Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus

Yun Gi Kim; Kyung Do Han; Seung Young Roh; Joo Hee Jeong; Yun Young Choi; Kyongjin Min; Jaemin Shim; Jong Il Choi; Young Hoon Kim

doi:10.3390/jcm12031045

Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus

Yun Gi Kim, Kyung Do Han, Seung Young Roh, Joo Hee Jeong, Yun Young Choi, Kyongjin Min, Jaemin Shim, Jong Il Choi, Young Hoon Kim

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m²) level in DM population. Methods: We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. Results: A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26–2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88–2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84–0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. Conclusions: Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group.

Original language	English
Article number	1045
Journal	Journal of Clinical Medicine
Volume	12
Issue number	3
DOIs	https://doi.org/10.3390/jcm12031045
Publication status	Published - 2023 Feb

Bibliographical note

Funding Information:
This work was supported by a Korea University grant (J.-I.C.), a grant from Korea University Anam Hospital, Seoul, Republic of Korea (J.-I.C.), and in part by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT, Ministry of Science and ICT) (No. 2021R1A2C2011325 to J.-I.C.). The funders had no role in data collection, analysis, or interpretation; trial design; patient recruitment; or any other aspect pertinent to the study.

Publisher Copyright:
© 2023 by the authors.

Keywords

diabetes mellitus
sudden cardiac death
underweight

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/jcm12031045

Cite this

@article{26a49880ec52404a9fbaf0e37ac828da,

title = "Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus",

abstract = "Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m2) level in DM population. Methods: We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. Results: A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26–2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88–2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84–0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. Conclusions: Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group.",

keywords = "diabetes mellitus, sudden cardiac death, underweight",

author = "Kim, {Yun Gi} and Han, {Kyung Do} and Roh, {Seung Young} and Jeong, {Joo Hee} and Choi, {Yun Young} and Kyongjin Min and Jaemin Shim and Choi, {Jong Il} and Kim, {Young Hoon}",

note = "Funding Information: This work was supported by a Korea University grant (J.-I.C.), a grant from Korea University Anam Hospital, Seoul, Republic of Korea (J.-I.C.), and in part by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT, Ministry of Science and ICT) (No. 2021R1A2C2011325 to J.-I.C.). The funders had no role in data collection, analysis, or interpretation; trial design; patient recruitment; or any other aspect pertinent to the study. Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = feb,

doi = "10.3390/jcm12031045",

language = "English",

volume = "12",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "3",

}

TY - JOUR

T1 - Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus

AU - Kim, Yun Gi

AU - Han, Kyung Do

AU - Roh, Seung Young

AU - Jeong, Joo Hee

AU - Choi, Yun Young

AU - Min, Kyongjin

AU - Shim, Jaemin

AU - Choi, Jong Il

AU - Kim, Young Hoon

N1 - Funding Information: This work was supported by a Korea University grant (J.-I.C.), a grant from Korea University Anam Hospital, Seoul, Republic of Korea (J.-I.C.), and in part by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT, Ministry of Science and ICT) (No. 2021R1A2C2011325 to J.-I.C.). The funders had no role in data collection, analysis, or interpretation; trial design; patient recruitment; or any other aspect pertinent to the study. Publisher Copyright: © 2023 by the authors.

PY - 2023/2

Y1 - 2023/2

N2 - Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m2) level in DM population. Methods: We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. Results: A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26–2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88–2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84–0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. Conclusions: Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group.

AB - Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m2) level in DM population. Methods: We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. Results: A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26–2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88–2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84–0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. Conclusions: Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group.

KW - diabetes mellitus

KW - sudden cardiac death

KW - underweight

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U2 - 10.3390/jcm12031045

DO - 10.3390/jcm12031045

M3 - Article

AN - SCOPUS:85147818005

SN - 2077-0383

VL - 12

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 3

M1 - 1045

ER -

Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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