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 journalArticlepeer-review

3 Citations (Scopus)


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 languageEnglish
Article number1045
JournalJournal of Clinical Medicine
Issue number3
Publication statusPublished - 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.


  • diabetes mellitus
  • sudden cardiac death
  • underweight

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus'. Together they form a unique fingerprint.

Cite this