was 1·12 (95 % CI 1·08, 1·16) per additional 2-year increase in the duration of obesity. Adjustment for sociodemographic variables, family history of diabetes, health behaviour and physical activity made little difference to these HR. For women the evidence of a dose–response relationship was less clear than for men, particularly for women with an older age at obesity onset.

Conclusions The duration of obesity is a relevant risk factor for type 2 diabetes, independent of the degree of BMI.

(Received November 04 2009)

(Accepted May 13 2010)

(Online publication June 29 2010)


c1 Corresponding author: Email