scholarly journals Body Weight Variability and the Risk of Cardiovascular Outcomes and Mortality in Patients with Type 2 Diabetes: a Nationwide Cohort Study

2020 ◽  
Author(s):  
Ga Eun Nam ◽  
Wonsock Kim ◽  
Kyungdo Han ◽  
Chung-woo Lee ◽  
Yeongkeun Kwon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Large Scale ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
National Health Insurance System ◽  
All Cause Mortality ◽  
Quartile Group ◽  
Diabetes Patients

<b>Objective: </b>Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and that commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. <div><p><b>Research Design and Methods: </b>We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with ≥3 body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). Multivariable-adjusted Cox proportional hazards regression analysis was performed.</p> <p><b>Results: </b>During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.58 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively.</p> <p><b>Conclusions: </b>Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in type 2 diabetes patients and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in type 2 diabetes patients.</p> </div> <br>

scholarly journals Body Weight Variability and the Risk of Cardiovascular Outcomes and Mortality in Patients with Type 2 Diabetes: a Nationwide Cohort Study

2020 ◽  
Author(s):  
Ga Eun Nam ◽  
Wonsock Kim ◽  
Kyungdo Han ◽  
Chung-woo Lee ◽  
Yeongkeun Kwon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Large Scale ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
National Health Insurance System ◽  
All Cause Mortality ◽  
Quartile Group ◽  
Diabetes Patients

<b>Objective: </b>Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and that commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. <div><p><b>Research Design and Methods: </b>We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with ≥3 body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). Multivariable-adjusted Cox proportional hazards regression analysis was performed.</p> <p><b>Results: </b>During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.58 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively.</p> <p><b>Conclusions: </b>Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in type 2 diabetes patients and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in type 2 diabetes patients.</p> </div> <br>

scholarly journals Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study

2019 ◽  
Vol 8 (7) ◽  
pp. 950 ◽  
Author(s):  
Kye-Yeung Park ◽  
Hwan-Sik Hwang ◽  
Kyung-Hwan Cho ◽  
Kyungdo Han ◽  
Ga Eun Nam ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Risk Factor ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
National Health Insurance System ◽  
Weight Fluctuation

We aimed to investigate how body weight fluctuation affects the risk of developing type 2 diabetes by conducting a nationwide cohort study. A total of 3,855,884 participants from the National Health Insurance System health check-up data from 2012 were included in this study, and follow-up continued until 2016. Body weight was measured at least thrice between 2009 and 2012. Body weight variability (BWV) was estimated using average successive variability (ASV) indices. Cox proportional hazards regression models were used to evaluate the association of BWV with the risk of type 2 diabetes using hazard ratios (HRs) and 95% confidence intervals (CIs). Body weight fluctuation was associated with a higher risk of incident diabetes after adjustment for confounders (HR 1.10, 95% CI 1.07, 1.12 in the highest BWV quartile compared to the lowest). Regardless of the weight change status, the highest ASV quartile of BWV increased the risk for diabetes. Even subjects with a normal glucose tolerance status and those aged under 65 years had a higher risk of diabetes if their body weight highly fluctuated during the follow-up years. Our results suggest that body weight variability is an independent risk factor for diabetes. It is important to pay attention to frequent body weight fluctuations.

scholarly journals Composite Primary End Points in Cardiovascular Outcomes Trials Involving Type 2 Diabetes Patients: Should Unstable Angina Be Included in the Primary End Point?

Diabetes Care ◽  
2017 ◽  
Vol 40 (9) ◽  
pp. 1144-1151 ◽  
Author(s):  
Nikolaus Marx ◽  
Darren K. McGuire ◽  
Vlado Perkovic ◽  
Hans-Juergen Woerle ◽  
Uli C. Broedl ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Unstable Angina ◽  
Cardiovascular Outcomes ◽  
End Points ◽  
End Point ◽  
Diabetes Patients

scholarly journals Associations of Diet Quality and All-Cause Mortality Across Levels of Cardiometabolic Health and Disease: A 7.6-Year Prospective Analysis From the Dutch Lifelines Cohort

2021 ◽  
Author(s):  
Petra C Vinke ◽  
Gerjan Navis ◽  
Daan Kromhout ◽  
Eva Corpeleijn
Keyword(s):  
Type 2 Diabetes ◽  
Diet Quality ◽  
Total Population ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dietary Guidelines ◽  
Cardiometabolic Health ◽  
Ageing Population ◽  
All Cause Mortality

<b>Objective: </b>To simultaneously investigate the association of diet quality and all-cause mortality in groups with varying cardiometabolic diseases (CMDs) at baseline.<br><p> <b>Design:</b> From the population-based Lifelines cohort, 40,892 non-underweight participants aged ≥50 years with data on diet quality and confounding factors were included (enrollment 2006-2013). From food frequency questionnaire data, tertiles of the Lifelines diet score were calculated (T1 = poorest, T3 = best diet quality). Four CMD categories were defined: 1) CMD-free, 2) type 2 diabetes, 3) one cardiovascular disease (CVD), 4) two or more CMDs. Months when deaths occurred were obtained from municipal registries up until November 2019. Multivariable Cox proportional hazards models were applied for the total population and stratified by CMD categories.<br> <b>Results</b>: After a median follow-up of 7.6 years, 1,438 participants died. Diet quality and CMD categories were independently associated with all-cause mortality in crude and adjusted models (p < 0.001). A dose-response relationship of diet quality with all-cause mortality was observed in the total population (P for trend < 0.001, T2 vs. T3 = 1.22 (1.07-1.41), T1 vs. T3 = 1.57 (1.37-1.80)). In stratified analyses, the association was significant for CMD-free individuals (T1 vs. T3 = 1.63 (1.38-1.93)) and for type 2 diabetes patients (1.87 (1.17-3.00)), but not for patients with one CVD (1.39 (0.93-2.08)) or multiple CMDs (1.19 (0.80-1.76)).<br> <b>Conclusions</b>: A high-quality diet can potentially lower all-cause mortality risk in the majority of the ageing population. Its effect may be greatest for CMD-free individuals and patients with type 2 diabetes. Tailored dietary guidelines may be required for patients with extensive histories of CMDs. </p>

scholarly journals Effect of Irbesartan on AGEs-RAGE and MMPs systems in rat type 2 diabetes myocardial-fibrosis model

2019 ◽  
Vol 244 (7) ◽  
pp. 612-620 ◽  
Author(s):  
Ye Hongwei ◽  
Cao Ruiping ◽  
Fang Yingyan ◽  
Zhang Guanjun ◽  
Hu Jie ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Myocardial Fibrosis ◽  
Fasting Blood Glucose ◽  
Left Ventricular ◽  
Heart Weight ◽  
Sensitivity Index ◽  
Protein Expressions ◽  
Diabetes Patients

To investigate the effect of Irbesartan on the changes of myocardial advanced glycation end products and their receptor (AGEs-RAGE), and matrix metalloproteinases (MMPs) systems in rat type 2 diabetes myocardial fibrosis model. All male Sprague-Dwaley rats were randomly divided into four groups: control (CON), high glucose and high-caloric diet (HC), type 2 diabetes (T2DM) and Irbesartan + T2DM (Ir+T2DM) groups. At 12th week, the fasting blood glucose (FBG) and fasting serum insulin (FINS) levels, insulin resistance index (IRI), insulin sensitivity index (ISI), body weight (BW), the ratio of heart weight/body weight (H/B), left ventricular weight index (LVWI), and cardiac col I, col III contents, plasma MMP-2, MMP-9 levels were evaluated. The protein expressions of col I, AGE, RAGE, MMP-2, MMP-14, and TIMP-2 were analyzed by Western blot. In the T2DM group, FBG, H/B, LVWI, IRI were increased ( P < 0.01), while FINS, BW, ISI were decreased in contrast to the CON and HC groups ( P < 0.05–0.01). In the Ir+ T2DM group, BW was higher, IRI, H/B, LVWI were lower than in the T2DM group. Compared with the CON and HC groups, the contents of col I and col III, the protein expressions of col I, AGE, RAGE, TIMP-2 and MMP-14 were increased, MMP-2 protein expression, the ratios of MMP-2/TIMP-2 and MMP-14/TIMP-2, MMP-2, and MMP-9 levels were decreased in the T2DM group ( P < 0.01). After Irbesartan treatment, all parameters were reversed. Irbesartan can ameliorate myocardial fibrosis in type 2 diabetes rat model, the likely mechanisms may be related to the down-regulation of AGEs-RAGE system and changes of MMPs pathway. Impact statement There are about 425 million diabetes patients (20–79 years) in the world according to the International Diabetes Federation Diabetes Atlas – 8th Edition. The cardiovascular complication is one of the major causes of death in diabetes patients. Myocardial fibrosis is one of the serious pathological changes, so investigating the pathogenesis of myocardial fibrosis has the significant value. Our study aims to investigate the effect of Irbesartan (the angiotensin II receptor antagonist) on the changes of AGE-RAGE system and MMP family components, and analyzes the potential mechanisms in type 2 diabetes-induced myocardial fibrosis. Our results provide the theoretical base for better understanding the pathogenesis in type 2 diabetes-induced myocardial complication. It is useful for clinicians to select the effective therapeutic measures for treatment of type 2 diabetes-induced organ fibrosis.

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