title: Association between obesity and diabetes mellitus in veterans with spinal cord injuries and disorders.
abstract: OBJECTIVE
  To examine the association between body mass index (BMI) and clinically diagnosed diabetes in veterans with spinal cord injuries and disorders. We also sought to determine whether there is evidence to support a 10% reduction in BMI cut points, which would lower the upper limit of normal BMI from 24.99 to 22.49 kg/m, for persons with spinal cord injuries and disorders.
  
  
  METHODS
  Cross-sectional analysis using clinical data on 1938 male veterans. Prevalence ratios (95% confidence intervals) were calculated using a generalized linear model and adjusted for age, race, tobacco use, and paraplegia/tetraplegia status.
  
  
  RESULTS
  Compared with the National Heart Lung Blood Institute normal BMI category (18.5-24.99 kg/m), the prevalence of diabetes was 50% higher (adjusted prevalence ratio: 1.50, 95% CI: 1.11-2.01) in the overweight category (25-29.99 kg/m) and approximately 3-fold higher (for obese classes 1-3, adjusted prevalence ratio: 2.74-3.03) in the obese category (BMI >or= 30 kg/m). Compared with the World Health Organization low-normal category (BMI, 18.5-22.99 kg/m), there was no significant difference in the prevalence of diabetes for those in the high normal weight (BMI, 23-24.99 kg/m) or low overweight (BMI, 25-27.49 kg/m) categories. However, the prevalence of diabetes was 2-fold higher among those in the high overweight category (BMI, 27.5-29.99 kg/m; adjusted prevalence ratio: 2.00, 95% CI: 1.33-2.99).
  
  
  CONCLUSIONS
  BMI >or=25 kg/m was associated with significantly higher diabetes prevalence in male veterans with spinal cord injuries and disorders, and this risk was especially pronounced at BMI >or=27.5 kg/m. These findings do not support the need to create spinal cord injuries and disorder-specific BMI definitions of overweight for purposes of determining diabetes risk.
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, VA Puget Sound Health Care System, Seattle, Washington 98108, USA.
authors.forename: Suparna
authors.initials: S
authors.lastname: Rajan
authors.forename: Marguerite J
authors.initials: MJ
authors.lastname: McNeely
authors.forename: Margaret
authors.initials: M
authors.lastname: Hammond
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
authors.forename: Frances
authors.initials: F
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D010264:Paraplegia / Q000150:complications; D015995:Prevalence; D011782:Quadriplegia / Q000150:complications; D012016:Reference Values; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D014728:Veterans