title: Associations between diabetes, leanness, and the risk of death in the Japanese general population: the Jichi Medical School Cohort Study.
abstract: OBJECTIVE
  To examine the BMI-stratified associations between diabetes and the risks of all-cause death, cardiovascular disease (CVD) death, and cancer death.
  
  
  METHODS
  Using a prospective study with 12 rural Japanese general populations (n = 3,641, mean age, 53.7 years; 33.5% men), we examined the associations between diabetes and the risk of all-cause death, CVD death, and cancer death. We also examined the effects of BMI and age on such associations.
  
  
  RESULTS
  During an average duration of 10.2 years (37,278 person-years), 240 deaths occurred (54 deaths from CVD, 101 from cancer, and 85 from other causes). Cox regression analysis showed leanness (defined as the lowest quartile of entire BMI; mean, 19.5 kg/m(2)), but not obesity (BMI ≥25 kg/m(2)), and diabetes were independently associated with an increased risk of all-cause death (hazard ratio [HR] 1.70 and 1.65, respectively; both P < 0.01.). Stratification with cause-specific deaths showed that leanness and obesity were associated with CVD death (HR 3.77 and 2.94, respectively), whereas diabetes was associated with cancer death (HR 1.87; all P < 0.05). The increased risk of all-cause death in diabetes was substantially higher in lean subjects aged <65 years (HR 3.4) or those aged ≥65 years (HR 4.2), whereas the risk in obese diabetes patients was significant only in subjects aged <65 years (HR 2.32; all P < 0.05).
  
  
  CONCLUSIONS
  Among the Japanese general population, diabetes confers an increased risk of all-cause death. Particular attention must be paid to the pronounced high mortality in diabetes accompanied with leanness, regardless of age.
authors.affiliation: Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Shizukiyo
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ojima
authors.forename: Tadao
authors.initials: T
authors.lastname: Gotoh
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kayaba
authors.forename: Akizumi
authors.initials: A
authors.lastname: Tsutsumi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajii
mesh_terms: D000368:Aged; D044466:Asian People; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality; D009765:Obesity / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D013851:Thinness / Q000453:epidemiology* / Q000401:mortality