Adolescent BMI and early-onset type 2 diabetes among Ethiopian immigrants and their descendants: A nationwide study

Maya Simchoni, Uri Hamiel, Orit Pinhas-Hamiel, Inbar Zucker, Tali Cukierman-Yaffe, Miri Lutski, Estela Derazne, Zivan Beer, Doron Behar, Lital Keinan-Boker, Ofri Mosenzon, Dorit Tzur, Arnon Afek, Amir Tirosh, Itamar Raz, Gilad Twig

Research output: Contribution to journalArticlepeer-review


Background: We assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin. Methods: Normoglycemic adolescents (range 16-20 years old), including 93,806 native Israelis (≥ 3rd generation in Israel) and 27,684 Israelis of Ethiopian origin, were medically assessed for military service between 1996 and 2011. Weight and height were measured. Data were linked to the Israeli National Diabetes Registry. Incident type 2 diabetes by December 31, 2016 was the outcome. Cox regression models stratified by sex and BMI categories were applied. Results: 226 (0.29%) men and 79 (0.18%) women developed diabetes during 992,980 and 530,814 person-years follow-up, respectively, at a mean age of 30.4 and 27.4 years, respectively. Among native Israeli men with normal and high (overweight and obese) BMI, diabetes incidence was 9.5 and 62.0 (per 105 person-years), respectively. The respective incidences were 46.9 and 112.3 among men of Ethiopian origin. After adjustment for sociodemographic confounders, the hazard ratios for type 2 diabetes among Ethiopian men with normal and high BMI were 3.4 (2.3-5.1) and 15.8 (8.3-30.3) respectively, compared to third-generation Israelis with normal BMI. When this analysis was limited to Israeli-born Ethiopian men, the hazard ratios were 4.4 (1.7-11.4) and 29.1 (12.9-70.6), respectively. Results persisted when immigrants of other white Caucasian origin were the reference; and among women with normal, but not high, BMI. Conclusions: Ethiopian origin is a risk factor for early-onset type 2 diabetes among young men at any BMI, and may require selective interventions.

Original languageEnglish
Article number168
JournalCardiovascular Diabetology
Issue number1
StatePublished - 6 Oct 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 The Author(s).


  • Adolescents
  • BMI
  • Early-onset
  • Epidemiology
  • Immigration
  • Type 2 diabetes
  • Body Mass Index
  • Risk Assessment
  • Humans
  • Risk Factors
  • Israel/epidemiology
  • Male
  • Diabetes Mellitus, Type 2/diagnosis
  • Black People
  • Incidence
  • Young Adult
  • Ethiopia/ethnology
  • Adolescent
  • Age of Onset
  • Sex Factors
  • Female
  • Pediatric Obesity/diagnosis
  • Emigrants and Immigrants
  • Longitudinal Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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