J Prev Med Public Health.
2012 Nov;45(6):394-401.
Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study
- Affiliations
-
- 1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. suepark@snu.ac.kr
- 2Cancer Research Institute, Seoul National University, Seoul, Korea.
- 3Cancer Epidemiology Branch, National Cancer Center, Goyang, Korea.
- 4Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea.
- 5Department of Preventive Medicine, Konkuk University School of Medicine, Chungju, Korea.
- 6Non-communicable Disease and Health Promotion, Western Pacific Regional Office, World Health Organization, Manila, Philippines.
Abstract
OBJECTIVES
Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD).
METHODS
Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model.
RESULTS
Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI > or =25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension.
CONCLUSIONS
This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.
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