Associations Between General and Abdominal Adiposity and Mortality in Individuals With Diabetes Mellitus

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title = "Associations Between General and Abdominal Adiposity and Mortality in Individuals With Diabetes Mellitus",
abstract = "Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54{\%} were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22{\%} of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95{\%} confidence interval: 1.33, 2.65) for men and 2.46 (95{\%} confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.",
keywords = "adiposity, body mass index, diabetes complications, diabetes mellitus, mortality, waist circumference, waist-hip ratio",
author = "Diewertje Sluik and Heiner Boeing and Jukka Montonen and Tobias Pischon and Rudolf Kaaks and Birgit Teucher and Anne Tjonneland and Jytte Halkjaer and Berentzen, {Tina L.} and Kim Overvad and Larraitz Arriola and Eva Ardanaz and Benedetta Bendinelli and Sara Grioni and Rosario Tumino and Carlotta Sacerdote and Amalia Mattiello and Spijkerman, {Annemieke M. W.} and {van der A}, {Daphne L.} and Beulens, {Joline W.} and {van der Schouw}, {Yvonne T.} and Peter Nilsson and Bo Hedblad and Olov Rolandsson and Paul Franks and Ute Noethlings",
year = "2011",
doi = "10.1093/aje/kwr048",
language = "English",
volume = "174",
pages = "22--34",
journal = "American journal of hygiene",
issn = "0002-9262",
publisher = "Oxford University Press",
number = "1",