Underweight increases the risk of end-stage renal diseases for type 2 diabetes in Korean population: Data from the National Health Insurance Service Health Checkups 2009–2017

Yang Hyun Kim, Jun Goo Kang, Seong Jin Lee, Kyung Do Han, Sung Hee Ihm, Kyung Hwan Cho, Yong Gyu Park

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

OBJECTIVE There is a controversy over the association between obesity and end-stage renal disease (ESRD) in people with or without type 2 diabetes; therefore, we examined the effect of BMI on the risk of ESRD according to glycemic status in the Korean population. RESEARCH DESIGN AND METHODS The study monitored 9,969,848 participants who underwent a National Health Insurance Service health checkup in 2009 from baseline to the date of diagnosis of ESRD during a follow-up period of ∼8.2 years. Obesity was categorized by World Health Organization recommendations for Asian populations, and glycemic status was categorized into the following five groups: normal, impaired fasting glucose (IFG), newly diagnosed diabetes, diabetes <5 years, and diabetes ‡5 years. RESULTS Underweight was associated with a higher risk of ESRD in all participants after adjustment for all covariates. In the groups with IFG, newly diagnosed type 2 diabetes, diabetes duration <5 years, and diabetes ‡5 years, the hazard ratio (HR) of the underweight group increased with worsening glycemic status (HR 1.431 for IFG, 2.114 for newly diagnosed diabetes, 4.351 for diabetes <5 years, and 6.397 for diabetes ‡5 years), using normal weight with normal fasting glucose as a reference. The adjusted HRs for ESRD were also the highest in the sustained underweight group regardless of the presence of type 2 diabetes (HR 1.606 for nondiabetes and 2.14 for diabetes). CONCLUSIONS Underweight showed more increased HR of ESRD according to glycemic status and diabetes duration in the Korean population. These associations also persisted in the group with sustained BMI during the study period.

Original languageEnglish
Pages (from-to)1118-1125
Number of pages8
JournalDiabetes Care
Volume43
Issue number5
DOIs
Publication statusPublished - 2020 May 1

Bibliographical note

Funding Information:
Acknowledgments. The authors would like to thank the Korean National Health Insurance Corporation and all the participants of the study and health checkup. Funding. This study was supported by a National Research Foundation of Korea (NRF) grant funded bytheKoreagovernment(MinistryofScience and Information and Communications Technology) (grant no. 2017R1D1A1B03029575). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. Y.-H.K. and J.G.K. wrote theoriginaldraftofthemanuscript.Y.-H.K.,J.G.K., and K.-d.H. contributed to methodology. Y.-H.K., J.G.K., K.-d.H., K.-H.C., and Y.-G.P. contributed to conceptualization. Y.-H.K. and K.-d.H. contributed to data curation and to investigation. S.J.L., K.-d.H., S.-H.I., K.-H.C., and Y.-G.P. reviewed and edited the manuscript. K.-d.H. and Y.-G.P. contributed to formal analysis. All authors approved the final version of the manuscript to be published. Y.-H.K. and J.G.K. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding Information:
The authors would like to thank the Korean National Health Insurance Corporation and all the participants of the study and health checkup. This study was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and Information and Communications Technology) (grant no. 2017R1D1A1B03029575).

Publisher Copyright:
© 2020 by the American Diabetes Association.

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

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