Key result
Body mass index exhibited a J-shaped relationship with the composite of new-onset diabetes, cardio-cerebrovascular events, and all-cause mortality, with grade 3 obesity in men significantly increasing risk (HR 2.376).
Why the study?
With the increasing prevalence of diabetes mellitus and cardio-cerebrovascular diseases, the study aimed to investigate the relationship between body mass index and diabetes, cardio-cerebrovascular diseases, or mortality.
Does body mass index predict the incidence of diabetes mellitus, cardio-cerebrovascular diseases, and all-cause mortality in Korean adults?
Cohort (n=311,416)
Does body mass index predict the incidence of diabetes mellitus, cardio-cerebrovascular diseases, and all-cause mortality in Korean adults?
In a large Korean cohort, BMI demonstrated a J-shaped relationship with all-cause mortality (supporting the obesity paradox) but a linear dose-response relationship with incident diabetes.
Answers are grounded in this paper and cite their sources.
Supports J-shaped BMI risk stratification in Korean adults; leaves open causal effects of weight change on composite outcomes.
Objective The prevalence of diabetes mellitus (DM), cardio-cerebrovascular diseases (CCVDs) has increased during recent decades. We aimed to investigate the relationship between body mass index (BMI) and each of several outcomes (DM, CCVDs, or mortality) based on the Korean National Health Insurance Service-Health Screening cohort. Methods BMI was categorized as appropriate for Asian populations, into underweight (< 18.5 kg/m2), normal (18.5–< 23 kg/m2), overweight (23–< 25 kg/m2), grade 1 obesity (25–< 30 kg/m2), grade 2 obesity (30–< 35 kg/m2), and grade 3 obesity (≥35 kg/m2). In addition, BMI was further stratified into one unit. Multivariate Cox proportional hazards regression analyses were conducted to examine the association between BMI category and the primary outcomes (DM, CCVDs, or mortality). Results A total of 311,416 individuals were included. The median follow-up was 12.5 years. Compared to normal BMI, underweight, overweight, and grade 1–3 obese individuals had a higher risk of the primary outcomes (hazard ratio [95% confidence intervals] 1.293 [1.224–1.365], 1.101 [1.073–1.129], 1.320 [1.288–1.353], 1.789 [1.689–1.897], and 2.376 [2.019–2.857], respectively, in men and 1.084 [1.010–1.163], 1.150 [1.116–1.185], 1.385 [1.346–1.425], 1.865 [1.725–2.019], and 2.472 [2.025–3.028], respectively, in women). Setting the reference BMI to 20–< 21 kg/m2 and categorizing into one unit increment, BMI was associated with the primary outcomes in a J-shaped manner in both sexes. The risk of DM increased with higher BMI in both sexes, while all-cause mortality decreased in men with a BMI 21–< 31 kg/m2 and women with BMI 22–< 30 kg/m2. Conclusions BMI was associated with all-cause mortality in a J-shaped manner in both sexes, while it was associated with risk of DM in a dose-response relationship. The relationship between BMI and the primary outcomes was J-shaped.
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Bae et al. (2022) conducted a cohort in Healthy adults (n=311,416). Grade 3 obesity (BMI ≥ 35 kg/m2) in men vs. Normal BMI (18.5–< 23 kg/m2) was evaluated on Composite of diabetes mellitus, cardio-cerebrovascular diseases, or all-cause mortality (HR 2.376, 95% CI 2.019-2.857). Body mass index exhibited a J-shaped relationship with the composite of new-onset diabetes, cardio-cerebrovascular events, and all-cause mortality, with grade 3 obesity in men significantly increasing risk (HR 2.376).
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