American Diabetes Association
dc200019_o6d99y_Supplementary materials_2 Aug 2020.pdf (2.12 MB)

Analysis of attained height and diabetes among 554,122 adults across 25 low- and middle-income countries

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posted on 2020-08-06, 16:28 authored by Felix Teufel, Pascal Geldsetzer, Jennifer Manne-Goehler, Omar Karlsson, Viola Koncz, Andreas Deckert, Michaela Theilmann, Maja-Emilia Marcus, Cara Ebert, Jacqueline A. Seiglie, Kokou Agoudavi, Glennis Andall-Brereton, Gladwell Gathecha, Mongal S Gurung, David Guwatudde, Corine Houehanou, Nahla Hwalla, Gibson B Kagaruki, Khem B Karki, Demetre Labadarios, Joao S Martins, Mohamed Msaidie, Bolormaa Norov, Abla M Sibai, Lela Sturua, Lindiwe Tsabedze, Chea S Wesseh, Justine Davies, Rifat Atun, Sebastian Vollmer, SV Subramanian, Till Bärnighausen, Lindsay M Jaacks, Jan-Walter De Neve
Objective: The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes, and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent.

Research Design and Methods: We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample, major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics.

Results: Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI: 161.2–162.3) and the crude prevalence of diabetes was 7.5% (95% CI: 6.9–8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2/50). Results were robust to alternative model specifications.

Conclusions: Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.


We would like to thank each of the country-level survey teams and study participants that made this analysis possible. JWDN was supported by the Alexander von Humboldt Foundation, funded by Germany’s Federal Ministry of Education and Research; European Commission (825823); German Science Foundation (405898232); NICHD of NIH (R03-HD098982); and the Heidelberg University Excellence Initiative. FT was supported by the Else Kröner-Fresenius-Stiftung within the Heidelberg Graduate School of Global Health.


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