title: Anthropometrics indices of obesity, and all-cause and cardiovascular disease-related mortality, in an Asian cohort with type 2 diabetes mellitus.
abstract: OBJECTIVE
  The study investigated the relationship of general (body mass index [BMI]) and central (waist circumference [WC]; waist-hip ratio [WHipR]; waist-height ratio [WHeightR]) adiposity with all-cause and cardiovascular disease (CVD)-related mortality in an Asian population with diabetes.
  
  
  METHODS
  A total of 13,278 participants with type 2 diabetes mellitus (T2DM) recruited from public-sector primary-care and specialist outpatients clinics in Singapore were followed-up for a median duration of 2.9 years, during which time there were 524 deaths. Cox proportional-hazards regression and competing-risk models were used to obtain hazard ratios (HRs) for anthropometric variables of all-cause and CVD-related mortality.
  
  
  RESULTS
  After adjusting for BMI, the highest quintiles of WC, WHipR and WHeightR were all positively associated with mortality compared with the lowest quintiles, with WHeightR exhibiting the largest effect sizes [all-cause mortality HR: 2.13, 95% confidence interval (CI): 1.33-3.42; CVD-related mortality HR: 3.42, 95% CI: 1.62-7.19]. Being overweight but not obese (BMI:≥23.0 but<27.5kg/m(2)) was associated with a decreased risk of CVD-related mortality in those aged≥65 years (HR: 0.47, 95% CI: 0.29-0.75), but not in those aged<65 years (HR: 1.11, 95% CI: 0.49-2.50).
  
  
  CONCLUSIONS
  Overweight, but not obesity, was associated with a reduction in risk of mortality. This was seen in T2DM patients aged≥65 years, but not in those younger than this. At the same BMI, having higher central-obesity indices such as WC, WHipR and WHeightR also increased the risk of mortality.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore. Electronic address: raymondlim1302@gmail.com.
authors.forename: R B T
authors.initials: RBT
authors.lastname: Lim
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: N
authors.initials: N
authors.lastname: Naidoo
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: G
authors.initials: G
authors.lastname: Gay
authors.affiliation: National Healthcare Group Polyclinics, Singapore City, Singapore.
authors.forename: W E
authors.initials: WE
authors.lastname: Tang
authors.affiliation: National Healthcare Group Polyclinics, Singapore City, Singapore.
authors.forename: D
authors.initials: D
authors.lastname: Seah
authors.affiliation: Changi General Hospital, Singapore City, Singapore.
authors.forename: R
authors.initials: R
authors.lastname: Chen
authors.affiliation: Singhealth Polyclinics, Singapore City, Singapore.
authors.forename: N C
authors.initials: NC
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: E S
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: K S
authors.initials: KS
authors.lastname: Chia
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
authors.forename: W Y
authors.initials: WY
authors.lastname: Lim
mesh_terms: D050154:Adiposity / Q000208:ethnology; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D015992:Body Mass Index; D001837:Body Weights and Measures / Q000592:standards / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000208:ethnology / Q000378:metabolism / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000208:ethnology / Q000378:metabolism / Q000401:mortality*; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D055105:Waist Circumference / Q000208:ethnology; D049629:Waist-Hip Ratio / Q000706:statistics & numerical data
keywords: Anthropometric indices; Central obesity; Diabetes mellitus; Obesity; Short-term mortality