Body mass index versus surrogate measures of central adiposity as independent predictors of mortality in type 2 diabetes

Cardiovascular Diabetology

Research

Antonio Nicolucci¹  Franco Cavalot²  Monica Vedovato³  Giuseppe Penno⁴  Giuseppe Pugliese⁵  Jonida Haxhi⁵  Olga Lamacchia⁶  Anna Solini⁷  Emanuela Orsi⁸  Cecilia Fondelli⁹  Enzo Bonora^1,10  Roberto Trevisan^1,11 

[1] Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy;Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy;Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy;Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy;Department of Clinical and Molecular Medicine, “La Sapienza” University, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy;Department of Medical Sciences, University of Foggia, Foggia, Italy;Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy;Diabetes Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy;Diabetes Unit, University of Siena, Siena, Italy;Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy;Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy;

关键词: Type 2 diabetes;    Body mass index;    Central adiposity;    All-cause-mortality;    Physical activity;   

DOI  :  10.1186/s12933-022-01706-2

 received in 2022-06-06, accepted in 2022-11-22,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAn “obesity paradox” for mortality has been shown in chronic disorders such as diabetes, and attributed to methodological bias, including the use of body mass index (BMI) for obesity definition. This analysis investigated the independent association of BMI versus surrogate measures of central adiposity with all-cause mortality in individuals with type 2 diabetes.MethodsThe Renal Insufficiency And Cardiovascular Events Italian Multicentre Study is a prospective cohort study that enrolled 15,773 patients in 19 Italian centres in 2006–2008. Exposures were BMI and the surrogate measures of central adiposity waist circumference (WC), waist-to-height ratio (WHtR), and A Body Shape Index (ABSI). Vital status was retrieved on 31 October 2015 for 15,656 patients (99.3%),ResultsAge- and sex-adjusted hazard ratios and 95% confidence intervals were significantly higher in BMI-based underweight (1.729 [1.193–2.505), P = 0.004), moderately obese (1.214 [1.058–1.392), P = 0.006) and severely obese (1.703 [1.402–2.068), P < 0.0001), lower in overweight (0.842 [0.775–0.915), P < 0.0001) and similar in mildly obese (0.950 [0.864–1.045), P = 0.292), compared to normal-weight individuals. When further adjusting for smoking, physical activity (PA), and comorbidities, risk was lower also in mildly obese versus normal-weight patients. The BMI-mortality relationship did not change after sequentially excluding ever smokers, individuals with comorbidities, and those died within two years from enrollment and when analyzing separately participants below and above the median age. Conversely, a paradox relationship was observed among inactive/moderately inactive, but not moderately/highly active patients. Mortality risk adjusted for age, gender, smoking, PA and comorbidities was significantly higher in the highest tertile of WC (1.279 [1.089–1.501], P = 0.003), WHtR (1.372 [1.165–1.615], P < 0.0001), and ABSI (1.263 [1.067–1.495], P = 0.007) versus the lowest tertile. However, risk was lower in the intermediate versus lowest tertile for WC (0.823 [0.693–0.979], P = 0.028), similar for WHtR, and higher, though not significantly, for ABSI.ConclusionsAn “overweight paradox” remained after controlling for age, smoking, and comorbidities, arguing against a collider bias or reverse causation. However, it could be partly explained by confounding from PA level, possibly through its impact on lean mass and cardiorespiratory fitness. No obesity paradox was observed with WHtR and especially ABSI, which predicted mortality risk associated with central adiposity better than WC.Trial registration ClinicalTrials.gov, NCT00715481, 15 July, 2008

【 授权许可】

CC BY   
© The Author(s) 2022

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