Complex interaction of fasting glucose, body mass index, age and sex on all-cause mortality: a cohort study in 15 million Korean adults

Abstract

Aims/hypothesis The aim of this work was to examine whether synergistic associations with mortality exist for BMI and fasting blood glucose (FBG) and to identify FBG-BMI combined subgroups with higher mortality according to sex and age. Methods A total of 15,149,275 Korean adults participated in health examinations during 2003-2006 and were followed up until December 2018. Mortality HRs of 40 FBG-BMI combined groups were assessed by Cox proportional hazards models. Results During a mean 13.7 years of follow-up, 1,213,401 individuals died. A J-shaped association was seen between FBG and all-cause mortality for all BMI categories. Those with BMI <20 kg/m 2 had the highest mortality for any given FBG level, followed by those with BMI 20-22.4 kg/m 2. The detrimental effect of elevated FBG was greater among leaner individuals than more corpulent individuals. Moreover, the synergistic adverse effects of hyperglycaemia and leanness was stronger in younger adults than in older adults. Compared with the reference group (overweight with normoglycaemia), age-and sex-adjusted HRs of the leanest with normoglycaemia (BMI <20 kg/m 2 and FBG 4.4-5.2 mmol/l), overweight with diabetes (BMI 25-27.4 kg/m 2 and FBG ≥10.0 mmol/l) and leanest with diabetes (BMI <20 kg/m 2 and FBG ≥10.0 mmol/l) were 1.29, 2.59 and 11.18, respectively, in those aged 18-44 years and 1.56, 1.72 and 2.87, respectively, in those aged 75-99 years. The identification of BMI-FBG subgroups associated with higher mortality was not straightforward, illustrated by the group with FBG 6.1-6.9 mmol/l and BMI 20-22.4 kg/m 2 having a similar or higher mortality compared with the group with FBG 7.0-9.9 mmol/l and BMI ≥22.5 kg/m 2. In women aged <45 years with FBG <6.9 mmol/l, those with BMI ≥27.5 kg/m 2 had the highest mortality, whereas individuals with BMI <20 kg/m 2 had the highest mortality for each given FBG level in other age and sex groups. Conclusions/interpretation Leanness and hyperglycaemia interact together to increase mortality in a supra-multiplicative manner, especially in younger adults; the interactions of BMI, FBG, sex and age with mortality are complex.

6-Year trajectory of fasting plasma glucose (FPG) and mortality risk among individuals with normal FPG at baseline: a prospective cohort study

“…This observation could be explained by the increased susceptibility of individuals with T2D to the adverse health effects of hypertension on macrovascular and microvascular complications [ 32 ], leading to elevated mortality risk. Different from our findings, some previous studies reported that FPG levels were more strongly associated with mortality risk among participants who were older, male, or had a higher BMI [ 1 , 33 , 34 ]. The inconsistencies may be attributed to the distinct characteristics of different study populations.…”

Associations between the triglyceride-glucose index and cardiovascular disease in over 150,000 cancer survivors: a population-based cohort study

“…Venous samples, which included fasting glucose and lipid profiles, were obtained after overnight fasting [ 18 ]. Blood pressure was measured after ≥ 5 min of rest at least twice by trained staff members.…”

Association of Physical Activity and Lower Respiratory Tract Infection Outcomes in Patients With Cardiovascular Disease

“…A previous study in Hong Kong reported that the beneficial effect of physical activity for influenza was more evident in younger than in older adults; however, the CIs of the effect between age groups overlapped. 15 The age‐specific association in the current study is noteworthy because older individuals generally have smaller relative effect size of risk or protective factors than the younger population in most epidemiologic studies 23 , 24 ; however, they have a greater absolute effect size. Our study implies that the absolute benefit for older individuals with CVDs from engaging in physical activity would be much greater.…”