BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study
Aims/hypothesis Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type...
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| Veröffentlicht in: | Diabetologia 2021-04, Vol.64 (4), p.814-825 |
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| creator | Polemiti, Elli Baudry, Julia Kuxhaus, Olga Jäger, Susanne Bergmann, Manuela M. Weikert, Cornelia Schulze, Matthias B. |
| description | Aims/hypothesis
Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study.
Methods
We studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (
n
= 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models.
Results
There were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m
2
(IQR 27.4–33.2), and the median relative annual BMI change was −0.4% (IQR −2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m
2
[95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers.
Conclusions/interpretation
Among people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications |
| doi_str_mv | 10.1007/s00125-020-05362-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7940263</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2478594977</sourcerecordid><originalsourceid>FETCH-LOGICAL-c574t-48da401a4bf83887e6ea261feb0e07cc0323ba955f5b26a63883314a4d6fe0b3</originalsourceid><addsrcrecordid>eNp9ks9u1DAQxi0EokvhBTggS1zgEPB_OxyQyqrQlRbRQw_cLMdxdl2SeGsni_YJeG2cTSmlB04jzfzmG8_4A-AlRu8wQvJ9QggTXiCCCsSpIIV8BBaYUVIgRtRjsJjqBVbi-wl4ltI1QohyJp6CE0oZJ1yJBfj16esKmr6GU7Rb028cbELbhp--30DfW1-7foDDYecggbU3lRtcOnZEn37A0MDO2xj2JtmxNfFY6cz9jA3drvXWDD706QMctg6eX66WxWUYUm06mIaxPjwHTxrTJvfiNp6Cq8_nV8uLYv3ty2p5ti4sl2womKoNQ9iwqlFUKemEM0TgxlXIIWktooRWpuS84RURRmSGUswMq0XjUEVPwcdZdjdWnatt3i2aVu-i70w86GC8_rfS-63ehL2WJUNE0CzwdhbYPmi7OFvrKYcolvm4bI8z--Z2WAw3o0uD7nyyrm1N78KYNGFS8ZKVUmb09QP0Ooyxz5fIVKlkqVhJMkVmKp83peiauxdgpCdL6NkSOltCHy2hJ-lX91e-a_njgQzQGUi5lP8__p39H9nf3A3CNA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2498798492</pqid></control><display><type>article</type><title>BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Polemiti, Elli ; Baudry, Julia ; Kuxhaus, Olga ; Jäger, Susanne ; Bergmann, Manuela M. ; Weikert, Cornelia ; Schulze, Matthias B.</creator><creatorcontrib>Polemiti, Elli ; Baudry, Julia ; Kuxhaus, Olga ; Jäger, Susanne ; Bergmann, Manuela M. ; Weikert, Cornelia ; Schulze, Matthias B.</creatorcontrib><description>Aims/hypothesis
Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study.
Methods
We studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (
n
= 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models.
Results
There were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m
2
(IQR 27.4–33.2), and the median relative annual BMI change was −0.4% (IQR −2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m
2
[95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers.
Conclusions/interpretation
Among people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications, while a reduced risk was observed with weight loss when compared with stable weight. The relationships with macrovascular disease were less clear.
Graphical abstract</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-020-05362-7</identifier><identifier>PMID: 33452586</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Body Mass Index ; Body weight ; Body weight loss ; Cardiovascular diseases ; Cerebral infarction ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetic Angiopathies - diagnosis ; Diabetic Angiopathies - epidemiology ; Diabetic neuropathy ; Diagnosis ; Female ; Germany - epidemiology ; Health risks ; Human Physiology ; Humans ; Incidence ; Internal Medicine ; Kidney diseases ; Life Sciences ; Male ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Microvasculature ; Middle Aged ; Myocardial infarction ; Obesity ; Obesity - diagnosis ; Obesity - epidemiology ; Overweight ; Prognosis ; Prospective Studies ; Protective Factors ; Retinopathy ; Risk Assessment ; Risk Factors ; Time Factors ; Weight Gain ; Weight Loss</subject><ispartof>Diabetologia, 2021-04, Vol.64 (4), p.814-825</ispartof><rights>The Author(s) 2021</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c574t-48da401a4bf83887e6ea261feb0e07cc0323ba955f5b26a63883314a4d6fe0b3</citedby><cites>FETCH-LOGICAL-c574t-48da401a4bf83887e6ea261feb0e07cc0323ba955f5b26a63883314a4d6fe0b3</cites><orcidid>0000-0002-7919-6039 ; 0000-0003-1756-0146 ; 0000-0001-9526-3468 ; 0000-0001-5064-227X ; 0000-0001-6619-0861 ; 0000-0002-0830-5277</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00125-020-05362-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00125-020-05362-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33452586$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03174524$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Polemiti, Elli</creatorcontrib><creatorcontrib>Baudry, Julia</creatorcontrib><creatorcontrib>Kuxhaus, Olga</creatorcontrib><creatorcontrib>Jäger, Susanne</creatorcontrib><creatorcontrib>Bergmann, Manuela M.</creatorcontrib><creatorcontrib>Weikert, Cornelia</creatorcontrib><creatorcontrib>Schulze, Matthias B.</creatorcontrib><title>BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>Aims/hypothesis
Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study.
Methods
We studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (
n
= 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models.
Results
There were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m
2
(IQR 27.4–33.2), and the median relative annual BMI change was −0.4% (IQR −2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m
2
[95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers.
Conclusions/interpretation
Among people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications, while a reduced risk was observed with weight loss when compared with stable weight. The relationships with macrovascular disease were less clear.
Graphical abstract</description><subject>Adult</subject><subject>Body Mass Index</subject><subject>Body weight</subject><subject>Body weight loss</subject><subject>Cardiovascular diseases</subject><subject>Cerebral infarction</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetic Angiopathies - diagnosis</subject><subject>Diabetic Angiopathies - epidemiology</subject><subject>Diabetic neuropathy</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Germany - epidemiology</subject><subject>Health risks</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Kidney diseases</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Microvasculature</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Obesity</subject><subject>Obesity - diagnosis</subject><subject>Obesity - epidemiology</subject><subject>Overweight</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Protective Factors</subject><subject>Retinopathy</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Weight Gain</subject><subject>Weight Loss</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9ks9u1DAQxi0EokvhBTggS1zgEPB_OxyQyqrQlRbRQw_cLMdxdl2SeGsni_YJeG2cTSmlB04jzfzmG8_4A-AlRu8wQvJ9QggTXiCCCsSpIIV8BBaYUVIgRtRjsJjqBVbi-wl4ltI1QohyJp6CE0oZJ1yJBfj16esKmr6GU7Rb028cbELbhp--30DfW1-7foDDYecggbU3lRtcOnZEn37A0MDO2xj2JtmxNfFY6cz9jA3drvXWDD706QMctg6eX66WxWUYUm06mIaxPjwHTxrTJvfiNp6Cq8_nV8uLYv3ty2p5ti4sl2womKoNQ9iwqlFUKemEM0TgxlXIIWktooRWpuS84RURRmSGUswMq0XjUEVPwcdZdjdWnatt3i2aVu-i70w86GC8_rfS-63ehL2WJUNE0CzwdhbYPmi7OFvrKYcolvm4bI8z--Z2WAw3o0uD7nyyrm1N78KYNGFS8ZKVUmb09QP0Ooyxz5fIVKlkqVhJMkVmKp83peiauxdgpCdL6NkSOltCHy2hJ-lX91e-a_njgQzQGUi5lP8__p39H9nf3A3CNA</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Polemiti, Elli</creator><creator>Baudry, Julia</creator><creator>Kuxhaus, Olga</creator><creator>Jäger, Susanne</creator><creator>Bergmann, Manuela M.</creator><creator>Weikert, Cornelia</creator><creator>Schulze, Matthias B.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7919-6039</orcidid><orcidid>https://orcid.org/0000-0003-1756-0146</orcidid><orcidid>https://orcid.org/0000-0001-9526-3468</orcidid><orcidid>https://orcid.org/0000-0001-5064-227X</orcidid><orcidid>https://orcid.org/0000-0001-6619-0861</orcidid><orcidid>https://orcid.org/0000-0002-0830-5277</orcidid></search><sort><creationdate>20210401</creationdate><title>BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study</title><author>Polemiti, Elli ; Baudry, Julia ; Kuxhaus, Olga ; Jäger, Susanne ; Bergmann, Manuela M. ; Weikert, Cornelia ; Schulze, Matthias B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c574t-48da401a4bf83887e6ea261feb0e07cc0323ba955f5b26a63883314a4d6fe0b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Body Mass Index</topic><topic>Body weight</topic><topic>Body weight loss</topic><topic>Cardiovascular diseases</topic><topic>Cerebral infarction</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - diagnosis</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetic Angiopathies - diagnosis</topic><topic>Diabetic Angiopathies - epidemiology</topic><topic>Diabetic neuropathy</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Germany - epidemiology</topic><topic>Health risks</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Kidney diseases</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Microvasculature</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Obesity</topic><topic>Obesity - diagnosis</topic><topic>Obesity - epidemiology</topic><topic>Overweight</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Protective Factors</topic><topic>Retinopathy</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Weight Gain</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Polemiti, Elli</creatorcontrib><creatorcontrib>Baudry, Julia</creatorcontrib><creatorcontrib>Kuxhaus, Olga</creatorcontrib><creatorcontrib>Jäger, Susanne</creatorcontrib><creatorcontrib>Bergmann, Manuela M.</creatorcontrib><creatorcontrib>Weikert, Cornelia</creatorcontrib><creatorcontrib>Schulze, Matthias B.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Polemiti, Elli</au><au>Baudry, Julia</au><au>Kuxhaus, Olga</au><au>Jäger, Susanne</au><au>Bergmann, Manuela M.</au><au>Weikert, Cornelia</au><au>Schulze, Matthias B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>64</volume><issue>4</issue><spage>814</spage><epage>825</epage><pages>814-825</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>Aims/hypothesis
Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study.
Methods
We studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (
n
= 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models.
Results
There were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m
2
(IQR 27.4–33.2), and the median relative annual BMI change was −0.4% (IQR −2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m
2
[95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers.
Conclusions/interpretation
Among people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications, while a reduced risk was observed with weight loss when compared with stable weight. The relationships with macrovascular disease were less clear.
Graphical abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33452586</pmid><doi>10.1007/s00125-020-05362-7</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-7919-6039</orcidid><orcidid>https://orcid.org/0000-0003-1756-0146</orcidid><orcidid>https://orcid.org/0000-0001-9526-3468</orcidid><orcidid>https://orcid.org/0000-0001-5064-227X</orcidid><orcidid>https://orcid.org/0000-0001-6619-0861</orcidid><orcidid>https://orcid.org/0000-0002-0830-5277</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0012-186X |
| ispartof | Diabetologia, 2021-04, Vol.64 (4), p.814-825 |
| issn | 0012-186X 1432-0428 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7940263 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adult Body Mass Index Body weight Body weight loss Cardiovascular diseases Cerebral infarction Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - epidemiology Diabetic Angiopathies - diagnosis Diabetic Angiopathies - epidemiology Diabetic neuropathy Diagnosis Female Germany - epidemiology Health risks Human Physiology Humans Incidence Internal Medicine Kidney diseases Life Sciences Male Medicine Medicine & Public Health Metabolic Diseases Microvasculature Middle Aged Myocardial infarction Obesity Obesity - diagnosis Obesity - epidemiology Overweight Prognosis Prospective Studies Protective Factors Retinopathy Risk Assessment Risk Factors Time Factors Weight Gain Weight Loss |
| title | BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study |
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