title: Impact of hypertension on the association of BMI with risk and age at onset of type 2 diabetes mellitus: age- and gender-mediated modifications.
abstract: OBJECTIVE
  Given that BMI correlates with risk of Type 2 diabetes mellitus (T2DM), and that hypertension is a common comorbid condition, we hypothesize that hypertension augments significantly the impact of obesity on T2DM onset.
  
  
  METHODS
  We obtained data on T2DM in Kuwaiti natives from Kuwait Health Network Registry. We considered 1339 comorbid individuals with onset of hypertension preceding that of T2DM, and 3496 non-hypertensive individuals but with T2DM. Multiple linear regressions, ANOVA tests, and Cox proportional hazards models were used to quantify the impact of hypertension on correlation of BMI with age at onset and risk of T2DM.
  
  
  RESULTS
  Impact of increasing levels of BMI on age at onset ot T2DM is seen augmented in patients diagnosed with hypertension. We find that the slope of the inverse linear relationship between BMI and onset age of T2DM is much steep in hypertensive patients (-0.69, males and -0.39, females) than in non-hypertensive patients (-0.36, males and -0.17, females). The decline in onset age for an unit increase of BMI is two-fold in males than in females. Upon considering BMI as a categorical variable, we find that while the mean onset age of T2DM in hypertensive patients decreases by as much as 5-12 years in every higher BMI categories, significant decrease in non-hypertensive patients exists only when severely obese. Hazard due to hypertension (against the baseline of non-hypertension and normal weight) increases at least two-fold in every obese category. While males have higher hazard due to hypertension in early adulthood, females have higher hazard in late adulthood.
  
  
  CONCLUSIONS
  Pre-existing condition of hypertension augments the association of BMI with Type 2 diabetes onset in both males and females. The presented results provide health professionals directives on the extent of weight-loss required to delay onset of Type 2 diabetes in hypertensive versus non-hypertensive patients.
authors.affiliation: Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Arshad Mohamed
authors.initials: AM
authors.lastname: Channanath
authors.affiliation: Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Bassam
authors.initials: B
authors.lastname: Farran
authors.affiliation: Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Kazem
authors.initials: K
authors.lastname: Behbehani
authors.affiliation: Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Thangavel Alphonse
authors.initials: TA
authors.lastname: Thanaraj
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult
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