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Biomedical subjects

J H Fuller

Publications and source records attributed to J H Fuller.

At least 73 records · Page 4Linked to original sources
PubMed1997

Which features of smoking determine mortality risk in former cigarette smokers with diabetes? The World Health Organization Multinational Study Group.

OBJECTIVE: The effects of quitting smoking on mortality risk in individuals with diabetes is unknown and may differ from the benefits observed in the general population. We therefore determined the mortality risks in ex-smokers with diabetes, compared with subjects who have never smoked, by the number of years since quitting, the number of cigarettes smoked, and the number of years of smoking. RESEARCH DESIGN AND METHODS: An international cohort study of 4,427 individuals with diabetes was studied. Baseline examinations were performed in 1975-1977 when smoking habits were determined by questionnaire. Mortality follow-up continued until 1988. RESULTS: All-cause mortality risks were higher for recent quitters (1-9 years; relative risk [RR], 1.53 [95% CI 1.19-1.97]; P = 0.001) than for those who quit earlier (> or = 10 years; RR, 1.25 [95% CI 1.03-1.52]; P = 0.02), compared with subjects who have never smoked. These risks were highest in those who had smoked the longest (> or = 30 years: RR, 1.66 [95% CI 1.22-2.26]; P = 0.001; vs. 1-9 years: RR, 1.17 [95% CI 0.85-1.60]; P = 0.3). Risks were also highest in those who had smoked the most and least number of cigarettes. Adjustment for key confounders, which included a previous history of heart disease, proteinuria, and blood pressure, did not materially affect these relationships. CONCLUSIONS: Quitting smoking does reduce mortality risk in ex-smokers with diabetes, but risks remain high several years after quitting and are highly dependent on the duration of smoking. Thus, individuals with diabetes who smoke should be encouraged to quit as soon as possible in the course of disease.

Adult↗
PubMed1996

Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study.

OBJECTIVE: To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans. DESIGN: Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1995. PATIENTS: 150 Europeans and 77 African Caribbeans with non-insulin dependent diabetes. MAIN OUTCOME MEASURES: All cause and cardiovascular mortality; prevalence of microvascular and macrovascular complications. RESULTS: Duration of diabetes was shorter in African Caribbeans, particularly women. African Caribbeans were more likely than the Europeans to have been given a diagnosis after the onset of symptoms and less likely to be taking insulin. Mean cholesterol concentration was lower in African Caribbeans, but blood pressure and body mass index were not different in the two ethnic groups. Prevalence of microvascular and macrovascular complications was insignificantly lower in African Caribbens than in Europeans. 59 Europeans and 16 African Caribbeans had died by the end of follow up. The risk ratio for all cause mortality was 0.41 (95% confidence interval 0.23 to 0.73) (P = 0.002) for African Caribbeans v Europeans. This was attenuated to 0.59 (0.32 to 1.10) (P = 0.1) after adjustment for sex, smoking, proteinuria, and body mass index. Further adjustment for systolic blood pressure, cholesterol concentration, age, duration of diabetes, and treatment made little difference to the risk ratio. Unadjusted risk ratio for cardiovascular and ischaemic heart disease were 0.33 (0.15 to 0.70) (P = 0.004) and 0.37 (0.16 to 0.85) (P = 0.02) respectively. CONCLUSIONS: African Caribbeans with non-insulin dependent diabetes maintain a low risk of heart disease. Management priorities for diabetes developed in one ethnic group may not necessarily be applicable to other groups.

Adult↗
PubMed1996

Eye position and target amplitude effects on human visual saccadic latencies.

Gaze shifts vary in the extent of eye and head contribution; a large amplitude and/or an eccentric ocular orbital starting position alter the participation of head movement in the shift. The interval between eye onset and head onset determines compensatory counterrolling before and after the shift and the extent of vestibular ocular reflex reduction during the shift. The latency of eye saccades in the head-fixed condition was measured with respect to target amplitude and orbital position in order to establish base-line operations of these two variables as they apply to the head-free condition. Eye movements were measured during single-step saccades in nine young adult humans. The target step, hereafter called a jump, started from three possible fixation lights; e.g., rightward saccades started from the midline (0 degree) or from -20 or -40 degrees left of the midline, with a maximum amplitude of 80 degrees. The latency of saccades starting from the primary position increased with jump amplitude (amplitude-latency relation). When the eye started eccentrically, the latency was decreased (orbital position-latency relation), with the largest jump amplitudes most affected. These changes can be related to active eye-head coordination. Thus, with a leftward maximal orbital eccentricity, compensatory eye rotation would be impossible with a rightward head movement; however, incorporating the orbital position-latency relation, the forward ocular saccade is expedited by 90 ms. Conversely, with a primary starting position, the ocular component of an 80 degrees gaze saccade could be slowed 125 ms by incorporating the amplitude-latency relation, thus facilitating a head contribution to the gaze shift. The orbital position and amplitude-latency relations were prominent in those subjects with habitually large head contributions to the gaze shift and minimal in individuals with typically small head contributions.

Adult↗
PubMed1996

Is autonomic neuropathy a risk factor for severe hypoglycaemia? The EURODIAB IDDM Complications Study.

The hypothesis that diabetic patients with autonomic neuropathy are at increased risk of severe hypoglycaemia was examined in an epidemiological study of over 3000 IDDM patients in Europe (EURODIAB IDDM Complications Study). Autonomic function was assessed by two standard cardiovascular tests: change in heart rate and systolic blood pressure on standing. Severe hypoglycaemia was defined as an attack serious enough to require the help of another person. Compared to patients (68%) reporting no attacks in the last year, those reporting one or more attacks were older (34.0 +/- 10.7 vs 32.1 +/- 9.9 years, mean +/- SD, p < 0.0001), had had diabetes for a longer period (16.6 +/- 9.5 vs 13.8 +/- 9.1 years, p < 0.0001), had better glycaemic control (HbA1c 6.4 +/- 1.8 vs 6.9 +/- 1.9%, p < 0.0001) and were more likely (p = 0.002) to have abnormal responses to both autonomic tests (13.0 vs 7.7%). A single abnormal autonomic response was not associated with an increased risk of severe hypoglycaemia. The odds ratio for severe hypoglycaemia in people with abnormal responses to both autonomic tests, compared to those with normal responses, was 1.7 (95% confidence interval 1.3, 2.2) after controlling for age, duration of diabetes, glycaemic control and study centre. In conclusion, a combined autonomic deficit in heart rate and blood pressure responses to standing is associated with only a modest increase in the risk of severe spontaneous hypoglycaemia. Although the increase in risk is not large, severe hypoglycaemia was a frequently reported event in this study. IDDM patients with deficient autonomic responses who strive for tight glycaemic control may therefore be at particular risk of severe hypoglycaemia.

Adult↗
PubMed1996

Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study.

The EURODIAB IDDM Complications Study involved the examination of 3250 randomly selected insulin-dependent diabetic patients, from 31 centres in 16 European countries. Part of the examination included an assessment of neurological function including neuropathic symptoms and physical signs, vibration perception threshold, tests of autonomic function and the prevalence of impotence. The prevalence of diabetic neuropathy across Europe was 28% with no significant geographical differences. Significant correlations were observed between the presence of diabetic peripheral neuropathy with age (p < 0.05), duration of diabetes (p < 0.001), quality of metabolic control (p < 0.001), height (p < 0.01), the presence of background or proliferative diabetic retinopathy (p < 0.01), cigarette smoking (p < 0.001), high-density lipoprotein cholesterol (p < 0.001) and the presence of cardiovascular disease (p < 0.05), thus confirming previous associations. New associations have been identified from this study - namely with elevated diastolic blood pressure (p < 0.05), the presence of severe ketoacidosis (p < 0.001), an increase in the levels of fasting triglyceride (p < 0.001), and the presence of microalbuminuria (p < 0.01). All the data were adjusted for age, duration of diabetes and HbA1c. Although alcohol intake correlated with absence of leg reflexes and autonomic dysfunction, there was no overall association of alcohol consumption and neuropathy. The reported problems of impotence were extremely variable between centres, suggesting many cultural and attitudinal differences in the collection of such information in different European countries. In conclusion, this study has identified previously known and new potential risk factors for the development of diabetic peripheral neuropathy.

Adolescent↗
PubMed1996

The use of the Micral-Test strip to identify the presence of microalbuminuria in people with insulin dependent diabetes mellitus (IDDM) participating in the EUCLID study.

In IDDM, microalbuminuria (urinary albumin excretion rate (AER) of 20-200 micrograms/min) is a predictor of persistent proteinuria and diabetic nephropathy. Early intervention may prevent or reduce the rate of progression of renal complications. The Micral-Test strip can be used to establish a semi-quantitative estimate of AER. We assessed the field performance of the Micral-Test strip in detecting microalbuminuria in the EUCLID study, an European wide, 18 centre study of 530 IDDM participants, aged 20 to 59 years. People with macroalbuminuria were excluded. On entry, all participants had albumin concentrations from two overnight urine collections measured by a central laboratory, and the corresponding Micral-Test performed on the two collections locally. a cut off of > or = mg/l albumin from the first Micral-Test, to detect a centrally measured albumin concentration > or = 20 mg/l, yielded 29 (5.8%) false negative results and 58 (11.6%) false positive results (sensitivity 70%, specificity 87%). The mean AER, from two collections, was compared with the corresponding 'pooled' Micral-Test results (mean of the two readings). Receiver Operating Characteristic (ROC) curves were used to assess if there was a suitable 'pooled' Micral-Test result for screening microalbuminuria. A 'pooled' Micral-Test result (> or = 15 mg/l) was used to detect mean AER > or = 20 micrograms/min (sensitivity 78%, specificity 77%). This 'pooled cut-off' had already been used for screening on to the study and led to an over-estimate (154 vs. 77) of the true number of microalbuminuric participants on the study. In conclusion, our findings suggest that the Micral-Test strip is not an effective screening tool for microalbuminuria, using the 'pooled' result from two measurements did not improve the sensitivity of the test.

Adult↗
PubMed1996

Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes?

STUDY OBJECTIVE: To determine whether ethnic differences in cardiovascular disease mortality persist in people with non-insulin-dependent diabetes mellitus. DESIGN: This was an ecological study in which routine mortality data from 1985-86, which coded all mentioned causes of death, provided the numerator. The UK population derived from 1981 census formed the denominator. SETTING: United Kingdom. PARTICIPANTS: Records of all deaths in people aged 45 years and above were extracted if diabetes was mentioned anywhere on the death certificate. The denominator was aged five years to approximate to the 1986 population. Mortality rates where a cardiovascular underlying cause was given were compared between South Asians, African-Caribbeans, and those born in England and Wales. The latter group formed the standard for directly standardised rate ratios. MAIN RESULTS: Mortality from heart disease was approximately three times higher in diabetic South Asian born men and women than in those with diabetes born in England and Wales. This ethnic difference was greatest in the younger age group. Conversely, stroke mortality rates in African-Caribbeans were 3.5-4 times higher than those in the England and Wales population. Despite this high mortality from stroke, ischaemic heart disease death rates were not high in African-Caribbean men. CONCLUSIONS: Ethnic differences in cardiovascular mortality persisted and were greater in those with diabetes. Thus the high risk of heart disease should be targeted for intervention in South Asians, and the high rates of stroke targeted in African-Caribbeans.

Age Distribution↗
PubMed1996

A comparison of renal disease across two continents; the epidemiology of diabetes complications study and the EURODIAB IDDM Complications Study.

OBJECTIVE: To compare prevalence rates of increased albumin excretion in the Epidemiology of Diabetes Complications Study (EDC) (in the U.S.) to similar rates in the EURODIAB study (in Europe) and determine if any differences relate to hypertension, glycemic control, or smoking status. RESEARCH DESIGN AND METHODS: The study population is made up of two epidemiological clinic-based IDDM populations with comparable ages (chi = 28 years, both studies), sex distribution (50% male, EURODIAB; 49% male, EDC), and duration characteristics. Comparison of two cross-sectional (prevalence) studies was made. Despite different laboratory assays, comparability was established for urinary albumin (r = 0.98) and GHb measures (r = 0.95). Hypertension was measured with an identical protocol. Renal status was determined by 24-h urine albumin excretion (< 20 micrograms/min normal, 20-200 micrograms/min microalbuminuria, > 200 micrograms/min macroalbuminuria) in EURODIAB. Identical cutoffs were used for EDC, though two of three samples (24-h, 4-h clinic, and/or overnight sample) had to be positive in one range. (Main findings are confirmed using only 24-h results from EDC.) RESULTS: The prevalence of macroalbuminuria was higher in EDC (27%) than in EURODIAB (12%). Rates of microalbuminuria were similar (22 vs. 25%, respectively). These patterns were seen at all durations and ages and in both sexes. Controlling for glycemic control, hypertension, or smoking did not account for the higher rate in EDC, nor did exclusion of subjects with raised serum creatinine. CONCLUSIONS: Advanced renal disease is more prevalent in IDDM in EDC (Pittsburgh, PA) than in Europe. This is not explained by hypertension, glycemic control, or smoking.

Adolescent↗
PubMed1996

Excess mortality and its relation to hypertension and proteinuria in diabetic patients. The world health organization multinational study of vascular disease in diabetes.

OBJECTIVE: To determine the extent that mortality in IDDM and NIDDM patients is in excess of that of the general population and examine its relation to hypertension and proteinuria in diabetic patients. RESEARCH DESIGN AND METHODS: A stratified random sample of 4,714 diabetic patients aged 35-55 years participating in the World Health Organization Multinational Study of Vascular Disease in Diabetes has been followed up from 1975 to 1987. Excess mortality, compared with the background population, was assessed in terms of standardized mortality ratios (SMRs) for each of the 10 international cohorts. The relationship between excess mortality and proteinuria/hypertension was examined by diabetes type and sex. RESULTS: SMRs were in general higher in patients with IDDM (ranging from 188 to 686 for men and from 336 to 790 for women) than with NIDDM (from 138 to 370 for men and from 126 to 435 for women). For both diabetes types and in both sexes, SMRs decreased with increasing age and increased with increasing diabetes duration. Patients with both hypertension and proteinuria experienced a strikingly high mortality risk: 11-fold for men with IDDM and 18-fold for women with IDDM and 5-fold for men with NIDDM and 8-fold for women with NIDDM. Even in the absence of proteinuria and hypertension, SMRs were significantly increased in both IDDM (284 men and 360 women) and NIDDM (192 men and 236 women) patients. CONCLUSIONS: Considerable international differences were found not only in mortality rates for the two types of diabetes but also in the extent of excess mortality among centers. IDDM patients had a high excess mortality in comparison with the general population. The significant excess mortality was demonstrated even in patients without proteinuria and without hypertension for both sexes and diabetes types.

Adult↗
PubMed1996

The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM Complications Study.

OBJECTIVE: To determine whether there are socioeconomic differences in diabetes control and complications in people with IDDM. RESEARCH DESIGN AND METHODS: We conducted a prevalence survey of 1,217 men and 1,170 women with IDDM age 25-60 years from European clinics. Age at completion of education defined socioeconomic status: < or = 14 years defined those with primary education; 15-18 years, as secondary education; and > 19 years, as college education. Glycemic control, lipids, diet, retinopathy, neuropathy, and heart disease were assessed centrally. RESULTS: People with a primary education were older and had diabetes for longer than those with a college education. The mean percentage of HbA1c was worst in the primary-educated men (6.6 vs. 6.1%, P = 0.0007 for trend) and women (6.5 vs. 6.0%, P = 0.0007). Total cholesterol level was higher in primary-educated than in college-educated men (5.6 vs 5.3 mmol/l, P = 0.002), as was triglyceride level (1.23 vs. 1.02 mmol/l, P = 0.0001). College-educated people were the least likely to be current smokers (P < 0.0001), and were most likely to partake in vigorous exercise (P < 0.001). Surprisingly, There was little difference in the prevalence of heart disease by educational status in men, while it was highest in the least educated women, but proliferative retinopathy was more common in primary- than in college-educated men (16 vs 10%, P = 0.04) as was macroalbuminuria (15 vs 9%, P = 0.03). Glycemic control could not fully account for these differences. CONCLUSIONS: Healthy lifestyles are more prevalent in better educated men and women with IDDM, but these are not reflected in heart disease prevalence in men. The lower prevalence of severe microvascular complications in better educated men, unaccounted for by better glycemic control, requires further investigation.

Adult↗
PubMed1996

International variations in cardiovascular mortality associated with diabetes mellitus: the WHO Multinational Study of Vascular Disease in Diabetes.

The WHO Multinational Study of Vascular Disease in Diabetes was launched in 1975-77 to investigate international variations in the occurrence of different manifestations of vascular disease in subjects with insulin-dependent and non-insulin-dependent diabetes. A morbidity and mortality follow-up extending until January 1, 1988 was carried out in 10 centres, including five European centres (London, Switzerland, Berlin, Warsaw and Zagreb), two East Asian centres (Hong Kong and Tokyo), two Native American centres (Arizona and Oklahoma) and one Caribbean centre (Havana). Of a total of 4714 diabetic subjects (2310 men and 2404 women) aged between 35 and 55 years at baseline who were successfully followed up, 1266 were classified as having insulin-dependent diabetes and 3448 as having non-insulin-dependent diabetes. There was a large variation between the centres in ischaemic heart disease and cerebrovascular disease mortality rates for both insulin-dependent and non-insulin-dependent diabetic subjects, presumably reflecting in part differences between the background populations in mortality rates from these cardiovascular causes. The lowest ischaemic heart disease mortality rates for diabetic subjects were observed in Hong Kong and Tokyo centres, representing industrialized countries which have continued to have low ischaemic heart disease mortality rates. The importance of raised blood pressure and proteinuria as potentially modifiable cardiovascular risk factors in diabetic subjects was confirmed in this study.

Cardiovascular Diseases↗
PubMed1995

The cytochrome subunit is necessary for covalent FAD attachment to the flavoprotein subunit of p-cresol methylhydroxylase.

When p-cresol methylhydroxylase (PCMH) is expressed in its natural host Pseudomonas putida, or when the genes of the alpha and beta subunits of the enzyme are expressed together in the heterologous host Escherichia coli, flavin-adenine dinucleotide (FAD) is covalently attached to Tyr384 of the alpha subunit and the correct alpha 2 beta 2 form of the enzyme is assembled. The apoflavoprotein has been expressed in E. coli in the absence of the beta cytochrome c subunit and purified. While noncovalent FAD binding to apoflavoprotein in the absence of the cytochrome subunit could not be directly demonstrated, circumstantial evidence suggests that this indeed occurs. Covalent flavinylation requires one molecule each of FAD and cytochrome for each flavoprotein subunit. The flavinylation process leads to the 2-electron-reduced form of covalently bound FAD, and the resulting alpha 2 beta 2 enzyme is identical to wild-type PCMH. This work presents clear evidence that covalent flavinylation occurs by a self-catalytic mechanism; an external enzyme or chaperon is not required, nor is prior chemical activation of FAD or of the protein. This work is the first to define the basic chemistry of covalent flavinylation of an enzyme to produce the normal, active species, and confirms a long standing, postulated chemical mechanism of this process. It also demonstrates, for the first time, the absolute requirement for a partner subunit in the post-translational modification of a protein. It is proposed that the covalent FAD bond to Tyr384 and the phenolic portion of this Tyr are part of the essential electron transfer path from FAD to heme.

Amino Acid Sequence↗
PubMed1995

Blood pressure, retinopathy and urinary albumin excretion in IDDM: the EURODIAB IDDM Complications Study.

Several studies have shown an association between blood pressure and nephropathy, but few have been large enough to examine whether, or how, this relation is influenced by retinopathy. We have therefore examined the independent relations of blood pressure to urinary albumin excretion and retinopathy in a cross-sectional observational study of over 3000 insulin-dependent diabetic patients (the EURODIAB IDDM Complications Study). The relation of blood pressure to urinary albumin excretion differed strikingly between patients with (46%) and without (54%) retinopathy. In those with retinopathy, mean urinary albumin excretion rate was normal (< 20 micrograms/min) below median diastolic pressure (75 mmHg) and increased steeply (p < 0.001) with blood pressure above this level. However, in patients without retinopathy, mean albumin excretion rate was normal across the range of diastolic pressure. This finding could not be explained by differences in glycaemic control or duration of diabetes between patients with and without retinopathy. These data identify a subgroup of patients whose high risk of nephropathy may reflect abnormal renal vulnerability to mildly raised blood pressure. Retinopathy is a close correlate of this vulnerability. Detection of even mild retinopathy, together with raised blood pressure, may be important in assessing nephropathy risk.

Adult↗
PubMed1995

Proteinuria and mortality in diabetes: the WHO Multinational Study of Vascular Disease in Diabetes.

The relation between proteinuria and mortality was investigated in 1188 patients with Type 1 diabetes and 3234 patients with Type 2 diabetes, aged 35-55 at baseline and followed up for a mean of 9.4 +/- 3.1 years in the WHO Multinational Study of Vascular Disease in Diabetes. Baseline prevalence of light or heavy proteinuria was the same (25%) in both types of diabetes after adjustment for differences in diabetes duration. Compared with patients with no proteinuria, all cause mortality ratios were 1.5 (95% confidence interval 1.1-2.0) and 2.9 (2.2-3.8) for Type 1 patients with light and heavy proteinuria, respectively, and 1.5 (1.2-1.8) and 2.8 (2.3-3.4) for Type 2 patients, after adjustment for age, duration of diabetes, blood pressure, cholesterol, and smoking. Proteinuria was associated with significantly increased mortality from renal failure, cardiovascular disease, and all other causes of death. In both types of diabetes, the association was strongest for renal deaths, and of similar magnitude for cardiovascular and all other causes of death. In conclusion, proteinuria is a common, important, and rather non-specific risk factor for increased morbidity and mortality in diabetes. The relation of proteinuria to mortality is similar for both types of diabetes. The benefits and risks of proteinuria reduction should be examined in large randomized trials with clinical endpoints.

Adult↗
PubMed1995

The relationship between pregnancy and long-term maternal complications in the EURODIAB IDDM Complications Study.

Pregnancy is believed to exacerbate diabetes complications, although the degree to which this occurs, and the advice that should be given to women contemplating pregnancy is unclear. We examined 776 nulliparous and 582 parous women with Type 1 diabetes from a cross-sectional study performed in 31 European centres. Glycaemic control was better in parous women. Age and duration adjusted prevalence of microalbuminuria was similar in parous and nulliparous women, but macroalbuminuria was lower in parous women (6% versus 10%, p < 0.0001). Prevalence of all retinopathy was lower in parous women (34% in women who had two or more pregnancies, 45% in women who had one), compared with 48% in nulliparous women (chi 2 for trend = 47.1, p < 0.0001). Proliferative retinopathy was lower in parous (8% and 7%, respectively) compared with nulliparous women (16%, chi 2 for trend = 52.2, p < 0.0001). These differences persisted when adjusted for glycaemic control. Excluding referrals for pregnancy, parous women were more likely to have been referred to the diabetes clinic with complications than nulliparous women (p = 0.001). It is unlikely that our findings can be explained by women with complications being advised against pregnancy, or by the better glycaemic control in parous women. Equivalent levels of microalbuminuria and background retinopathy in parous and nulliparous women suggests that pregnancy may not exacerbate these early complications.

Adult↗
PubMed1995

Mortality and morbidity associated with body weight in people with IDDM. The WHO Multinational Study of Vascular Disease in Diabetes.

OBJECTIVE: Strict glycemic control in people with insulin-dependent diabetes mellitus (IDDM) reduces the risk of microvascular complications, but improvements in control are also associated with weight gain. Fears about the mortality risks of obesity may limit the acceptability of tight control. Therefore, we examined morbidity and mortality risks associated with body weight in people with IDDM. RESEARCH DESIGN AND METHODS: This was a cohort study of 644 men and 576 women with IDDM from nine centers worldwide. Baseline examinations were performed in 1975-1977, and mortality follow-up continued until 1988. RESULTS: Body weight was positively associated with blood pressure and, in men, with cholesterol. Fasting blood glucose was higher in the most obese groups in women only. There were 204 deaths among the men and 148 among the women. There was a reverse J-shaped relationship between body weight and all-cause mortality, with the highest mortality rates occurring in the leanest body mass index (BMI) category. The age-, duration-, and center-adjusted mortality rate ratio (95% confidence interval) comparing BMI category < 20 kg/m2 with BMI category > or = 22 and < 24 kg/m2 was 2.64 (1.59-4.38) in men and 1.54 (0.77-3.06) in women. Additional adjustment for smoking, blood pressure, glucose, cholesterol, and proteinuria did not qualitatively alter these findings. CONCLUSIONS: We conclude that except in very lean people with IDDM, body weight is not significantly associated with mortality. Thus, efforts to improve glycemic control should not be restricted by concerns about the effects of weight gain on mortality.

Adult↗