Upper arm length and knee height are associated with diabetes in the middle-aged and elderly: evidence from the China Health and Retirement Longitudinal Study

Objective: To determine if limb lengths, as markers of early life environment, are associated with the risk of diabetes in China. Design: We performed a cohort analysis using data from the China Health and Retirement Longitudinal Study (CHARLS), and multivariable-adjusted Cox proportional hazard regression models were used to examine the associations between baseline limb lengths and subsequent risk of diabetes. Setting: The CHARLS, 2011-2018. Participants: The study confined the eligible subject to 10 711 adults aged over 45 years from the CHARLS. Results: During a mean follow-up period of 6 center dot 13 years, 1358 cases of incident diabetes were detected. When controlling for potential covariates, upper arm length was inversely related to diabetes (hazard ratio (HR) 0 center dot 95, 95 % CI (0 center dot 91, 0 center dot 99), P = 0 center dot 028), and for every 1-cm difference in knee height, the risk of diabetes decreased by about 4 % (HR 0 center dot 96, 95 % CI (0 center dot 93, 0 center dot 99), P = 0 center dot 023). The association between upper arm length and diabetes was only significant among females while the association between knee height and diabetes was only significant among males. In analyses stratified by BMI, significant associations between upper arm length/knee height and diabetes only existed among those who were underweight (HR 0 center dot 91, 95 % CI (0 center dot 83, 1 center dot 00), P = 0 center dot 049, HR 0 center dot 92, 95 % CI (0 center dot 86, 0 center dot 99), P = 0 center dot 031). Conclusions: Inverse associations were observed between upper arm length, knee height and the risk for diabetes development in a large Asian population, suggesting early life environment, especially infant nutritional status, may play an important role in the determination of future diabetes risk.