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Body surface area and glucose tolerance – The smaller the person, the greater the 2-hour plasma glucose

  • Samuel Palmu
    Correspondence
    Corresponding author at: Koulukatu 2, 29200 Harjavalta, Finland.
    Affiliations
    Department of General Practice, Turku University and Turku University Hospital, Turku, Finland

    Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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  • Simo Rehunen
    Affiliations
    Department of General Practice, Turku University and Turku University Hospital, Turku, Finland

    Satakunta Hospital District, Rauma, Finland
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  • Hannu Kautiainen
    Affiliations
    Folkhälsan Research Center, Helsinki, Finland

    Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
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  • Johan G. Eriksson
    Affiliations
    Folkhälsan Research Center, Helsinki, Finland

    Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    National University Singapore, Yong Loo Lin School of Medicine, Department of Obstetrics and Gynecology, Singapore, Singapore
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  • Päivi E. Korhonen
    Affiliations
    Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
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Published:October 14, 2019DOI:https://doi.org/10.1016/j.diabres.2019.107877

      Abstract

      Background

      The oral glucose tolerance test (OGTT) is standardized globally with a uniform glucose load of 75 g to all adults irrespective of body size. An inverse association between body height and 2-hour postload plasma glucose (2hPG) has been demonstrated. Our aim was to evaluate the relationship between body surface area (BSA) and plasma glucose values during an OGTT.

      Methods

      An OGTT was performed on 2659 individuals at increased cardiovascular risk aged between 45 and 70 years of age, who had not previously been diagnosed with diabetes or cardiovascular disease. Their BSA was calculated according to the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5, 25, 25, 25, and 12.5% of the total distribution.

      Findings

      When adjusted for age, sex, waist circumference, alcohol intake, current smoking, and leisure-time physical activity, BSA level showed an inverse linear relationship with the 2hPG in all categories of glucose tolerance (p for linearity < 0.001). Moreover, the smaller the adjusted BSA of the study person, the higher the proportion of newly diagnosed type 2 diabetes based on 2hPG in the OGTT.

      Interpretation

      Body size has a considerable impact on the findings from a standardized OGTT. Smaller persons are more likely to be diagnosed as glucose intolerant than relatively larger sized individuals.

      Funding

      This work was supported by the State Provincial Office of Western Finland, the Central Satakunta Health Federation of Municipalities, Satakunta Hospital District, and the Hospital District of Southwest Finland.

      Research in context

      Evidence before this study. We searched PubMed using the MeSH terms “glucose tolerance test”, “body surface area”, “body height”, “body size”, “glucose tolerance”, “insulin resistance”, “blood glucose” and “diabetes mellitus” on March 10, 2019 without language restrictions. We also used Cited Reference Search in Web of Science for relevant articles. The oral glucose tolerance test (OGTT) is standardized globally with a uniform glucose load of 75 g to all adults irrespective of body size. An inverse association between body height and 2-hour postload plasma glucose (2hPG) has been demonstrated. Several studies have shown that 2hPG predicts all-cause mortality better than elevated fasting glucose. However, body height or body surface area are not usually adjusted in epidemiological studies. It is well known that short adult stature is a risk factor for cardiovascular and all-cause mortality.
      Added value of this study. This is the first study to assess the relationship of body surface area and 2hPG in a typical primary care population at increased cardiovascular risk. Body surface area has a considerable impact on the result of a standardized OGTT. Smaller individuals are more likely to be diagnosed as glucose intolerant than relatively larger sized individuals.
      Implications of all the available evidence. There is a possibility that the diagnosis of type 2 diabetes made by an OGTT is a false positive result in a relatively small individual, and a false negative result in a relatively larger individual. Association of 2hPG concentrations and mortality may be influenced by body size as confounding factor. Given that the OGTT is a time and effort consuming test both for patients and laboratory personnel, validity of the OGTT for different body sizes should be reconsidered.
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      References

        • Klimt C.R.
        • Prout T.E.
        • Bradley R.F.
        • et al.
        Standardization of the oral glucose tolerance test. Report of the Committee on Statistics of the American Diabetes Association June 14, 1968.
        Diabetes. 1969; 18: 299-307
        • Keen H.
        • Jarrett R.J.
        • Alberti K.G.M.M.
        Diabetes mellitus: a new look at diagnostic criteria.
        Diabetologia. 1979; 16: 283-285
      1. World Health Organization. WHO Expert Committee on Diabetes Mellitus. Second Report. Geneva: World Health Organization; 1980 [Tech. Rep. Ser., no. 646].

        • American Diabetes Association
        Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes.
        Diabetes Care. 2017; 40: 11-24
        • Riste L.
        • Khan F.
        • Cruickshank K.
        High prevalence of type 2 diabetes in all ethnic groups, including Europeans, in a British inner city: relative poverty, history, inactivity, or 21st century Europe?.
        Diabetes Care. 2001; 24: 1377-1383
        • Brown D.C.
        • Byrne C.D.
        • Clark P.M.S.
        • et al.
        Height and glucose tolerance in adult subjects.
        Diabetologia. 1991; 34: 531-533
        • Sicree R.A.
        • Zimmet P.Z.
        • Dunstan D.W.
        • Cameron A.J.
        • Welborn T.A.
        • Shaw J.E.
        Differences in height explain gender differences in the response to the oral glucose tolerance test – the AusDiab study.
        Diabet Med. 2008; 25: 296-302
        • Færch K.
        • Borch-Johnsen K.
        • Vaag A.
        • Jørgensen T.
        • Witte D.R.
        Sex differences in glucose levels: a consequence of physiology or methodological convenience? the Inter99 study.
        Diabetologia. 2010; 53: 858-865
        • Vangipurapu J.
        • Stančáková A.
        • Jauhiainen R.
        • Kuusisto J.
        • Laakso M.
        Short adult stature predicts impaired β-Cell function, insulin resistance, glycemia, and type 2 diabetes in finnish men.
        J Clin Endocrinol Metab. 2017; 102: 443-450
        • Rehunen S.K.J.
        • Kautiainen H.
        • Eriksson J.G.
        • Korhonen P.E.
        Research: epidemiology Adult height and glucose tolerance: a re-appraisal of the importance of body mass index.
        Diabet Med. 2017; 34: 1129-1135
        • Lindström J.
        • Tuomilehto J.
        The diabetes risk score.
        Diabetes Care. 2003; 26: 725-731
        • World Health Organization
        Denition diagnosis and classication of diabetes mellitus and its complications: report of a WHO consultation. Part 1: Diagnosis and classication of diabetes mellitus.
        WHO, Geneva1999
        • Mosteller R.D.
        Simplified calculation of body surface area.
        N Engl J Med. 1987; 317: 1098
      2. Babor TF, de la Fuente JR, Saunders JGM. AUDIT: the alcohol use disorders identification test: guidelines for use in primary healthcare. WHO/MNH/DAT 89.4. Geneva: World Health Organization; 1989.

        • NCD Risk Factor
        Collaboration (NCD-RisC). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participants.
        Lancet Diab Endocrinol. 2015; 3: 624-637
        • Menke A.
        • Casagrande S.
        • Cowie C.C.
        Contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence: NHANES 2011–2014.
        Ann Epidemiol. 2018; 28: 681-685
        • Vauthey J.N.
        • Abdalla E.K.
        • Doherty D.A.
        • et al.
        Body surface area and body weight predict total liver volume in western adults.
        Liver Transpl. 2002; 8: 233-240
        • Jones G.T.
        • Sandiford P.
        • Hill G.B.
        • et al.
        Correcting for body surface area identifies the true prevalence of abdominal aortic aneurysm in screened women.
        Eur J Vasc Endovasc Surg. 2019; 57: 221-228
        • Anderwald C.
        • Gastaldelli A.
        • Tura A.
        • et al.
        Mechanism and effects of glucose absorption during an oral glucose tolerance test among females and males.
        J Clin Endocrinol Metab. 2011; 96: 515-524
        • Færch K.
        • Pacini G.
        • Nolan J.J.
        • Hansen T.
        • Tura A.
        • Vistisen D.
        Impact of glucose tolerance status, sex, and body size on glucose absorption patterns during OGTTs.
        Diabetes Care. 2013; 36: 3691-3697
        • Engel D.J.
        • Schwartz A.
        • Homma S.
        Athletic cardiac remodeling in us Professional Basketball players.
        JAMA Cardiol. 2016; 1: 80-87
        • Zierler K.
        Whole body glucose metabolism.
        Am J Physiol. 1999; 276: 409-426
        • Stančáková A.
        • Javorský M.
        • Kuulasmaa T.
        • Haffner S.M.
        • Kuusisto J.
        • Laakso M.
        Changes in insulin sensitivity and insulin release in relation to glycemia and glucose tolerance in 6,414 Finnish Men.
        Diabetes. 2009; 58: 1212-1221
        • Huang Y.
        • Cai X.
        • Mai W.
        • Li M.
        • Hu Y.
        Association between prediabetes and risk of cardiovascular disease and all cause mortality: Systematic review and meta-analysis.
        BMJ. 2016; 355: i5953
        • The Emerging Risk Factors Collaboration
        Adult height and the risk of cause-specific death and vascular morbidity in 1 million people: individual participant meta-analysis.
        Int J Epidemiol. 2012; 41: 1419-1433
        • Schmidt M.
        • Bøtker H.E.
        • Pedersen L.
        • Sørensen H.T.
        Adult height and risk of ischemic heart disease, atrial fibrillation, stroke, venous thromboembolism, and premature death: a population based 36-year follow-up study.
        Eur J Epidemiol. 2014; 29: 111-118
        • Lee C.M.Y.
        • Barzi F.
        • Woodward M.
        • et al.
        Adult height and the risks of cardiovascular disease and major causes of death in the Asia-Pacific region: 21 000 deaths in 510 000 men and women.
        Int J Epidemiol. 2009; 38: 1060-1071