Skip to main content
Top
Published in: Cardiovascular Diabetology 1/2022

Open Access 01-12-2022 | Obesity | Original investigation

Variability of adiposity indices and incident heart failure among adults with type 2 diabetes

Authors: Arnaud D. Kaze, Sebhat Erqou, Prasanna Santhanam, Alain G. Bertoni, Rexford S. Ahima, Gregg C. Fonarow, Justin B. Echouffo-Tcheugui

Published in: Cardiovascular Diabetology | Issue 1/2022

Login to get access

Abstract

Background

It remains unclear how the variability of adiposity indices relates to incident HF. This study evaluated the associations of the variability in several adiposity indices with incident heart failure (HF) in individuals with type 2 diabetes (T2DM).

Methods

We included 4073 participants from the Look AHEAD (Action for Health in Diabetes) study. We assessed variability of body mass index (BMI), waist circumference (WC), and body weight across four annual visits using three variability metrics, the variability independent of the mean (VIM), coefficient of variation (CV), and intraindividual standard deviation (SD). Multivariable Cox regression models were used to generate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for incident HF.

Results

Over a median of 6.7 years, 120 participants developed incident HF. After adjusting for relevant confounders including baseline adiposity levels, the aHR for the highest (Q4) versus lowest quartile (Q1) of VIM of BMI was 3.61 (95% CI 1.91–6.80). The corresponding aHRs for CV and SD of BMI were 2.48 (95% CI 1.36–4.53) and 2.88 (1.52–5.46), respectively. Regarding WC variability, the equivalent aHRs were 1.90 (95% CI 1.11–3.26), 1.79 (95% CI 1.07–3.01), and 1.73 (1.01–2.95) for Q4 versus Q1 of VIM, CV and SD of WC, respectively.

Conclusions

In a large sample of adults with T2DM, a greater variability of adiposity indices was associated with higher risks of incident HF, independently of traditional risk factors and baseline adiposity levels.
Appendix
Available only for authorised users
Literature
1.
go back to reference Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015;314:1021–9.CrossRef Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015;314:1021–9.CrossRef
2.
go back to reference Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143:e254-743.CrossRef Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143:e254-743.CrossRef
3.
go back to reference Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315:2284–91.CrossRef Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315:2284–91.CrossRef
4.
go back to reference Horwich TB, Fonarow GC, Clark AL. Obesity and the obesity paradox in heart failure. Prog Cardiovasc Dis. 2018;61:151–6.CrossRef Horwich TB, Fonarow GC, Clark AL. Obesity and the obesity paradox in heart failure. Prog Cardiovasc Dis. 2018;61:151–6.CrossRef
5.
go back to reference Lorenzo-Almorós A, Tuñón J, Orejas M, Cortés M, Egido J, Lorenzo Ó. Diagnostic approaches for diabetic cardiomyopathy. Cardiovasc Diabetol. 2017;16:28.CrossRef Lorenzo-Almorós A, Tuñón J, Orejas M, Cortés M, Egido J, Lorenzo Ó. Diagnostic approaches for diabetic cardiomyopathy. Cardiovasc Diabetol. 2017;16:28.CrossRef
6.
go back to reference Cong S, Ramachandra CJA, Mai Ja KM, Yap J, Shim W, Wei L, et al. Mechanisms underlying diabetic cardiomyopathy: from pathophysiology to novel therapeutic targets. Cond Med. 2020;3:82–97.PubMedPubMedCentral Cong S, Ramachandra CJA, Mai Ja KM, Yap J, Shim W, Wei L, et al. Mechanisms underlying diabetic cardiomyopathy: from pathophysiology to novel therapeutic targets. Cond Med. 2020;3:82–97.PubMedPubMedCentral
7.
go back to reference Verdonschot JAJ, Ferreira JP, Pellicori P, Brunner-La Rocca H-P, Clark AL, Cosmi F, et al. Proteomic mechanistic profile of patients with diabetes at risk of developing heart failure: insights from the HOMAGE trial. Cardiovasc Diabetol. 2021;20:163.CrossRef Verdonschot JAJ, Ferreira JP, Pellicori P, Brunner-La Rocca H-P, Clark AL, Cosmi F, et al. Proteomic mechanistic profile of patients with diabetes at risk of developing heart failure: insights from the HOMAGE trial. Cardiovasc Diabetol. 2021;20:163.CrossRef
8.
go back to reference American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43:S89-97.CrossRef American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43:S89-97.CrossRef
9.
go back to reference Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63:2985–3023.CrossRef Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63:2985–3023.CrossRef
10.
go back to reference Montani J-P, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev an Off J Int Assoc Study Obes. 2015;16(Suppl 1):7–18.CrossRef Montani J-P, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev an Off J Int Assoc Study Obes. 2015;16(Suppl 1):7–18.CrossRef
11.
go back to reference Lissner L, Odell PM, D’Agostino RB, Stokes J 3rd, Kreger BE, Belanger AJ, et al. Variability of body weight and health outcomes in the Framingham population. N Engl J Med. 1991;324:1839–44.CrossRef Lissner L, Odell PM, D’Agostino RB, Stokes J 3rd, Kreger BE, Belanger AJ, et al. Variability of body weight and health outcomes in the Framingham population. N Engl J Med. 1991;324:1839–44.CrossRef
12.
go back to reference Nam GE, Kim W, Han K, Lee C-W, Kwon Y, Han B, et al. Body weight variability and the risk of cardiovascular outcomes and mortality in patients with type 2 diabetes: a Nationwide Cohort Study. Diabetes Care. 2020;43:2234–41.CrossRef Nam GE, Kim W, Han K, Lee C-W, Kwon Y, Han B, et al. Body weight variability and the risk of cardiovascular outcomes and mortality in patients with type 2 diabetes: a Nationwide Cohort Study. Diabetes Care. 2020;43:2234–41.CrossRef
13.
go back to reference Bangalore S, Fayyad R, DeMicco DA, Colhoun HM, Waters DD. Body weight variability and cardiovascular outcomes in patients with type 2 diabetes mellitus. Circ Cardiovasc Qual Outcomes. 2018;11:e004724.PubMed Bangalore S, Fayyad R, DeMicco DA, Colhoun HM, Waters DD. Body weight variability and cardiovascular outcomes in patients with type 2 diabetes mellitus. Circ Cardiovasc Qual Outcomes. 2018;11:e004724.PubMed
14.
go back to reference Yeboah P, Hsu F-C, Bertoni AG, Yeboah J. Body mass index, change in weight, body weight variability and outcomes in type 2 diabetes mellitus (from the ACCORD Trial). Am J Cardiol. 2019;123:576–81.CrossRef Yeboah P, Hsu F-C, Bertoni AG, Yeboah J. Body mass index, change in weight, body weight variability and outcomes in type 2 diabetes mellitus (from the ACCORD Trial). Am J Cardiol. 2019;123:576–81.CrossRef
15.
go back to reference Bangalore S, Fayyad R, Laskey R, DeMicco DA, Messerli FH, Waters DD. Body-weight fluctuations and outcomes in coronary disease. N Engl J Med 2017;376:1332–1340.CrossRef Bangalore S, Fayyad R, Laskey R, DeMicco DA, Messerli FH, Waters DD. Body-weight fluctuations and outcomes in coronary disease. N Engl J Med 2017;376:1332–1340.CrossRef
16.
go back to reference Segar MW, Patel KV, Vaduganathan M, Caughey MC, Butler J, Fonarow GC, et al. Association of long-term change and variability in glycemia with risk of incident heart failure among patients with type 2 diabetes: a secondary analysis of the ACCORD Trial. Diabetes Care. 2020;43:1920–8.CrossRef Segar MW, Patel KV, Vaduganathan M, Caughey MC, Butler J, Fonarow GC, et al. Association of long-term change and variability in glycemia with risk of incident heart failure among patients with type 2 diabetes: a secondary analysis of the ACCORD Trial. Diabetes Care. 2020;43:1920–8.CrossRef
17.
go back to reference Kaze AD, Santhanam P, Erqou S, Bertoni AG, Ahima RS, Echouffo-Tcheugui JB. Long-term variability of blood pressure and incidence of heart failure among individuals with type 2 diabetes. ESC Hear Fail. 2021;8:2959–67.CrossRef Kaze AD, Santhanam P, Erqou S, Bertoni AG, Ahima RS, Echouffo-Tcheugui JB. Long-term variability of blood pressure and incidence of heart failure among individuals with type 2 diabetes. ESC Hear Fail. 2021;8:2959–67.CrossRef
18.
go back to reference Ryan DH, Espeland MA, Foster GD, Haffner SM, Hubbard VS, Johnson KC, et al. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24:610–28. https://www.ncbi.nlm.nih.gov/pubmed/14500058. Ryan DH, Espeland MA, Foster GD, Haffner SM, Hubbard VS, Johnson KC, et al. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24:610–28. https://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​14500058.
19.
go back to reference Echouffo-Tcheugui JB, Zhao S, Brock G, Matsouaka RA, Kline D, Joseph JJ. Visit-to-visit glycemic variability and risks of cardiovascular events and all-cause mortality: the ALLHAT Study. Diabetes Care. 2019;42:486–93.CrossRef Echouffo-Tcheugui JB, Zhao S, Brock G, Matsouaka RA, Kline D, Joseph JJ. Visit-to-visit glycemic variability and risks of cardiovascular events and all-cause mortality: the ALLHAT Study. Diabetes Care. 2019;42:486–93.CrossRef
20.
go back to reference Hall PS, Nah G, Howard BV, Lewis CE, Allison MA, Sarto GE, et al. Reproductive factors and incidence of heart failure hospitalization in the women’s health initiative. J Am Coll Cardiol. 2017;69:2517–26.CrossRef Hall PS, Nah G, Howard BV, Lewis CE, Allison MA, Sarto GE, et al. Reproductive factors and incidence of heart failure hospitalization in the women’s health initiative. J Am Coll Cardiol. 2017;69:2517–26.CrossRef
21.
go back to reference Pandey A, Patel KV, Bahnson JL, Gaussoin SA, Martin CK, Balasubramanyam A, et al. Association of intensive lifestyle intervention, fitness and body mass index with risk of heart failure in overweight or obese adults with type 2 diabetes mellitus: an analysis from the look AHEAD trial. Circulation. 2020;141:1295–306.CrossRef Pandey A, Patel KV, Bahnson JL, Gaussoin SA, Martin CK, Balasubramanyam A, et al. Association of intensive lifestyle intervention, fitness and body mass index with risk of heart failure in overweight or obese adults with type 2 diabetes mellitus: an analysis from the look AHEAD trial. Circulation. 2020;141:1295–306.CrossRef
22.
go back to reference Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.CrossRef Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.CrossRef
23.
go back to reference Després J-P. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126:1301–13.CrossRef Després J-P. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126:1301–13.CrossRef
24.
go back to reference Zoppini G, Verlato G, Targher G, Bonora E, Trombetta M, Muggeo M. Variability of body weight, pulse pressure and glycaemia strongly predict total mortality in elderly type 2 diabetic patients. The Verona Diabetes Study. Diabetes Metab Res Rev. 2008;24:624–8.CrossRef Zoppini G, Verlato G, Targher G, Bonora E, Trombetta M, Muggeo M. Variability of body weight, pulse pressure and glycaemia strongly predict total mortality in elderly type 2 diabetic patients. The Verona Diabetes Study. Diabetes Metab Res Rev. 2008;24:624–8.CrossRef
25.
go back to reference Kim MK, Han K, Park Y-M, Kwon H-S, Kang G, Yoon K-H, et al. Associations of variability in blood pressure, glucose and cholesterol concentrations, and body mass index with mortality and cardiovascular outcomes in the general population. Circulation. 2018;138:2627–37.CrossRef Kim MK, Han K, Park Y-M, Kwon H-S, Kang G, Yoon K-H, et al. Associations of variability in blood pressure, glucose and cholesterol concentrations, and body mass index with mortality and cardiovascular outcomes in the general population. Circulation. 2018;138:2627–37.CrossRef
26.
go back to reference Cereda E, Malavazos AE, Caccialanza R, Rondanelli M, Fatati G, Barichella M. Weight cycling is associated with body weight excess and abdominal fat accumulation: a cross-sectional study. Clin Nutr. 2011;30:718–23.CrossRef Cereda E, Malavazos AE, Caccialanza R, Rondanelli M, Fatati G, Barichella M. Weight cycling is associated with body weight excess and abdominal fat accumulation: a cross-sectional study. Clin Nutr. 2011;30:718–23.CrossRef
27.
go back to reference Lissner L, Andres R, Muller DC, Shimokata H. Body weight variability in men: metabolic rate, health and longevity. Int J Obes. 1990;14:373–83.PubMed Lissner L, Andres R, Muller DC, Shimokata H. Body weight variability in men: metabolic rate, health and longevity. Int J Obes. 1990;14:373–83.PubMed
28.
go back to reference Zhang H, Tamakoshi K, Yatsuya H, Murata C, Wada K, Otsuka R, et al. Long-term body weight fluctuation is associated with metabolic syndrome independent of current body mass index among Japanese men. Circ J. 2005;69:13–8.CrossRef Zhang H, Tamakoshi K, Yatsuya H, Murata C, Wada K, Otsuka R, et al. Long-term body weight fluctuation is associated with metabolic syndrome independent of current body mass index among Japanese men. Circ J. 2005;69:13–8.CrossRef
29.
go back to reference Tamakoshi K, Yatsuya H, Kondo T, Ishikawa M, Zhang H, Murata C, et al. Long-term body weight variability is associated with elevated C-reactive protein independent of current body mass index among Japanese men. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2003;27:1059–65.CrossRef Tamakoshi K, Yatsuya H, Kondo T, Ishikawa M, Zhang H, Murata C, et al. Long-term body weight variability is associated with elevated C-reactive protein independent of current body mass index among Japanese men. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2003;27:1059–65.CrossRef
30.
go back to reference Anderson EK, Gutierrez DA, Kennedy A, Hasty AH. Weight cycling increases T-cell accumulation in adipose tissue and impairs systemic glucose tolerance. Diabetes. 2013;62:3180–8.CrossRef Anderson EK, Gutierrez DA, Kennedy A, Hasty AH. Weight cycling increases T-cell accumulation in adipose tissue and impairs systemic glucose tolerance. Diabetes. 2013;62:3180–8.CrossRef
31.
go back to reference Levitan EB, Kaciroti N, Oparil S, Julius S, Muntner P. Blood pressure measurement device, number and timing of visits, and intra-individual visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich). 2012;14:744–50.CrossRef Levitan EB, Kaciroti N, Oparil S, Julius S, Muntner P. Blood pressure measurement device, number and timing of visits, and intra-individual visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich). 2012;14:744–50.CrossRef
Metadata
Title
Variability of adiposity indices and incident heart failure among adults with type 2 diabetes
Authors
Arnaud D. Kaze
Sebhat Erqou
Prasanna Santhanam
Alain G. Bertoni
Rexford S. Ahima
Gregg C. Fonarow
Justin B. Echouffo-Tcheugui
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2022
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-021-01440-1

Other articles of this Issue 1/2022

Cardiovascular Diabetology 1/2022 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.