Basal metabolic rate and risk for diabetes and its complications among 341,790 adults from the UK Biobank

Figures

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  Fig. 1. Diabetes rates by levels of estimated BMR, stratified by sex Diabetes rates per 100,000 person-years and corresponding 95% confidence intervals were derived from the group-specific number of events and their corresponding person-years at risk. BMR = Basal Metabolic Rate; CI = confidence intervals; kcal = kilocalories.

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  Fig. 2. Relevance of estimated BMR to diabetes risk, by sex Hazard ratios were calculated from multivariable Cox models, and are shown as squares, plotted against the estimated mean BMR in each category, with the area of each square being inversely proportional to the variance of the log-HR and the corresponding vertical bars indicating the 95% confidence intervals. Black squares represent HR estimates after adjustment for age-at-risk (5 groups). White squares represent HR estimates after additional adjustment for ethnicity, Townsend Deprivation Index, processed meat intake, alcohol drinking, smoking status and assessment centre. Continuous estimates were calculated per each standard deviation higher estimated BMR (corresponding to 7.9 kcal/day in men and 9.1 kcal/day in women) across the full ranges. Residual-BMI adjusted HRs were 1.52 (1.46–1.57) in men and 1.54 (1.47–1.60) in women respectively (Supplemental Fig. S5). Regression dilution corrected HRs per each standard deviation higher usual BMR were 1.58 (95% CI 1.53–1.64) for men and 1.61 (1.54–1.68) for women. (Supplemental Fig. S11 shows the regression dilution ratios of 0.94 in mean and 0.93 in women). Exclusions as per Table1.…

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  Fig. 3. Associations of estimated BMR with risk of diabetes subtypes and diabetes complications, by sex Estimates and conventions as per fully adjusted model in Fig. 2, now with estimated BMR as a continuum per one standard deviation higher level. The diamond and the dashed vertical line represent the overall hazards. Of all diabetes events, only 53 were fatal. (Supplemental Table S1 shows the ICD-10 classification of the diabetes subtypes and of the specific complications that occurred among those with incident diabetes). BMR = Basal Metabolic Rate; CI = confidence intervals; HR = hazard ratios; kcal = kilocalories; SD = standard deviation.

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  Fig. 4. Associations of estimated BMR with risk of diabetes, by sex and various characteristics at baseline Analyses and conventions as per Fig. 3, now within strata of various characteristics as indicated in the plot. Tertiles of absolute residual BMI values were used to test for interaction (due to the high correlation between BMI and BMR). The number of diabetes cases among Asians was limited to only 138 cases in men and 85 cases in women, and among Afro-Caribbeans to only 105 cases in men and 46 cases in women. χ2 and p-values were estimated by likelihood-ratio tests of heterogeneity. BMR = Basal Metabolic Rate; BMI = body mass index; CI = confidence intervals; HR = hazard ratios; kcal = kilocalories; SD = standard deviation; χ2 = chi-squared statistic.

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  Fig. 5. Association of estimated BMR with risk of diabetes and its complications, given selected vascular-metabolic mediators, by sex Analyses and conventions as per Fig. 3, now with each candidate mediator considered as increase per one standard deviation of measured levels at baseline (for comparison), and with additional account for assay batch and fasting time. A subset of 132,171 men and 147,408 women had complete biochemistry data, hence imputation for the remaining 62,220 (18.2%) participants included in the main analyses was performed. The shapes of the association between higher estimated BMR and each candidate mediator considered was first assessed with linear plots (e.g. dose–response associations) and regression models adjusted for age and sex (as shown in Supplemental Fig. S3). The percentage change in HR attributed to mediators was calculated to the 3rd decimal point as follows: [(HRconfounders-HRconfounders + mediators)*100)/(HRconfounders-1)]. BMR = Basal Metabolic Rate; CI = confidence intervals; CRP=C-reactive protein; HbA1c = Glycated haemoglobin 1c; HDL-c=High-density lipoprotein cholesterol; HR = hazard ratios; kcal = kilocalories; SD = standard deviation; χ2 =…