title: A curvilinear association of body mass index with cardiovascular diseases in Chinese patients with type 2 diabetes mellitus - A population-based retrospective cohort study.
abstract: This epidemiological and longitudinal study aimed to confirm the association between BMI and CVD and determine the optimal BMI range for Chinese patients with T2DM.
  
  
  
  A retrospective cohort study was conducted on 113,194 Chinese adult primary care T2DM patients without prior CVD history at baseline, and had a documented BMI in 2008-2010. Using the average of the annual mean of BMI records (updated BMI) over a median follow-up of 4.2years, the risk of CVD associated with BMI by gender, age group, smoking status and presence of chronic kidney disease group was evaluated using multivariable Cox proportional hazard regression adjusted by socio-demographics and clinical characteristics.
  
  
  
  The updated BMI value and the incidence of CVD showed a J-shaped curvilinear relationship. Low (<18.5kg/m(2)) or high (≥25kg/m(2)) BMI range was associated with higher risk of CVD and the optimal BMI range associated with the lowest likelihood of CVD was 20-22.9kg/m(2) in overall cohort and all selected groups.
  
  
  
  There was no evidence of benefit of underweight or adiposity with regard to the risk of CVD and thus the maintenance of a normal weight should be emphasized as an integral part of preventive intervention in the diabetes management.
authors.affiliation: Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong; School of Nursing, the University of Hong Kong, Hong Kong. Electronic address: yfwan@hku.hk.
authors.forename: Eric Yuk Fai
authors.initials: EY
authors.lastname: Wan
authors.affiliation: Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong. Electronic address: cfsc@hku.hk.
authors.forename: Colman Siu Cheung
authors.initials: CS
authors.lastname: Fung
authors.affiliation: School of Nursing, the University of Hong Kong, Hong Kong. Electronic address: dytfong@hku.hk.
authors.forename: Daniel Yee Tak
authors.initials: DY
authors.lastname: Fong
authors.affiliation: Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong. Electronic address: kcchanae@hku.hk.
authors.forename: Anca Ka Chun
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong. Electronic address: clklam@hku.hk.
authors.forename: Cindy Lo Kuen
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000208:ethnology*; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: BMI; Cardiovascular diseases; Diabetes mellitus; Management; Mortality; Primary care