The impact of central obesity on the risk of hospitalization or death due to heart failure in type 1 diabetes: a 16-year cohort study

Erika B Parente,Per-Henrik Groop,Carol Forsblom,Valma Harjutsalo

doi:10.1186/s12933-021-01340-4

Erika B Parente, Per-Henrik Groop + Show 2 more

Open Access

https://doi.org/10.1186/s12933-021-01340-4

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Abstract

BackgroundObesity and type 2 diabetes are well-known risk factors for heart failure (HF). Although obesity has increased in type 1 diabetes, studies regarding HF in this population are scarce. Therefore, we investigated the impact of body fat distribution on the risk of HF hospitalization or death in adults with type 1 diabetes at different stages of diabetic nephropathy (DN).MethodsFrom 5401 adults with type 1 diabetes in the Finnish Diabetic Nephropathy Study, 4668 were included in this analysis. The outcome was HF hospitalization or death identified from the Finnish Care Register for Health Care or the Causes of Death Register until the end of 2017. DN was based on urinary albumin excretion rate. A body mass index (BMI) ≥ 30 kg/m2 defined general obesity, whilst WHtR ≥ 0.5 central obesity. Multivariable Cox regression was used to explore the associations between central obesity, general obesity and the outcome. Then, subgroup analyses were performed by DN stages. Z statistic was used for ranking the association.ResultsDuring a median follow-up of 16.4 (IQR 12.4–18.5) years, 323 incident cases occurred. From 308 hospitalizations due to HF, 35 resulted in death. Further 15 deaths occurred without previous hospitalization. The WHtR showed a stronger association with the outcome [HR 1.51, 95% CI (1.26–1.81), z = 4.40] than BMI [HR 1.05, 95% CI (1.01–1.08), z = 2.71]. HbA1c [HR 1.35, 95% CI (1.24–1.46), z = 7.19] was the most relevant modifiable risk factor for the outcome whereas WHtR was the third. Individuals with microalbuminuria but no central obesity had a similar risk of the outcome as those with normoalbuminuria. General obesity was associated with the outcome only at the macroalbuminuria stage.ConclusionsCentral obesity associates with an increased risk of heart failure hospitalization or death in adults with type 1 diabetes, and WHtR may be a clinically useful screening tool.

Highlights

Obesity and type 2 diabetes are well-known risk factors for heart failure (HF)
At the baseline visit, compared to individuals who did not develop the outcome, those who developed had a longer duration of diabetes, higher body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), waist and visceral adiposity index (VAI), worse glucose and lipid control, lower estimated glomerular filtration rate (eGFR) and insulin sensitivity, despite similar blood pressure and distribution of sex (Table 1)
Using a BMI threshold of 25 kg/m2, we found that individuals with a BMI ≥ 25 kg/m2 showed a 2.5-fold higher risk (HR 2.51, p = 0.003) of the outcome at the microalbuminuria stage and 1.5-fold higher risk (HR 1.50, p = 0.04), at the macroalbuminuria stage compared to those below BMI of 25 kg/m2 (Additional file 2: Figure S1), which follows the pattern of the association between central obesity and the outcome according to diabetic nephropathy (DN) stages

Summary

Introduction

Obesity and type 2 diabetes are well-known risk factors for heart failure (HF). Obesity has increased in type 1 diabetes, studies regarding HF in this population are scarce. We investigated the impact of body fat distribution on the risk of HF hospitalization or death in adults with type 1 diabetes at different stages of diabetic nephropathy (DN). Diabetes is a major risk factor for heart failure (HF), individuals with HF and diabetes have a worse prognosis than those without diabetes [1, 2]. Finding predictors of HF in individuals with diabetes is warranted, especially if they are modifiable risk factors. Obesity is a well-known risk factor for HF in the general population [2, 7].

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