한빛사논문
- 조회350
Tae Kyung Yoo1, Kyung-Do Han2, Eun-Jung Rhee3* & Won-Young Lee3,4*
1Department of Medicine, MetroWest Medical Center, Framingham, MA, USA;
2Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea;
3Department of Internal Medicine, Division of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea;
4Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
Tae Kyung Yoo and Kyung-Do Han contributed equally to this work as first authors.
Won-Young Lee and Eun-Jung Rhee contributed equally to this work as corresponding authors.
Abstract
Background: The risk of heart failure (HF) in underweight diabetes mellitus (DM) patients has rarely been studied. We conducted a cohort study to investigate the association between underweight (BMI < 18.5 kg/m2 ) and BMI change over time and the risk of HF in patients with type 2 DM.
Methods: We utilized the health screening data from the National Health Insurance Service and the Korean National Health Screening database from 2009 to 2012, with follow-up until December 2018. Participants with DM were categorized into four groups based on their BMI at 4 years before study inclusion and BMI at the study entry: (1) Always Normal Weight (BMI at 4 years ago/BMI at study entry ≥18.5/≥18.5 kg/m2 , reference group); (2) Transitioned to Underweight (≥18.5/<18.5 kg/m2 ); (3) Transitioned to Normal Weight (<18.5/≥18.5 kg/m2 ) and (4) Always Underweight (<18.5/<18.5 kg/m2 ). Participants were followed until the development of HF or at the end of the follow-up. Initial screening data included participants with DM who had the health screening during the study period (n = 2,746,079). Participants aged <20 years (n = 390), those who did not undergo health examination 4 years prior (n = 1,306,520), and those with missing data (n = 77,410) were excluded. Participants diagnosed with HF before study participation (n = 81,645) and within 1 year of study enrolment (n = 11,731) were excluded. After applying exclusion criteria, 1,268,383 participants were finally included in the analysis. The primary outcome was the development of HF. We employed Cox proportional hazards models, adjusting for various confounding factors, to assess the risk of developing HF.
Results: Median follow-up duration was 6.88 years and men were 63.16%. The mean ages of each groups were as follows: Always Normal Weight (57.92 ± 11.64 years), Transitioned to Underweight (62 ± 13.5 years), Transitioned to Normal Weight (56.6 ± 15.29 years) and Always Underweight (57.76 ± 15.35 years). In comparison with the Always Normal Weight group (n = 1,245,381, HF = 76,360), Transitioned to Underweight group (≥18.5/<18.5 kg/m2 , n = 9304, HF = 880, adjusted Hazard Ratio (aHR)1.389, 95% confidence interval (CI) 1.3-1.485) or Transitioned to Normal Weight (<18.5/≥18.5 kg/m2 , n = 6024, HF = 478, aHR 1.385, 95% CI 1.266-1.515) exhibited an increased risk of HF. The highest risk was observed in the Always Underweight group (<18.5/<18.5 kg/m2 , n = 7674, HF = 665, aHR 1.612, 95% CI 1.493-1.740).
Conclusions: Underweight was significantly associated with the risk of HF in the DM population. Active surveillance for HF in an underweight DM population is needed.
논문정보
- Research article
- 2024년 01월 (BRIC 등록일 2024-01-19)
- 국내(교신)+국외 연구진
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