Size at Birth, Weight Gain in Infancy and Childhood, and Adult Diabetes Risk in Five Low- or Middle-Income Country Birth Cohorts

  1. and the COHORTS group*
  1. 1Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  2. 2Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K.
  3. 3Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
  4. 4Department of Anthropology, Northwestern University, Evanston, Illinois
  5. 5Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
  6. 6Office of Population Studies Foundation, Cebu City, Philippines
  7. 7Institute of Nutrition of Central American and Panama, Guatemala City, Guatemala
  8. 8Hubert Department of Global Health, Emory University, Atlanta, Georgia
  9. 9Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
  1. Corresponding author: Shane A. Norris, san{at}


OBJECTIVE We examined associations of birth weight and weight gain in infancy and early childhood with type 2 diabetes (DM) risk in five cohorts from low- and middle-income countries.

RESEARCH DESIGN AND METHODS Participants were 6,511 young adults from Brazil, Guatemala, India, the Philippines, and South Africa. Exposures were weight at birth, at 24 and 48 months, and adult weight, and conditional weight gain (CWG, deviation from expected weight gain) between these ages. Outcomes were adult fasting glucose, impaired fasting glucose or DM (IFG/DM), and insulin resistance homeostasis model assessment (IR-HOMA, three cohorts).

RESULTS Birth weight was inversely associated with adult glucose and risk of IFG/DM (odds ratio 0.91[95% CI 0.84–0.99] per SD). Weight at 24 and 48 months, and CWG 0–24 and 24–48 months, were unrelated to glucose and IFG/DM; however, CWG 48 months–adult was positively related to IFG/DM (1.32 [1.22–1.43] per SD). After adjusting for adult waist circumference, birth weight, weight at 24 and 48 months, and CWG 0–24 months were inversely associated with glucose and IFG/DM. Birth weight was unrelated to IR-HOMA, whereas greater CWG at 0–24 and 24–48 months, and 48 months–adults predicted higher IR-HOMA (all P < 0.001). After adjusting for adult waist circumference, birth weight was inversely related to IR-HOMA.

CONCLUSIONS Lower birth weight and accelerated weight gain after 48 months are risk factors for adult glucose intolerance. Accelerated weight gain between 0 and 24 months did not predict glucose intolerance but did predict higher insulin resistance.

  • Received March 6, 2011.
  • Accepted October 7, 2011.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.

This Article

  1. Diabetes Care
  1. All Versions of this Article:
    1. dc11-0456v1
    2. 35/1/72 most recent