Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial

Abstract

Background: Obesity is associated with adverse health events among diabetic patients, however, the relationship between obesity fluctuation and risk of microvascular complications among this specific population is unclear. We aimed to examine the effect of waist circumference (WC) and body mass index (BMI) variability on the risk of diabetic microvascular outcomeMethods: Annually recorded anthropometric data in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was used to examine the association of WC and BMI variability defined as variability independent of mean, with the risk of microvascular outcomes, including neuropathy, nephropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) (Trial registration: ClinicalTrials.gov., no. NCT00000620).Results: There were 4,031, 5,369, and 2,601 cases of neuropathy, nephropathy, and retinopathy during a follow-up period of 22,524, 23,941, and 23,850 person-years, respectively. Higher levels of WC and BMI variability were associated with an increased risk of neuropathy. Compared with the lowest quartile, the fully-adjusted HR (95% CI) for the highest quartile of WC and BMI variability for neuropathy risk were 1.21 (1.05 to 1.40) and 1.16 (1.00 to 1.33), respectively. Also, higher quartiles of BMI variability but not WC variability were associated with increased risk of nephropathic events. The fully-adjusted HR (95% CI) for the highest quartile compared with the lowest quartile of BMI variability was 1.31 (1.18 to 1.46). However, the results for retinopathic events were all insignificant.Conclusion: Among participants with type 2 diabetes mellitus, WC and BMI variability were associated with a higher risk of neuropathic events, whereas BMI variability was associated with an increased risk of nephropathic events.

Unraveling shared risk factors for diabetic foot ulcer: a comprehensive Mendelian randomization analysis

“…As an essential risk factor for various diseases, a meta-analysis of MR studies showed that BMI has causal associations with T2D, aortic valve stenosis, heart failure, stroke, peripheral artery disease, death due to chronic obstructive pulmonary disease (COPD), and kinds of tumors 15. Observational studies also confirm that BMI increases the risk of T2D and raises the risk of microvascular and cardiovascular complications in diabetes 16–18…”

Association of body mass index and blood pressure variability with 10-year mortality and renal disease progression in type 2 diabetes

“…Recently, the Action for Health in Diabetes (Look AHEAD) trial in the US reported that fluctuations in BMI over a 4-year period were associated with adverse outcome in the control group but not in the intensive lifestyle intervention group [ 10 ]. Little data exist with regard to the relationship between fluctuations in BMI and cancer mortality or microvascular disease, but Chang et al [ 11 ] recently reported that fluctuations in BMI were associated with increased risk of hepatocellular carcinoma in the general population, whilst a post hoc analysis of the ACCORD trial found that fluctuations in BMI in subjects with type 2 diabetes were associated with increased risk of renal events [ 12 ].…”

Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial (Diabetes Metab J 2022;46:767-80)

“…We appreciate the keen interest of Dr. Yun Kyung Cho in our published article, “Waist circumference and body mass index variability and incident diabetic microvascular complications: a post hoc analysis of ACCORD trial,” [ 1 ] and are also grateful for the opportunity to further discuss our work.…”