Ethnic differences in association of high body mass index with early onset of Type 1 diabetes - Arab ethnicity as case study

PLoS One. 2017 Apr 13;12(4):e0175728. doi: 10.1371/journal.pone.0175728. eCollection 2017.


Objective: The "accelerator hypothesis" predicts early onset of Type 1 diabetes (T1D) in heavier children. Studies testing direction of correlation between body mass index (BMI) and age at onset of T1D in different continental populations have reported differing results-inverse, direct, and neutral. Evaluating the correlation in diverse ethnic populations is required to generalize the accelerator hypothesis.

Methods: The study cohort comprised 474 Kuwaiti children of Arab ethnicity diagnosed with T1D at age 6 to 18 years during 2011-2013. Age- and sex-adjusted BMI z-scores were calculated by comparing the BMI measured at diagnosis with Kuwaiti pediatric population reference data recorded during comparable time-period. Multiple linear regression and Pearson correlation analyses were performed.

Results: BMI z-score was seen inversely associated with onset age (r,-0.28; p-value<0.001). Children with BMI z-score>0 (i.e. BMI >national average) showed a stronger correlation (r,-0.38; p-value<0.001) than those with BMI z-score<0 (r,-0.19; p-value<0.001); the former group showed significantly lower mean onset age than the latter group (9.6±2.4 versus 10.5±2.7; p-value<0.001). Observed inverse correlation was consistent with that seen in Anglo-saxon, central european, caucasian, and white children while inconsistent with that seen in Indian, New Zealander, and Australian children.

Conclusions: The accelerator hypothesis generalizes in Arab pediatric population from Kuwait.

MeSH terms

  • Adolescent
  • Age of Onset
  • Arabs*
  • Body Mass Index
  • Child
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / ethnology
  • Female
  • Humans
  • Kuwait / epidemiology
  • Male
  • Multivariate Analysis
  • Pediatric Obesity / epidemiology*
  • Pediatric Obesity / ethnology

Grant support

The authors acknowledge the Kuwait Foundation for Advancement of the Sciences for funding this study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.