Association of Body Mass Index with the Risk of Incident Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality: A Community-Based Prospective Study

Clinical characteristics and degree of cardiovascular risk factor control in patients with newly-diagnosed type 2 diabetes in Catalonia

Introduction

Women with type 2 diabetes mellitus (T2DM) face a greater risk of cardiovascular disease (CVD) and encounter challenges in managing cardiovascular risk factors (CVRF); however, limited data are available in individuals with newlydiagnosed T2DM.

Methods

This study aimed to examine differences between women and men at the onset of T2DM in terms of clinical characteristics, glycaemic status, and CVRF management. This was a retrospective cohort study including subjects with newly-diagnosed T2DM from the System for the Development of Research in Primary Care (SIDIAP) database in Catalonia (Spain). Sex differences (Dif) were assessed at baseline and 1-year post-diagnosis, by calculating the absolute difference of means or proportions.

Results

A total of 13,629 subjects with newly-diagnosed T2DM were analyzed. Women were older and had a higher BMI than men. At baseline, women had higher total cholesterol [Dif (95%CI) 10 mg/dL (9.1/10.8)] and low-density lipoprotein cholesterol (LDL-c) [Dif (95%CI) 7 mg/dL (6.3/7.7)], while men had higher rates of smoking and alcohol intake. Lipid target achievement was lower in women, in both primary prevention (LDL-c < 100 mg/dL) [Dif (95%CI) -7.3 mg/dL (-10.5/-4.1)] and secondary prevention (LDL-c < 70 mg/dL) [Dif (95%CI) -8.3 mg/dL (-17.3/0.7)], along with lower statin and antiplatelet prescriptions, especially one year after diagnosis. Changes in clinical and laboratory data one year post-diagnosis revealed that, in the primary prevention group, men experienced greater improvements in total cholesterol, LDL-c and triglycerides, while women had less success in achieving CVRF control targets compared to men. Additionally, cardiovascular events, such as coronary artery disease and peripheral artery disease increased more in men than in women within the first year of diagnosis, especially in primary prevention subjects.

Conclusion

Differences between men and women CVRF are already apparent at the onset of T2DM, particularly in primary prevention, with notable differences in lipid profile and target level attainment.

Association of obesity with cardiovascular disease in the absence of traditional risk factors

BACKGROUND

The association between obesity and cardiovascular disease (CVD) in people without traditional CVD risk factors is unclear. This study aimed to investigate the association of obesity with CVD and its subtypes in people without traditional CVD risk factors.

METHODS

Based on the Kailuan cohort study, the included participants were divided into different groups according to levels of body mass index (BMI) and waist height ratio (WHtR), respectively. Multivariate Cox proportional hazard models were used to evaluate the associations.

RESULTS

This study included 31,955 participants [men 63.99%; mean age (48.14 ± 3.33) years]. During a median follow-up period of 12.97 (interquartile range: 12.68-13.17) years, 1298 cases of CVD were observed. Compared with the normal BMI group, the hazard ratios (HRs) for CVD, stroke, and myocardial infarction (MI) in the BMI obese group were 1.31 (95% confidence interval [CI] 1.11-1.55), 1.21 (95%CI 1.01-1.46), 1.62 (95%CI 1.13-2.33), respectively. Compared with the WHtR non-obese group, the HRs for CVD, stroke, and MI in the obese group were 1.25(95%CI 1.11-1.41), 1.18 (95%CI 1.03-1.34), 1.57 (95%CI 1.18-2.09), respectively. There was an interaction between age and WHtR (P for interaction was 0.043). The association between WHtR and CVD was stronger in people under 60 years old, with a HR of 1.44 (95%CI 1.24-1.67).

CONCLUSION

We found that obesity increased the risk of CVD in people without traditional CVD risk factors. The association of WHtR with CVD was stronger in people under 60 years old.

Relationship between advanced lung cancer inflammation index and long-term all-cause, cardiovascular, and cancer mortality among type 2 diabetes mellitus patients: NHANES, 1999-2018

Background

Type 2 diabetes mellitus (T2DM) was a major global health threat. As a chronic low-grade inflammatory disease, the prognosis of diabetes was associated with inflammation. The advanced lung cancer inflammation index (ALI) served as a comprehensive index to assess inflammation. This study aimed to estimate the association between ALI and all-cause, cardiovascular disease (CVD), and cancer mortality in T2DM patients.

Methods

We extracted cohort data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2018 for analysis. The weighted Kaplan-Meier analysis and multivariate-adjusted Cox analysis were utilized to evaluate the relationship between ALI and all-cause, CVD, and cancer mortality in T2DM patients. Restricted cubic spline (RCS) analysis was employed to assess their non-linear relationship. Stratified analysis and interaction analysis were conducted to enhance the robustness of the results.

Results

The study incorporated a total of 3,888 patients. An increase in ALI was associated with a reduced risk of all-cause and CVD mortality in T2DM patients, but not related to cancer mortality. There were J-shaped and L-shaped non-linear relationships between ALI and all-cause, CVD mortality in T2DM patients, respectively. The inflection points were 90.20 and 93.06, respectively. For values below the inflection point, every 10U increase in ALI, both all-cause and CVD mortality risk decreased by 9%. Beyond the inflection point, all-cause mortality rose by 3%, while CVD mortality remained unaffected. Gender-stratified RCS analysis indicated a linear negative relationship between CVD mortality and ALI in female T2DM patients, whereas the trend in males aligned with the overall population.

Conclusion

Our research initially identified a significant correlation between increased ALI levels with decreased all-cause and CVD mortality in T2DM patients. There were J-shaped and L-shaped non-linear relationships between ALI and all-cause, CVD mortality in T2DM patients, respectively. For female patients, there was a linear negative relation between CVD mortality and ALI, whereas the trend in males aligned with the overall population. These findings suggested that maintaining ALI (for example, control body weight and keep albumin in the normal range) within a certain range in the clinical settings was crucial for improving all-cause and CVD mortality in T2DM patients.

Differential Impact of Obesity on the Risk of Diabetes Development in Two Age Groups: Analysis from the National Health Screening Program

BACKGRUOUND

The effect of obesity on the development of type 2 diabetes mellitus (DM) in different age groups remains unclear. We assessed the impact of obesity on the development of DM for two age groups (40-year-old, middle age; 66-year-old, older adults) in the Korean population.

METHODS

We analyzed Korean National Health Insurance Service data of 4,145,321 Korean adults with 40- and 66-year-old age without DM, between 2009 and 2014. Participants were followed up until 2017 or until the diagnosis of DM. We assessed the risk of DM based on the body mass index and waist circumference of the participants. Multiple confounding factors were adjusted.

RESULTS

The median follow-up duration was 5.6 years. The association of general and abdominal obesity with the risk of DM development was stronger in the 40-year-old group (general obesity: hazard ratio [HR], 3.566, 95% confidence interval [CI], 3.512 to 3.622; abdominal obesity: HR, 3.231; 95% CI, 3.184 to 3.278) than in the 66-year-old group (general obesity: HR, 1.739; 95% CI, 1.719 to 1.759; abdominal obesity: HR, 1.799; 95% CI, 1.778 to 1.820). In the 66-year-old group, abdominal obesity had a stronger association with the development of DM as compared to general obesity. In the 40-year-old group, general obesity had a stronger association with the risk of DM development than abdominal obesity.

CONCLUSION

The influence of general and abdominal obesity on the development of DM differed according to age. In older adults, abdominal obesity had a stronger association with DM development than general obesity.

Establishment and health management application of a prediction model for high-risk complication combination of type 2 diabetes mellitus based on data mining

In recent years, the prevalence of T2DM has been increasing annually, in particular, the personal and socioeconomic burden caused by multiple complications has become increasingly serious. This study aimed to screen out the high-risk complication combination of T2DM through various data mining methods, establish and evaluate a risk prediction model of the complication combination in patients with T2DM. Questionnaire surveys, physical examinations, and biochemical tests were conducted on 4,937 patients with T2DM, and 810 cases of sample data with complications were retained. The high-risk complication combination was screened by association rules based on the Apriori algorithm. Risk factors were screened using the LASSO regression model, random forest model, and support vector machine. A risk prediction model was established using logistic regression analysis, and a dynamic nomogram was constructed. Receiver operating characteristic (ROC) curves, harrell's concordance index (C-Index), calibration curves, decision curve analysis (DCA), and internal validation were used to evaluate the differentiation, calibration, and clinical applicability of the models. This study found that patients with T2DM had a high-risk combination of lower extremity vasculopathy, diabetic foot, and diabetic retinopathy. Based on this, body mass index, diastolic blood pressure, total cholesterol, triglyceride, 2-hour postprandial blood glucose and blood urea nitrogen levels were screened and used for the modeling analysis. The area under the ROC curves of the internal and external validations were 0.768 (95% CI, 0.744-0.792) and 0.745 (95% CI, 0.669-0.820), respectively, and the C-index and AUC value were consistent. The calibration plots showed good calibration, and the risk threshold for DCA was 30-54%. In this study, we developed and evaluated a predictive model for the development of a high-risk complication combination while uncovering the pattern of complications in patients with T2DM. This model has a practical guiding effect on the health management of patients with T2DM in community settings.

Metabolic status indicators and influencing factors in non-obese, non-centrally obese nonalcoholic fatty liver disease

Non-obese nonalcoholic fatty liver disease (NAFLD) is characterized by metabolic disorders and related complications. This study aimed to provide an integrated description of clinical, metabolic, and influencing factors for a specific category of patients with non-obese NAFLD. A total of 36 participants with body mass index (BMI) < 28 kg/m2 and visceral adipose tissue < 100 cm2 were classified into 2 groups: the non-obese, non-centrally obese control group (n = 17) and non-obese, non-centrally obese NAFLD group (n = 19). Hypertriglyceridemia, impaired fasting glucose, low high-density lipoprotein cholesterol levels, and hypertension were used to determine whether participants were metabolically abnormal. Based on a logistic regression model, odds ratios for the factors influencing NAFLD with 95% confidence intervals were calculated. Insulin resistance (IR) and fasting plasma glucose (FPG) levels were higher in the NAFLD group than in the control group (P < .05). The NAFLD group had a higher metabolic abnormality rate than the healthy control group (36.84% vs 5.88%, P = .044). Correlation analysis showed that IR was positively correlated with FPG and triglyceride (P < .05). BMI was the main influencing factor of NAFLD (regression coefficient β = 0.631; odds ratio = 1.879; 95% confidence interval, 1.233-2.863). NAFLD patients with a BMI < 28 kg/m2 and visceral adipose tissue < 100 cm2 had more apparent IR, higher FPG, and a higher metabolic abnormality rate. IR may be affected by FPG and triglyceride. Even in non-obese and non-centrally obese individuals, BMI should be controlled to avoid NAFLD.

The Prognostic Value of Combined Status of Body Mass Index and Psychological Well-Being for the Estimation of All-Cause and CVD Mortality Risk: Results from a Long-Term Cohort Study in Lithuania

Background and Objectives: It is very important to analyze how body mass index (BMI) and psychological well-being (PWB) combination may be differentially associated with mortality risk. The aim of this study was to evaluate the additional prognostic value of the combined status of BMI and PWB for the estimation of all-cause and cardiovascular disease (CVD) mortality risk in the adult Lithuanian urban population. Materials and Methods: Initial data were collected within the framework of the international cohort HAPIEE study from 2006 to 2008. A random sample of 7115 individuals aged 45-72 years was screened. The response rate was 65%. Deaths were evaluated by the death register of Kaunas city (Lithuania) in a follow-up study until 31 December 2020. The mean (SD) duration of the follow-up for the endpoints period was 12.60 (2.79) years. PWB was evaluated by a CASP-12 questionnaire. Results: The findings from the Cox proportional hazards regression multivariable analysis showed that the combinations of underweight plus lower PWB and severe obesity plus lower PWB increased all-cause mortality risk in men (respectively hazard ratio (HR) = 5.65 and HR = 1.60) and in women (respectively HR = 6.02 and HR = 1.77); and increased the risk of mortality from CVD in men (respectively HR = 6.69 and HR = 2.19) compared with responders with normal weight plus higher PWB. The combination of severe obesity plus higher PWB significantly increased the risk of all-cause and CVD mortality risk in men. The combinations of normal weight plus lower PWB and overweight plus lower PWB significantly increased the risk of all-cause mortality risk in men. Conclusions: The combination of severe obesity independently on lower or higher PWB and the combination of underweight plus lower PWB is a strong predictor for all-cause and CVD mortality risk in men and a strong predictor for all-cause mortality risk in women.

Association of Shift Work with Normal-Weight Obesity in Community-Dwelling Adults

BACKGRUOUND

Shift work is associated with obesity and metabolic syndrome. However, this association in the normal-weight population remains unclear. This study aimed to investigate whether shift work is associated with normal-weight obesity (NWO).

METHODS

From the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) dataset (2008 to 2011), 3,800 full-time workers aged ≥19 years with a body mass index (BMI) ≤25 kg/m2 were analysed. We defined NWO as BMI ≤25 kg/m2 and body fat percentage ≥25% in men and ≥37% in women. Working patterns were classified into "daytime," "other than daytime," and "shift." Multivariable logistic regression analysis was performed to evaluate the relationship between shift work and NWO.

RESULTS

Shift work was associated with higher odds of NWO than daytime work (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.04 to 2.09) and night/evening work (aOR, 1.87; 95% CI, 1.11 to 3.14) after adjustment for type of work, working hours, age, sex, BMI, 25-hydroxyvitamin D levels, homeostatic model assessment for insulin resistance, and other sociodemographic factors. In subgroup analyses, the association between shift work and NWO was more robust in those aged ≥60 years and those working ≥56 hours/week.

CONCLUSION

Shift work was associated with NWO in community-dwelling Korean adults, independent of age, sex, BMI, and other covariates.

Body mass index at baseline directly predicts new-onset diabetes and to a lesser extent incident cardio-cerebrovascular events, but has a J-shaped relationship to all-cause mortality

OBJECTIVE

The prevalence of diabetes mellitus (DM), cardio-cerebrovascular diseases (CCVDs) has increased during recent decades. We aimed to investigate the relationship between body mass index (BMI) and each of several outcomes (DM, CCVDs, or mortality) based on the Korean National Health Insurance Service-Health Screening cohort.

METHODS

BMI was categorized as appropriate for Asian populations, into underweight (< 18.5 kg/m²), normal (18.5-< 23 kg/m²), overweight (23-< 25 kg/m²), grade 1 obesity (25-< 30 kg/m²), grade 2 obesity (30-< 35 kg/m²), and grade 3 obesity (≥35 kg/m²). In addition, BMI was further stratified into one unit. Multivariate Cox proportional hazards regression analyses were conducted to examine the association between BMI category and the primary outcomes (DM, CCVDs, or mortality).

RESULTS

A total of 311,416 individuals were included. The median follow-up was 12.5 years. Compared to normal BMI, underweight, overweight, and grade 1-3 obese individuals had a higher risk of the primary outcomes (hazard ratio [95% confidence intervals] 1.293 [1.224-1.365], 1.101 [1.073-1.129], 1.320 [1.288-1.353], 1.789 [1.689-1.897], and 2.376 [2.019-2.857], respectively, in men and 1.084 [1.010-1.163], 1.150 [1.116-1.185], 1.385 [1.346-1.425], 1.865 [1.725-2.019], and 2.472 [2.025-3.028], respectively, in women). Setting the reference BMI to 20-< 21 kg/m² and categorizing into one unit increment, BMI was associated with the primary outcomes in a J-shaped manner in both sexes. The risk of DM increased with higher BMI in both sexes, while all-cause mortality decreased in men with a BMI 21-< 31 kg/m² and women with BMI 22-< 30 kg/m².

CONCLUSIONS

BMI was associated with all-cause mortality in a J-shaped manner in both sexes, while it was associated with risk of DM in a dose-response relationship. The relationship between BMI and the primary outcomes was J-shaped.

Obesity Measures as Predictors of Type 2 Diabetes and Cardiovascular Diseases among the Jordanian Population: A Cross-Sectional Study

Obesity is strongly associated with cardiovascular diseases (CVD) and type 2 diabetes (T2D). This study aimed to use obesity measures, body mass index (BMI) and waist circumference (WC) to predict the CVD and T2D risk and to determine the best predictor of these diseases among Jordanian adults. A cross-sectional study was conducted at the governmental and military hospitals across Jordan. The study participants were healthy or previously diagnosed with CVD or T2D. The continuous variables were compared using ANOVA, and the categorical variables were compared using the X2 test. The multivariate logistic regression was used to predict CVD and T2D risk through their association with BMI and WC. The final sample consisted of 6000 Jordanian adults with a mean age of 41.5 ± 14.7 years, 73.6% females. The BMI (OR = 1.7, CI: 1.30–2.30, p < 0.001) was associated with a higher risk of T2D compared to WC (OR = 1.3, CI: 1.04–1.52, p = 0.016). However, our results showed that BMI was not associated with CVD risk, while the WC was significantly and positively associated with CVD risk (OR = 1.9, CI: 1.47–2.47, p < 0.001). In conclusion, an elevated BMI predicts a higher risk of T2D, while WC is more efficient in predicting CVD risk. Our results can be used to construct a population-specific intervention to reduce the risk of CVD and T2D among adults in Jordan and other countries with similar backgrounds.

Correlation between adiponectin level and the degree of fibrosis in patients with non-alcoholic fatty liver disease

Background

Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases, particularly in Egypt. It is defined as the accumulation of lipids inside the hepatocytes, in the absence of other etiologies of hepatic damage. It is frequently associated with obesity, diabetes mellitus, and metabolic syndrome. Adiponectin is an abundant adipocyte-derived protein with well-established anti-atherogenic, insulin-sensitizing, and anti-inflammatory properties. The liver is a major target organ for adiponectin especially in fatty liver diseases, and this adipocytokine has the ability to control many liver functions including metabolism, inflammation, and fibrosis. In this study, we aimed to find out the correlation between the degree of liver fibrosis in NAFLD patients and their serum adiponectin level as a future non-invasive method for the assessment of liver fibrosis to substitute liver biopsy to avoid its hazardous complication and also to study the correlation between diabetes mellitus as well as obesity and serum adiponectin level.

Results

Fifty patients were selected to participate in our study based on our inclusion criteria. They were recruited from the Internal Medicine Department, Gastroenterology Clinic in Al-Demerdash Hospital using a convenient sampling method. Diagnosis of NAFLD was confirmed by laboratory markers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, ultrasound, and FibroScan examination. Analyzing the adiponectin levels showed that besides its significant correlation with body mass index (BMI), hypertension, diabetes mellitus, and dyslipidemia, it was significantly lower in the high-grade fibrosis group compared to the low-grade fibrosis group with a P-value of (0.000) and a cutoff value for stage 3/4 fibrosis of about 2.31 μg/ml which marked a promising hope of adiponectin being of protective value against liver fibrosis.

Conclusion

Both serum levels and hepatic adiponectin receptor expression are decreased in NAFLD. Therefore, either adiponectin itself or adiponectin-inducing agents might be of key therapeutic interest in the near future in the treatment of NAFLD.

The Relationship between Body Mass Index and Incident Diabetes Mellitus in Chinese Aged Population: A Cohort Study

OBJECTIVES

Previous studies reported that overweight older adults had a lower mortality after cardiovascular diseases attack, indicating being thinner might not always be better. However, there is an ongoing debate about what is the optimal range of body mass index (BMI) for the aged population. We aimed to evaluate the value of BMI for the prediction of incident diabetes mellitus (DM) in the Chinese elderly population.

METHODS

A total number of 6,911 Chinese elderly people (4,110 men and 2,801 women, aged 71 ± 6.0 years) were included in this cohort study. BMI was measured at baseline (Jan 1, 2014, to Dec 31, 2014). All the participants were further classified into six groups: <18.5 kg/m², 18.5 to <22.5 kg/m², 22.5 to <25.0 kg/m², 25.0 to <27.5 kg/m², 27.5 to <30.0 kg/m², and ≥30.0 kg/m². Fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) were annually measured during follow-up (Jan 1, 2015-May 31, 2019). DM was confirmed if either FBG ≥ 7.0 mmol/L or HbA1c ≥ 6.5%. We used the Cox proportional hazard regression model to evaluate the association between BMI and the prediction of incident DM.

RESULTS

Comparing individuals with a BMI range of 18.5 to <22.5 kg/m² (reference), the hazard ratio for incident DM was 2.13 (95% CI: 1.54~2.95), 2.14 (95% CI: 1.53~3.00), 3.17 (95% CI: 2.19~4.59), 3.15 (95% CI: 1.94~5.09), and 3.14 (95% CI: 1.94~5.09) for the group with a BMI range of 22.5 to <25.0 kg/m², 25.0 to <27.5 kg/m², 27.5 to <30.0 kg/m², and ≥30.0 kg/m² after adjusting for baseline age, sex, blood pressure, lipid profiles, and eGFR (P trend < 0.001), after adjusting for the abovementioned confounders. The association tended to be closer in men and young participants, compared with their counterparts.

CONCLUSIONS

High BMI was associated with a high risk of developing DM in the Chinese aged population. Thus, it is optimal for the aged population to maintain their body weight within a reasonable range to prevent chronic diseases.