The effect of early life events on the burden of diabetes mellitus among Costa Rican elderly: Estimates and projections

During their childhood years, current cohorts of Latin American elderly experienced an environment characterized by economic deprivation, malnutrition, and high prevalence of infectious diseases, but survived to old age due to the introduction of medical technology and public health measures (Palloni, 1981). In light of the thrifty phenotype hypothesis (Hales and Barker, 1992; 2001), people that were undernourished during gestation and early childhood are more likely to develop Type II Diabetes Mellitus (DM). Given the high prevalence of these conditions among current Latin American elderly cohorts, Palloni et al. (2006) and Prentice and Moore (2005) have hypothesized that there might be an epidemic of DM.;The goal of this dissertation is to estimate the effect of early childhood conditions on DM burden among the population 60 years old and older in Costa Rica, and to project the prevalence of DM among this population for the period 2005--2030. I use short knee height (KH) and the level of childhood mortality (CMI) in the respondents' place of birth as surrogate markers of malnutrition during gestation and infancy.;I find that there is weak but significant effect of KH on DM incidence, but only when having short KH interacts with obesity. Being born in high CMI counties is positively associated with having high levels of glucose or glycosylated hemoglobin. The projected DM burden among Costa Rican elderly shows that the population age 60 years old and older with DM in Costa Rica is going to quadruple in the next 25 years, but this increase is basically due to the growth in the total elderly population.;I conclude that Costa Rica is going to have a sharp increase in the burden of DM among its senior population, but that this increase is related to population increase rather than to adverse health conditions during childhood. I argue that for other Latin American countries this increase in DM might happen if the same cohorts in those countries experienced adverse early childhood conditions and malnutrition, as well as obesity.