Anthropometrics indices of obesity, and all-cause and cardiovascular disease-related mortality, in an Asian cohort with type 2 diabetes mellitus

Aim. The study investigated the relationship of general (body mass index [BMI]) and central (waist circumference [WC]; waist hip ratio [WHipR]; waist height ratio [WHeightR]) adiposity with all-cause and cardiovascular disease (CVD)-related mortality in an Asian population with diabetes. Methods. A total of 13,278 participants with type 2 diabetes mellitus (T2DM) recruited from public-sector primary-care and specialist outpatients clinics in Singapore were followed-up for a median duration of 2.9 years, during which time there were 524 deaths. Cox proportional-hazards regression and competing-risk models were used to obtain hazard ratios (HRs) for anthropometric variables of all-cause and CVD-related mortality. Results. After adjusting for BMI, the highest quintiles of WC, WHipR and WHeightR were all positively associated with mortality compared with the lowest quintiles, with WHeightR exhibiting the largest effect sizes [all-cause mortality HR: 2.13, 95% confidence interval (CI): 1.33-3.42; CVD-related mortality HR: 3.42, 95% CI: 1.62-7.19]. Being overweight but not obese (BMI: >= 23.0 but <= 27.5 kg/m(2)) was associated with a decreased risk of CVD-related mortality in those aged >= 65 years (HR: 0.47, 95% CI: 0.29-0.75), but not in those aged <65 years (HR: 1.11, 95% CI: 0.49-2.50). Conclusion. Overweight, but not obesity, was associated with a reduction in risk of mortality. This was seen in T2DM patients aged >= 65 years, but not in those younger than this. At the same BMI, having higher central-obesity indices such as WC, WHipR and WHeightR also increased the risk of mortality. (C) 2014 Elsevier Masson SAS. All rights reserved.