title: Changes in body mass index following newly diagnosed type 2 diabetes and risk of cardiovascular mortality: a cohort study of 8486 primary-care patients.
abstract: OBJECTIVE
  Elevated body mass index (BMI) is associated with an increased risk of type 2 diabetes and cardiovascular disease (CVD). This study explored the association between BMI changes in the first 18 months of newly diagnosed type 2 diabetes and the risk of long-term CVD mortality.
  
  
  METHODS
  A total of 8486 patients with newly diagnosed type 2 diabetes and no previous history of CVD or cancer were identified from 84 primary-care centres in Sweden. During the first year after diagnosis, patients were grouped according to BMI change: 'Increase', or ≥+1 BMI unit; 'unchanged', or between +1 and-1 BMI unit; and 'decrease', or ≤-1 BMI unit. Associations between BMI change and CVD mortality, defined as death from stroke, myocardial infarction or sudden death, were estimated using adjusted Cox proportional hazards models (NCT 01121315).
  
  
  RESULTS
  Baseline mean age was 60.0 years and mean BMI was 30.2kg/m(2). Patients were followed for up to 9 years (median: 4.6 years). During the first 18 months, 53.4% had no change in their BMI, while 32.2% decreased and 14.4% increased. Compared with patients with unchanged BMI, those with an increased BMI had higher risks of CVD mortality (hazard ratio: 1.63, 95% CI: 1.11-2.39) and all-cause mortality (1.33, 1.01-1.76). BMI decreases had no association with these risks compared with unchanged BMI: 1.06 (0.76-1.48) and 1.06 (0.85-1.33), respectively.
  
  
  CONCLUSIONS
  Increased BMI within the first 18 months of type 2 diabetes diagnosis was associated with an increased long-term risk of CVD mortality. However, BMI decrease did not lower the long-term risk of mortality.
authors.affiliation: Department of Medicine, AstraZeneca AB, Karlebyhus, 151 85 Södertälje, Sweden. Electronic address: johan.bodegard@astrazeneca.com.
authors.forename: J
authors.initials: J
authors.lastname: Bodegard
authors.forename: J
authors.initials: J
authors.lastname: Sundström
authors.forename: B
authors.initials: B
authors.lastname: Svennblad
authors.forename: C J
authors.initials: CJ
authors.lastname: Östgren
authors.forename: P M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: G
authors.initials: G
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors
keywords: Cardiovascular disease mortality; Diabète de type 2; Epidemiology; La mortalité cardiovasculaire; Le contrôle du poids; Type 2 diabetes; Weight control; Épidémiologie