Changes in body mass index and waist circumference and heart failure in type 2 diabetes mellitus

Front Endocrinol (Lausanne). 2023 Dec 21:14:1305839. doi: 10.3389/fendo.2023.1305839. eCollection 2023.

Abstract

Background: To determine the association of unintentional changes in body mass index (BMI) and waist circumference (WC) with the risk of heart failure (HF) among adults with type 2 diabetes mellitus (T2DM).

Methods: This was a randomized controlled trial (the Action to Control Cardiovascular Risk in Diabetes [ACCORD] study), with a double 2×2 factorial design conducted at 77 clinical centers across the United States and Canada. In total, the study comprised 10,251 patients with T2DM and cardiovascular disease (CVD) or at a high risk of CVD. The outcome of interest in the present analysis was incident HF, defined as the first hospitalization event for HF or death due to HF. Hospitalization for HF was based on documented clinical and radiological evidence. Death due to HF was based on clinical, radiological, or postmortem evidence of HF, with an absence of an acute ischemic event according to clinical or postmortem evidence.

Results: Participants with class III obesity had the smallest BMI and WC changes, followed by those with normal weight, overweight, class I obesity, and class II obesity. Increasing BMI (hazard ratio [HR] per standard deviation increase, 1.24; 95% confidence interval [CI], 1.07-1.45) and WC (1.27; 1.10-1.47) were significantly associated with a higher risk of HF. The relationship between BMI and WC changes and HF formed a J-shaped curve, while stable BMI and WC were associated with lower risks of HF. Compared with participants in the first tertiles of BMI and WC change, those in the third tertiles had HRs of 1.41 (95% CI, 1.07-1.45) and 1.48 (1.12-1.95), respectively.

Conclusion: In conclusion, our findings suggest a noteworthy association between BMI and WC changes among adults with T2DM in HF. We observed a distinctive J-shaped curve in this relationship, indicating that participants with both low and high BMI and WC changes were more susceptible to developing HF.

Trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT00000620.

Keywords: BMI; T2DM; heart failure; type 2 diabetes mellitus; waist circumference.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • Cardiovascular Diseases* / complications
  • Cardiovascular Diseases* / etiology
  • Diabetes Mellitus, Type 2* / complications
  • Heart Failure* / complications
  • Heart Failure* / etiology
  • Humans
  • Obesity / complications
  • Risk Factors
  • United States
  • Waist Circumference

Associated data

  • ClinicalTrials.gov/NCT00000620

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported in part by the National Science Foundation of China project (No. 82000298); The Natural Science Foundation of Hunan Province (No.2021JJ40883; No. 2023JJ40867); Natural Science Foundation of Changsha (No. kq2208330); Hunan Health and Family Planning Commission Project (No. B202310007057); The Scientific Research Launch Project for new employees of the Second Xiangya Hospital of Central South University. Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare.