title: Estimating the risk of type-2 diabetes using obese-years in a contemporary population of the Framingham Study.
abstract: BACKGROUND
  We have recently demonstrated that an obese-years construct is a better predictor of the risk of diabetes than the severity of body weight alone. However, these risk estimates were derived from a population cohort study initiated in 1948 that might not apply to the current population.
  
  
  OBJECTIVE
  To validate an obese-years construct in estimating the risk of type-2 diabetes in a more contemporary cohort study.
  
  
  METHODS
  A total of 5,132 participants of the Framingham Offspring Study, initiated in 1972, were followed up for 45 years. Body mass index (BMI) above 29 kg/m(2) was multiplied by the number of years lived with obesity at that BMI to define the number of obese-years. Time-dependent Cox regression was used to explore the association.
  
  
  RESULTS
  The risk of type-2 diabetes increased significantly with increase in obese-years. Adjusted hazard ratios increased by 6% (95% CI: 5-7%) per additional 10 points of obese-years. This ratio was observed to be similar in both men and women, but was 4% higher in current smokers than in never/ex-smokers. The Akaike Information Criterion confirmed that the Cox regression model with the obese-years construct was a stronger predictor of the risk of diabetes than a model including either BMI or the duration of obesity alone.
  
  
  CONCLUSIONS
  In a contemporary cohort population, it was confirmed that the obese-years construct is strongly associated with an increased risk of type-2 diabetes. This suggests that both severity and the duration of obesity should be considered in future estimations of the burden of disease associated with obesity.
authors.affiliation: Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.|School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Asnawi.Abdullah@fkm.unmuha.ac.id.
authors.forename: Asnawi
authors.initials: A
authors.lastname: Abdullah
authors.affiliation: Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.
authors.forename: Fauzi Ali
authors.initials: FA
authors.lastname: Amin
authors.affiliation: Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.
authors.forename: Farida
authors.initials: F
authors.lastname: Hanum
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
authors.forename: Johannes
authors.initials: J
authors.lastname: Stoelwinder
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tanamas
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Wolf
authors.affiliation: School of Health & Social Development, Deakin University, Melbourne, Australia.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Wong
authors.affiliation: School of Health & Social Development, Deakin University, Melbourne, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Peeters
keywords: BMI; obese-years; obesity; offspring Framingham; type-2 diabetes