{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:21:18Z","timestamp":1789842078539,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T00:00:00Z","timestamp":1705190400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The risk of heart failure (HF) in underweight diabetes mellitus (DM) patients has rarely been studied. We conducted a cohort study to investigate the association between underweight (BMI\u00a0&lt;\u00a018.5\u00a0kg\/m<jats:sup>2<\/jats:sup>) and BMI change over time and the risk of HF in patients with type 2 DM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We utilized the health screening data from the National Health Insurance Service and the Korean National Health Screening database from 2009 to 2012, with follow\u2010up until December 2018. Participants with DM were categorized into four groups based on their BMI at 4\u00a0years before study inclusion and BMI at the study entry: (1) Always Normal Weight (BMI at 4\u00a0years ago\/BMI at study entry \u226518.5\/\u226518.5\u00a0kg\/m<jats:sup>2<\/jats:sup>, reference group); (2) Transitioned to Underweight (\u226518.5\/&lt;18.5\u00a0kg\/m<jats:sup>2<\/jats:sup>); (3) Transitioned to Normal Weight (&lt;18.5\/\u226518.5\u00a0kg\/m<jats:sup>2<\/jats:sup>) and (4) Always Underweight (&lt;18.5\/&lt;18.5\u00a0kg\/m<jats:sup>2<\/jats:sup>). Participants were followed until the development of HF or at the end of the follow\u2010up. Initial screening data included participants with DM who had the health screening during the study period (<jats:italic>n<\/jats:italic>\u00a0=\u00a02,746,079). Participants aged &lt;20\u00a0years (<jats:italic>n<\/jats:italic>\u00a0=\u00a0390), those who did not undergo health examination 4\u00a0years prior (<jats:italic>n<\/jats:italic>\u00a0=\u00a01,306,520), and those with missing data (<jats:italic>n<\/jats:italic>\u00a0=\u00a077,410) were excluded. Participants diagnosed with HF before study participation (<jats:italic>n<\/jats:italic>\u00a0=\u00a081,645) and within 1\u00a0year of study enrolment (<jats:italic>n<\/jats:italic>\u00a0=\u00a011,731) were excluded. After applying exclusion criteria, 1,268,383 participants were finally included in the analysis. The primary outcome was the development of HF. We employed Cox proportional hazards models, adjusting for various confounding factors, to assess the risk of developing HF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow\u2010up duration was 6.88\u00a0years and men were 63.16%. The mean ages of each groups were as follows: Always Normal Weight (57.92\u00a0\u00b1\u00a011.64\u00a0years), Transitioned to Underweight (62\u00a0\u00b1\u00a013.5\u00a0years), Transitioned to Normal Weight (56.6\u00a0\u00b1\u00a015.29\u00a0years) and Always Underweight (57.76\u00a0\u00b1\u00a015.35\u00a0years). In comparison with the Always Normal Weight group (<jats:italic>n<\/jats:italic>\u00a0=\u00a01,245,381, HF\u00a0=\u00a076,360), Transitioned to Underweight group (\u226518.5\/&lt;18.5\u00a0kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>n<\/jats:italic>\u00a0=\u00a09304, HF\u00a0=\u00a0880, adjusted Hazard Ratio (aHR)1.389, 95% confidence interval (CI) 1.3\u20131.485) or Transitioned to Normal Weight (&lt;18.5\/\u226518.5\u00a0kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>n<\/jats:italic>\u00a0=\u00a06024, HF\u00a0=\u00a0478, aHR 1.385, 95% CI 1.266\u20131.515) exhibited an increased risk of HF. The highest risk was observed in the Always Underweight group (&lt;18.5\/&lt;18.5\u00a0kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>n<\/jats:italic>\u00a0=\u00a07674, HF\u00a0=\u00a0665, aHR 1.612, 95% CI 1.493\u20131.740).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Underweight was significantly associated with the risk of HF in the DM population. Active surveillance for HF in an underweight DM population is needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.13417","type":"journal-article","created":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T03:39:43Z","timestamp":1705289983000},"page":"671-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Association between underweight and risk of heart failure in diabetes patients"],"prefix":"10.1002","volume":"15","author":[{"given":"Tae Kyung","family":"Yoo","sequence":"first","affiliation":[{"name":"Department of Medicine MetroWest Medical Center  Framingham MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung\u2010Do","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science Soongsil University  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6108-7758","authenticated-orcid":false,"given":"Eun\u2010Jung","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology and Metabolism, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won\u2010Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology and Metabolism, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Department of Health Sciences and Technology, SAIHST Sungkyunkwan University  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.316101"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0908292"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i4.613"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.09.011"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008769"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12682"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479164111422828"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-73640-w"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12010211"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12354"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2022.304"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000691"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0014"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2019.34.2.106"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.1.55"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.5551\/jat.63191"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2019.0104"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0235276"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.12997\/jla.2022.11.2.103"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2018.0184"},{"key":"e_1_2_9_22_1","first-page":"S17","article-title":"2. 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