Underweight is a major risk factor for atrial fibrillation in Asian people with type 2 diabetes mellitus

Abstract

Background Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies T2DM, and increases the risk of AF. However, the dose-relationship between body mass index (BMI) and AF risk has seldom been studied in patients with diabetes. Methods This cohort study utilized a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, 64,339 adult patients with T2DM were enrolled for analysis. BMI was measured and categorized as underweight (BMI < 18.5), normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), obesity class 1 (27 ≤ BMI < 30), obesity class 2 (30 ≤ BMI < 35), or obesity class 3 (BMI ≥ 35). Multivariate Cox regression and spline regression models were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM. Results The incidence of AF was 1.97 per 1000 person-years (median follow-up, 70.7 months). In multivariate Cox regression, using normal BMI as the reference group, underweight (HR 1.52, 95% CI 1.25–1.87, p < 0.001) was associated with a significantly higher risk of AF, while overweight was associated with significantly reduced risk of AF (HR 0.82, 95% CI 0.73–0.89, p < 0.001). Kaplan–Meier analysis showed AF risk was highest in the underweight group, followed by obesity class 3, while the overweight group had the lowest incidence of AF (log-rank test, p < 0.001). The cubic restrictive spline model revealed a “J-shaped” or “L-shaped” relationship between BMI and AF risk. Conclusions Underweight status confers the highest AF risk in Asian patients with T2DM.

Fatty Liver Index and the Risk of Atrial Fibrillation in a General Japanese Population ― The Suita Study ―

“…26, 27 Conversely, a low FLI could reflect underweight, a major risk factor for AF among Asian populations. 28 BMI is inversely associated with concentrations of B-type natriuretic peptide (BNP), 29 a marker of AF and heart failure. 30 Further, frailty associated with being underweight is associated with elevated BNP concentrations and AF risk.…”

Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest

“…We conducted a longitudinal retrospective cohort study using the electronic health records (EHRs) of Taiwanese individuals aged 45 years or older who received care at a tertiary medical center between January 1, 2014 and December 31, 2019. The EHRs were obtained from the National Taiwan University Hospital Integrated Medical Database (NTUH-iMD) [ 20 , 21 ], which collects data from the Taipei Main Hospital and branches in at least four counties in Taiwan. EHRs have been digitized and are available online since 2006 and include information on patients' demographics, diagnoses, medical orders, laboratory results, interventions, medications, and examinations.…”

Association between body mass index and results of cryoballoon ablation in Korean patients with atrial fibrillation: an analysis from the Korean Heart Rhythm Society Cryoablation registry

“…Obesity is a well-known risk factor for incident AF, 6 while some studies have also shown association between low body mass index (BMI) and new-onset AF. 7 , 8 Furthermore, as both underweight (UW) and extremely obese AF patients are reported to have worse clinical outcomes compared with normal weight (NW) patients, consideration of extreme BMI when diagnosing and planning treatment for AF patients is necessary. 9 Not only has BMI been reported to be associated with AF occurrence or clinical outcome, but prior studies have also demonstrated the relationship between BMI and outcomes after AF catheter ablation.…”