title: Weight cycling and the risk of type 2 diabetes in the EPIC-Germany cohort.
abstract: OBJECTIVE
  Studies on weight cycling and the risk of type 2 diabetes have revealed inconsistent results, possibly due to differences in the definition of weight fluctuations. Here, we investigated whether weight cycling during adulthood is related to diabetes risk in a large cohort study, using a complementary approach to define patterns of weight development.
  
  
  METHODS
  Weight cycling, weight loss and weight gain were defined (1) a priori, using distinct categories, and (2) by functional principal component analysis (FPCA) to capture weight patterns in greater detail. Associations of weight cycling, weight loss and weight gain with the risk of type 2 diabetes were evaluated by Cox regression models.
  
  
  RESULTS
  A priori defined weight cycling was associated with increased diabetes risk, compared with stable weight (HR 1.36 [95% CI 1.09, 1.68]). No significant association between FPCA-derived weight cycling and risk of diabetes was observed after adjustment for concurrent weight patterns (HR 1.19 [95% CI 0.89, 1.60]). Subgroup analyses showed that FPCA-derived weight cycling during net weight gain was associated with a higher risk of diabetes (HR 1.68 [95% CI 1.14, 2.48]). A priori defined weight gain (HR 2.08 [95% CI 1.60, 2.70]) was more clearly related to the risk of diabetes than FPCA-derived weight gain (HR 1.20 [95% CI 0.95, 1.51]), while no significant associations were observed for weight loss.
  
  
  CONCLUSIONS
  Overall, weight cycling may not be an independent risk factor for type 2 diabetes when accounting for concurrent patterns of weight development. However, weight cycling may pose a stronger risk of diabetes than non-cycling during net weight gain.
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Neamat-Allah
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Myrto
authors.initials: M
authors.lastname: Barrdahl
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Hüsing
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Verena A
authors.initials: VA
authors.lastname: Katzke
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Bachlechner
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Steffen
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.|German Center for Diabetes Research (DZD), Neuherberg, Germany.
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Schulze
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany. t.kuehn@dkfz.de.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D015430:Weight Gain; D015431:Weight Loss
keywords: Prospective study; Type 2 diabetes; Weight change; Weight cycling