title: Vital capacity as a predictor of incident type 2 diabetes: the Atherosclerosis Risk in Communities study.
abstract: OBJECTIVE
  To test the hypothesis that lower vital capacity is cross-sectionally associated with features of insulin resistance and is an independent predictor of incident type 2 diabetes.
  
  
  METHODS
  We conducted a prospective cohort study of vital capacity as a predictor of incident type 2 diabetes using 9-year follow-up data on 11,479 middle-aged adults without diabetes at baseline from the Atherosclerosis Risk in Communities (ARIC) Study.
  
  
  RESULTS
  Forced vital capacity (FVC) and forced expiratory volume in 1 s were measured at baseline using standard spirometry. Incident type 2 diabetes cases were ascertained during follow-up. At baseline, low FVC (% predicted) was independently associated with indicators of the insulin resistance syndrome, including higher fasting levels of glucose, insulin, and triglycerides; lower fasting HDL cholesterol; and higher systolic blood pressure. In prospective analyses, there were graded associations between low FVC (% predicted) and incidence of type 2 diabetes in men and women. These associations persisted in multivariable analyses that adjusted for age, race, adiposity, smoking, physical activity, and ARIC center. Compared with individuals in the highest quartile of FVC (% predicted), the fully adjusted hazard ratio (95% CI) of diabetes in individuals in the lowest quartile was 1.6 (1.3-2.0) in men and 1.7 (1.3-2.1) in women. These relationships were stronger in those who have never smoked.
  
  
  CONCLUSIONS
  Lower vital capacity is an independent predictor of incident type 2 diabetes. Pulmonary factors related to vital capacity deserve attention as possible risk factors for insulin resistance and diabetes.
authors.affiliation: The Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205, USA.
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: D001161:Arteriosclerosis / Q000453:epidemiology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012907:Smoking; D014797:Vital Capacity / Q000502:physiology*