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Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk

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Abstract

Aim

To evaluate the risk of CVD and all-cause mortality at different BMI levels in conjunction with weight change prior to diagnosis of T2DM in a multi-ethnic population.

Methods

Longitudinal study of 51,455 patients with T2DM and without a history of comorbid diseases at diagnosis. Weight changes prior to diagnosis of T2DM were evaluated, and the risk of CVD and all-cause mortality at different BMI levels among three ethnic groups estimated using treatment effects model.

Results

White Europeans (WE), African-Caribbeans (AC), and South Asians (SA) were mean 52, 49, and 47 years with a mean BMI of 33.0, 32.0, and 30.0 kg/m2 at diagnosis, respectively. Among WE, normal weight patients developed CVD significantly earlier by 0.5 years (95% CI 0.1, 0.9 years; p = 0.018) compared to obese patients. Furthermore, those with normal body weight at diagnosis were significantly more likely to die earlier by 0.6 years (95% CI 0.03, 1.2 years; p = 0.037) among WE and by 2.5 years (95% CI 0.3, 4.6 years; p = 0.023) among SA compared to their respective obese patients. However, BMI at diagnosis was not associated with increased risk of CVD and death among AC.

Conclusions

This study suggests a paradoxical association of BMI with cardiovascular and mortality risks in different ethnic groups, which may partially be driven by different cardiovascular and glycaemic risk profiles at diagnosis.

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References

  1. Carnethon MR, De Chavez PJD, Biggs ML, Lewis CE, Pankow JS, Bertoni AG, Golden SH, Liu K, Mukamal KJ, Campbell-Jenkins B, Dyer AR (2012) Association of weight status with mortality in adults with incident diabetes. JAMA 308(6):581–590. https://doi.org/10.1001/jama.2012.9282

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Logue J, Walker JJ, Leese G, Lindsay R, Mcknight J, Morris A, Philip S, Wild S, Sattar N, on behalf of the Scottish Diabetes Research Network Epidemiology Group (2013) Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality. Diabetes Care 36(4):887–893. https://doi.org/10.2337/dc12-0944

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mulnier HE, Seaman HE, Raleigh VS, Soedamah-Muthu SS, Colhoun HM, Lawrenson RA (2006) Mortality in people with type 2 diabetes in the UK. Diabet Med 23(5):516–521. https://doi.org/10.1111/j.1464-5491.2006.01838.x

    Article  PubMed  CAS  Google Scholar 

  4. Thomas G, Khunti K, Curcin V, Molokhia M, Millett C, Majeed A, Paul S (2014) Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease. Diabetes Obes Metab 16(4):317–325. https://doi.org/10.1111/dom.12217

    Article  PubMed  CAS  Google Scholar 

  5. Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Li W, Johnson J, Heymsfield SB, Cefalu WT, Ryan DH, Hu G (2014) Body mass index and the risk of all-cause mortality among patients with type 2 diabetes. Circulation 130(24):2143–2151. https://doi.org/10.1161/circulationaha.114.009098

    Article  PubMed  PubMed Central  Google Scholar 

  6. Banack HR, Kaufman JS (Cambridge (2013) The “Obesity Paradox” explained. Epidemiology (Cambridge, Mass) 24(3):461–462. https://doi.org/10.1097/EDE.0b013e31828c776c

    Article  Google Scholar 

  7. Banack HR, Kaufman JS (2015) Does selection bias explain the obesity paradox among individuals with cardiovascular disease? Ann Epidemiol 25(5):342–349. https://doi.org/10.1016/j.annepidem.2015.02.008

    Article  PubMed  Google Scholar 

  8. Hainer V, Aldhoon-Hainerová I (2013) Obesity paradox does exist. Diabetes Care 36(Supplement 2):S276–S281. https://doi.org/10.2337/dcS13-2023

    Article  PubMed  PubMed Central  Google Scholar 

  9. Owusu Adjah ES, Samanta M, Shaw JE, Majeed A, Khunti K, Paul SK (2018) Weight loss and mortality risk in patients with different adiposity at diagnosis of type 2 diabetes: a longitudinal cohort study. Nutr Diabetes 8(1):37. https://doi.org/10.1038/s41387-018-0042-0

    Article  Google Scholar 

  10. Hsu WC, Araneta MRG, Kanaya AM, Chiang JL, Fujimoto W (2015) BMI cut points to identify at-risk asian americans for type 2 diabetes screening. Diabetes Care 38(1):150–158. https://doi.org/10.2337/dc14-2391

    Article  PubMed  Google Scholar 

  11. Misra A, Vikram NK, Gupta R, Pandey RM, Wasir JS, Gupta VP (2006) Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity. Int J Obes (2005) 30(1):106–111. https://doi.org/10.1038/sj.ijo.0803111

    Article  CAS  Google Scholar 

  12. Shai I, Jiang R, Manson JE, Stampfer MJ, Willett WC, Colditz GA, Hu FB (2006) Ethnicity, obesity, and risk of type 2 diabetes in women: a 20-year follow-up study. Diabetes Care 29(7):1585–1590. https://doi.org/10.2337/dc06-0057

    Article  PubMed  Google Scholar 

  13. Tillin T, Sattar N, Godsland IF, Hughes AD, Chaturvedi N, Forouhi NG (2015) Ethnicity-specific obesity cut-points in the development of type 2 diabetes—a prospective study including three ethnic groups in the United Kingdom. Diabet Med 32(2):226–234. https://doi.org/10.1111/dme.12576

    Article  PubMed  CAS  Google Scholar 

  14. Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, Deanfield J, Smeeth L, Timmis A, Hemingway H (2015) Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 3(2):105–113. https://doi.org/10.1016/S2213-8587(14)70219-0

    Article  PubMed  PubMed Central  Google Scholar 

  15. U.K. Prospective Diabetes Study Group (1998) Ethnicity and cardiovascular disease: the incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type 2 diabetes (U.K. Prospective Diabetes Study 32). Diabetes Care 21(8):1271–1277. https://doi.org/10.2337/diacare.21.8.1271

    Article  Google Scholar 

  16. Lanting LC, Joung IMA, Mackenbach JP, Lamberts SWJ, Bootsma AH (2005) Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care 28(9):2280–2288. https://doi.org/10.2337/diacare.28.9.2280

    Article  PubMed  Google Scholar 

  17. Bellary S, O’Hare JP, Raymond NT, Mughal S, Hanif WM, Jones A, Kumar S, Barnett AH (2010) Premature cardiovascular events and mortality in South Asians with type 2 diabetes in the United Kingdom Asian Diabetes Study—effect of ethnicity on risk. Curr Med Res Opin 26(8):1873–1879. https://doi.org/10.1185/03007995.2010.490468

    Article  PubMed  Google Scholar 

  18. George J, Mathur R, Shah AD, Pujades-Rodriguez M, Denaxas S, Smeeth L, Timmis A, Hemingway H (2017) Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: associations in a linked electronic health record cohort of 1 million patients. PLoS One 12(6):e0178945. https://doi.org/10.1371/journal.pone.0178945

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Ramezankhani A, Azizi F, Hadaegh F, Momenan AA (2018) Diabetes and number of years of life lost with and without cardiovascular disease: a multi-state homogeneous semi-Markov model. Acta Diabetologica 55(3):253–262

    Article  PubMed  Google Scholar 

  20. Lavie CJ, De Schutter A, Patel D, Artham SM, Milani RV (2011) Body composition and coronary heart disease mortality—an obesity or a lean paradox? Mayo Clin Proc 86(9):857–864. https://doi.org/10.4065/mcp.2011.0092

    Article  CAS  Google Scholar 

  21. Lavie CJ, Milani RV, Ventura HO (2011) Obesity and the “Obesity Paradox” in cardiovascular diseases. Clin Pharmacol Ther 90(1):23–25. https://doi.org/10.1038/clpt.2011.87

    Article  PubMed  CAS  Google Scholar 

  22. Kokkinos P, Myers J, Faselis C, Doumas M, Kheirbek R, Nylen E (2012) BMI–mortality paradox and fitness in African American and Caucasian men with type 2 diabetes. Diabetes Care 35(5):1021–1027. https://doi.org/10.2337/dc11-2407

    Article  PubMed  PubMed Central  Google Scholar 

  23. Paul SK, Owusu Adjah ES, Samanta M, Patel K, Bellary S, Hanif W, Khunti K (2017) Comparison of body mass index at diagnosis of diabetes in a multi-ethnic population: a case–control study with matched non-diabetic controls. Diabetes Obes Metab 19(7):1014–1023. https://doi.org/10.1111/dom.12915

    Article  PubMed  Google Scholar 

  24. Read J (1991) The read clinical classification (read codes). Br Homoeopath J 80(1):14–20. https://doi.org/10.1016/S0007-0785(05)80418-1

    Article  Google Scholar 

  25. Owusu Adjah ES, Montvida O, Agbeve J, Paul SK (2017) Data mining approach to identify disease cohorts from primary care electronic medical records: a case of diabetes mellitus. Open Bioinform J 10:16–27. https://doi.org/10.2174/1875036201710010016

    Article  Google Scholar 

  26. WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403):157

    Article  Google Scholar 

  27. Ho AK, Bartels CM, Thorpe CT, Pandhi N, Smith MA, Johnson HM (2016) achieving weight loss and hypertension control among obese adults: a US Multidisciplinary Group Practice Observational Study. Am J Hypertens 29(8):984–991. https://doi.org/10.1093/ajh/hpw020

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rubin DB (1974) Estimating causal effects of treatments in randomized and nonrandomized studies. J Educ Psychol 66(5):688. https://doi.org/10.1037/h0037350

    Article  Google Scholar 

  29. Austin PC, Stuart EA (2015) The performance of inverse probability of treatment weighting and full matching on the propensity score in the presence of model misspecification when estimating the effect of treatment on survival outcomes. Stat Methods Med Res 26(4):1654–1670. https://doi.org/10.1177/0962280215584401

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cattaneo MD (2010) Efficient semiparametric estimation of multi-valued treatment effects under ignorability. J Econom 155(2):138–154. https://doi.org/10.1016/j.jeconom.2009.09.023

    Article  Google Scholar 

  31. Lee M-j (2012) Treatment effects in sample selection models and their nonparametric estimation. J Econom 167(2):317–329. https://doi.org/10.1016/j.jeconom.2011.09.018

    Article  Google Scholar 

  32. Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN (2014) Obesity and cardiovascular diseases. J Am Coll Cardiol 63(14):1345–1354. https://doi.org/10.1016/j.jacc.2014.01.022

    Article  PubMed  Google Scholar 

  33. Zheng Y, Song M, Manson JE, Giovannucci EL, Hu FB (2017) Group-based trajectory of body shape from ages 5 to 55 years and cardiometabolic disease risk in 2 US cohorts. Am J Epidemiol 186(11):1246–1255. https://doi.org/10.1093/aje/kwx188

    Article  PubMed  PubMed Central  Google Scholar 

  34. Canoy D, Wareham N, Luben R, Welch A, Bingham S, Day N, Khaw KT (2005) Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study. Obes Res 13(8):1466–1475. https://doi.org/10.1038/oby.2005.177

    Article  PubMed  Google Scholar 

  35. Wright AK, Kontopantelis E, Emsley R, Buchan I, Sattar N, Rutter MK, Ashcroft DM (2016) Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Diabetes Care. https://doi.org/10.2337/dc16-1616

    Article  PubMed  Google Scholar 

  36. Penno G, Solini A, Bonora E, Orsi E, Fondelli C, Zerbini G, Trevisan R, Vedovato M, Cavalot F, Laviola L (2018) Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol 55(6):603–612. https://doi.org/10.1007/s00592-018-1133-z

    Article  PubMed  CAS  Google Scholar 

  37. Owusu Adjah ES, Bellary S, Hanif W, Patel K, Khunti K, Paul SK (2018) Prevalence and incidence of complications at diagnosis of T2DM and during follow-up by BMI and ethnicity: a matched case–control analysis. Cardiovasc Diabetol 17(1):70. https://doi.org/10.1186/s12933-018-0712-1

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Melbourne EpiCentre gratefully acknowledges the support from the Australian Government’s National Collaborative Research Infrastructure Strategy (NCRIS) initiative through Therapeutic Innovation Australia.

Funding

National Health and Medical Research Council of Australia (GNT1063477).

Author information

Authors and Affiliations

  1. QIMR Berghofer Medical Research Institute, Brisbane, Australia

    Ebenezer S. Owusu Adjah

  2. Faculty of Medicine, The University of Queensland, Brisbane, Australia

    Ebenezer S. Owusu Adjah

  3. Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK

    Kausik K. Ray

  4. Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia

    Sanjoy K. Paul

Authors
  1. Ebenezer S. Owusu Adjah
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  3. Sanjoy K. Paul
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Contributions

SKP and ESOA conceived the idea and contributed to the study design. ESOA conducted the data extraction, data manipulation, and statistical analyses and developed the first draft of the manuscript. SKP contributed to the statistical analyses and had full access to all the data in the study and is the guarantor, taking responsibility for the integrity of the data and the accuracy of the data analysis. ESOA, KKR, and SKP were involved in writing the paper and had final approval of the submitted and published versions.

Corresponding author

Correspondence to Sanjoy K. Paul.

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Conflict of interest

SKP has acted as a consultant and/or speaker for Novartis, GI Dynamics, Roche, AstraZeneca, Guangzhou Zhongyi Pharmaceutical and Amylin Pharmaceuticals LLC. He has received grants in support of investigator and investigator-initiated clinical studies from Merck, Novo Nordisk, AstraZeneca, Hospira, Amylin Pharmaceuticals, Sanofi Aventis and Pfizer. KKR has acted as a speaker or consultant for Abbvie, Amgen, Pfizer, Astra Zeneca, Sanofi Resverlogix, Regeneron, Esperion, ACKCEA, Medicines Company, BI, Novo Nordisk. ESOA has no conflicts of interest to declare.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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Cite this article

Owusu Adjah, E.S., Ray, K.K. & Paul, S.K. Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk. Acta Diabetol 56, 87–96 (2019). https://doi.org/10.1007/s00592-018-1219-7

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  • DOI: https://doi.org/10.1007/s00592-018-1219-7

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