Ethiopian Immigration and Adolescent BMI As Risk Factors for Early-Onset Type 2 Diabetes in Young Adulthood- A Nationwide Study

מאיה שמחוני ¹ Uri Hamiel ² Inbar Zucker ^3,4 Tali Cukierman-Yaffe ^4,5 Miri Lutski ^3,4 Estela Derazne ³ Zivan Beer ¹ Ofri Mosenzon ⁶ Dorit Tzur ¹ Orit Pinhas-Hamiel ^3,7 Itamar Raz ⁶ Arnon Afek ^3,8 Amir Tirosh ^3,5 Gilad Twig ^1,3

¹Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, ישראל
²Department of Pediatrics, Shamir Medical Center, ישראל
³Sackler Faculty of Medicine, Tel Aviv University, ישראל
⁴The Israel Center for Disease Control, Ministry of Health, ישראל
⁵Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, ישראל
⁶The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, ישראל
⁷Department of Pediatric Endocrinology, Safra Children Hospital, Sheba Medical Center, Tel Hashomer, ישראל
⁸Central Management, Sheba Medical Center, Tel Hashomer, ישראל

Aims: We assessed in a nationwide cohort the association between adolescent BMI and early-onset (age

Methods: Normoglycemic adolescents (age 16-19 years old), including 93,713 native Israelis (≥3^rd generation in Israel) and 27,630 Israelis of Ethiopian origin (68% immigrants), were medically assessed for military service between 1996-2011. Weight and height were measured. Data were linked to Israeli National Diabetes Registry. Incident T2D by 31/12/2016 was the outcome. Cox regression models stratified by sex were applied.

Results: 205 men (81 Ethiopians) and 69 women (25 Ethiopians) developed T2D during 1,269,181 person-years follow-up. Among native Israeli men, the incidence rate of T2D was 9.1 and 53.5 (per 10⁵ person-years) for the normal BMI and overweight-obese groups, respectively, and among men of Ethiopian origin 41.9 and 112.3, respectively. After adjustment for socio-demographic confounders the hazard ratios for T2D among native Israelis were 1 (reference) and 6.5 (95%CI, 4.5-9.3) for those with normal BMI and overweight-obese, respectively, and among Ethiopian men were 4.5 (3.1-6.6) and 18.3 (9.7-34.5), respectively. Results were accentuated among Israeli-born Ethiopian men. Age of T2D diagnosis was 27.5±3.5 and 29.9±4.4 years for Ethiopians and native Israeli men with overweight-obesity, respectively. Results persisted among women with normal BMI, but small number of cases in the overweight-obese group limited a meaningful analysis.

Conclusions: Ethiopian origin is a risk factor for early-onset T2D among young men at any BMI regardless of socio-demographic status, and may require selective interventions to prevent T2D in this group.