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J Clin Endocrinol Metab. 2019 Apr 29. pii: jc.2019-00042. doi: 10.1210/jc.2019-00042. [Epub ahead of print]

Body mass index and mortality in individuals with type 1 diabetes.

Author information

1
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
2
Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
3
Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland.
4
Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Abstract

CONTEXT:

The relationship between BMI and mortality in type 1 diabetes might differ from the general population and it is not known which clinical characteristics modify the relationship.

OBJECTIVE:

Our aim was to assess the relationship between BMI and mortality and the interaction with clinically meaningful factors.

DESIGN, SETTING AND PARTICIPANTS:

This prospective study included 5,836 individuals with type 1 diabetes from the FinnDiane study.

MAIN OUTCOME MEASURE AND METHODS:

. We retrieved death data for all participants on December 31, 2015. We estimated the effect of BMI on the risk of mortality using a Cox proportional-hazards model with BMI as a restricted cubic spline, and the effect modification by adding interaction terms to the spline.

RESULTS:

During a median of 13.7 years, 876 individuals died. The relationship between baseline BMI and all-cause mortality was reverse-J-shaped. However, when analyses were restricted to those with normal AER, the relationship was U-shaped. The nadir BMI (=BMI with the lowest mortality) was in the normal weight region (24.3-24.8 kg/m2) but among individuals with diabetic nephropathy, the nadir BMI was in the overweight region (25.9-26.1 kg/m2). Diabetic nephropathy, diabetes onset age, and sex modified the relationship between BMI and mortality (Pinteraction <0.05).

CONCLUSIONS:

Normal weight is optimal for individuals with type 1 diabetes to delay mortality, whereas underweight might be an indication of underlying complications. Maintaining normal weight may translate into reduced risk of mortality in type 1 diabetes, particularly for individuals of male sex, later diabetes onset age and with normal albumin excretion rate.

PMID:
31034018
DOI:
10.1210/jc.2019-00042

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