Body Mass Index and Mortality in Individuals With Type 1 Diabetes

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FinnDiane Study Grp , Dahlström , E H , Sandholm , N , Forsblom , C M , Thorn , L M , Jansson , F J , Harjutsalo , V & Groop , P-H 2019 , ' Body Mass Index and Mortality in Individuals With Type 1 Diabetes ' , Journal of Clinical Endocrinology and Metabolism , vol. 104 , no. 11 , pp. 5192-5201 .

Title: Body Mass Index and Mortality in Individuals With Type 1 Diabetes
Author: FinnDiane Study Grp; Dahlström, Emma H.; Sandholm, Niina; Forsblom, Carol M.; Thorn, Lena M.; Jansson, Fanny J.; Harjutsalo, Valma; Groop, Per-Henrik
Contributor organization: Nefrologian yksikkö
HUS Abdominal Center
University of Helsinki
Department of Medicine
Research Programs Unit
Faculty of Medicine
CAMM - Research Program for Clinical and Molecular Metabolism
Per Henrik Groop / Principal Investigator
University Management
Date: 2019-11
Language: eng
Number of pages: 10
Belongs to series: Journal of Clinical Endocrinology and Metabolism
ISSN: 0021-972X
Abstract: Context: The relationship between body mass index (BMI) and mortality may differ between patients with type 1 diabetes and the general population; 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 5836 individuals with type 1 diabetes from the FinnDiane study. Main Outcome Measure and Methods: We retrieved death data for all participants on 31 December 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 as well as 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. When analyses were restricted to those with normal albumin excretion rate, the relationship was U-shaped. The nadir BMI (BMI with the lowest mortality) was in the normal weight region (24.3 to 24.8 kg/m(2)); however, among individuals with diabetic nephropathy, the nadir BMI was in the overweight region (25.9 to 26.1 kg/m(2)). Diabetic nephropathy, diabetes-onset age, and sex modified the relationship between BMI and mortality (P-interaction <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 normal albumin excretion rate.
Subject: OBESITY
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion

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