title: Obesity paradox in amputation risk among nonelderly diabetic men.
abstract: The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged <65 years at the end of follow-up were examined for their amputation risk and amputation-free survival during the next 5 years (2004-2008). Compared to overweight individuals (BMI 25-29.9 kg/m(2)), the risks of amputation and treatment failure (amputation or death) were higher for patients with BMI <25 kg/m(2) and were lower for those with BMI ≥30 kg/m(2). Individuals with BMI ≥40 kg/m(2) were only half as likely to experience any (hazard ratios (HR) = 0.49; 95% confidence interval (CI), 0.30-0.80) and major amputations (HR = 0.53; 95% CI, 0.39-0.73) during follow-up as overweight individuals. While the amputation risk continued to decrease for higher BMI, amputation-free survival showed a slight upturn at BMI >40 kg/m(2). The association between obesity and amputation risk in our data shows a pattern consistent with "obesity paradox" observed in many health conditions. More research is needed to better understand pathophysiological mechanisms that may explain the paradoxical association between obesity and lower-extremity amputation (LEA) risk.
authors: Center for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, Illinois, USA. Min-Woong.Sohn@va.gov
authors: Min-Woong
authors: MW
authors: Sohn
authors: Elly
authors: E
authors: Budiman-Mak
authors: Elissa H
authors: EH
authors: Oh
authors: Michael S
authors: MS
authors: Park
authors: Rodney M
authors: RM
authors: Stuck
authors: Neil J
authors: NJ
authors: Stone
authors: William B
authors: WB
authors: Pearce
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D012307:Risk Factors; D014728:Veterans / Q000706:statistics & numerical data