title: Body mass index and stroke risk among patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Previous studies have evaluated the association of body mass index (BMI) with the risk of all-cause and cardiovascular disease mortality among diabetic patients, and results were controversial. No studies have focused on the association between BMI and stroke risk among diabetic patients. We aimed to examine the association of BMI with stroke risk among diabetic patients.
  
  
  METHODS
  We performed a prospective cohort study with 29,554 patients with type 2 diabetes mellitus. Cox proportional hazards regression models were used to estimate the association of different levels of BMI with stroke risk.
  
  
  RESULTS
  During a mean follow-up period of 8.3 years, 2883 participants developed stroke (2821 ischemic and 109 hemorrhagic). The multivariable-adjusted (age, sex, race, smoking, income, and type of insurance) hazard ratios associated with different levels of BMI at baseline (18.5-24.9 [reference group], 25-29.9, 30-34.9, 35-39.9, and ≥40 kg/m(2)) were 1.00, 0.86, 0.83, 0.76, and 0.70 (Ptrend<0.001) for total stroke, 1.00, 0.87, 0.85, 0.78, and 0.72 (Ptrend <0.001) for ischemic stroke, and 1.00, 0.76, 0.72, 0.54, and 0.53 (Ptrend=0.034) for hemorrhagic stroke, respectively. When we used an updated mean or the last visit value of BMI, the inverse association of BMI with stroke risk did not change. This inverse association was consistent among patients of different races, sex, ages, HbA1c levels, never and current smoking, and patients with and without using glucose-lowering, cholesterol-lowering, or antihypertensive agents.
  
  
  CONCLUSIONS
  The present study demonstrates an inverse association between BMI and stroke risk among patients with type 2 diabetes mellitus.
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Weiqin
authors.initials: W
authors.lastname: Li
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Ronald
authors.initials: R
authors.lastname: Horswell
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Yonggang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Wenhui
authors.initials: W
authors.lastname: Zhao
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Yujie
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.).
authors.forename: Jolene
authors.initials: J
authors.lastname: Johnson
authors.affiliation: From the Pennington Biomedical Research Center, Baton Rouge, LA (W.L., P.T.K., R.H., Y.Z., W.Z., Y.W., G.H.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); China Japan Friendship Hospital, Beijing, China (W.Z.); and Louisiana State University Health, Baton Rouge (J.J.). gang.hu@pbrc.edu.
authors.forename: Gang
authors.initials: G
authors.lastname: Hu
mesh_terms: D015992:Body Mass Index; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D013223:Statistics as Topic; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: body mass index; diabetes mellitus; stroke