Please cite this article in press as: Lim RBT, et al. Anthropometrics indices of obesity, and all-cause and cardiovascular disease-related mortality, in an Asian cohort with type 2 diabetes mellitus. Diabetes Metab (2015), http://dx.doi.org/10.1016/j.diabet.2014.12.003 ARTICLE IN PRESS +Model DIABET-666; No. of Pages 10 Available online at ScienceDirect www.sciencedirect.com Diabetes & Metabolism xxx (2015) xxx–xxx Original article Anthropometrics indices of obesity, and all-cause and cardiovascular disease-related mortality, in an Asian cohort with type 2 diabetes mellitus R.B.T. Lim a,* , C. Chen a , N. Naidoo a , G. Gay a , W.E. Tang b , D. Seah b , R. Chen c , N.C. Tan d , J. Lee a , E.S. Tai a , K.S. Chia a , W.Y. Lim a a Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore b National Healthcare Group Polyclinics, Singapore City, Singapore c Changi General Hospital, Singapore City, Singapore d Singhealth Polyclinics, Singapore City, Singapore Received 27 July 2014; received in revised form 2 December 2014; accepted 7 December 2014 Abstract Aim. – The study investigated the relationship of general (body mass index [BMI]) and central (waist circumference [WC]; waist–hip ratio [WHipR]; waist–height ratio [WHeightR]) adiposity with all-cause and cardiovascular disease (CVD)-related mortality in an Asian population with diabetes. Methods. – A total of 13,278 participants with type 2 diabetes mellitus (T2DM) recruited from public-sector primary-care and specialist outpatients clinics in Singapore were followed-up for a median duration of 2.9 years, during which time there were 524 deaths. Cox proportional- hazards regression and competing-risk models were used to obtain hazard ratios (HRs) for anthropometric variables of all-cause and CVD-related mortality. Results. – After adjusting for BMI, the highest quintiles of WC, WHipR and WHeightR were all positively associated with mortality compared with the lowest quintiles, with WHeightR exhibiting the largest effect sizes [all-cause mortality HR: 2.13, 95% confidence interval (CI): 1.33–3.42; CVD-related mortality HR: 3.42, 95% CI: 1.62–7.19]. Being overweight but not obese (BMI: ≥ 23.0 but < 27.5 kg/m 2 ) was associated with a decreased risk of CVD-related mortality in those aged ≥ 65 years (HR: 0.47, 95% CI: 0.29–0.75), but not in those aged < 65 years (HR: 1.11, 95% CI: 0.49–2.50). Conclusion. – Overweight, but not obesity, was associated with a reduction in risk of mortality. This was seen in T2DM patients aged ≥ 65 years, but not in those younger than this. At the same BMI, having higher central-obesity indices such as WC, WHipR and WHeightR also increased the risk of mortality. © 2014 Elsevier Masson SAS. All rights reserved. Keywords: Short-term mortality; Diabetes mellitus; Obesity; Central obesity; Anthropometric indices 1. Introduction Obesity and type 2 diabetes mellitus (T2DM) are major causes of morbidity and mortality in both the developed and developing countries, affecting an estimated 500 million [1] and 382 million [2] adults worldwide, respectively. In particular, the * Corresponding author. Tel.: +65 6516 4988; fax: +65 6779 1489. E-mail address: raymondlim1302@gmail.com (R.B.T. Lim). prevalence of obesity [3] and T2DM [4] has increased sharply in Asia over just a few decades. Among anthropometric indices, body mass index (BMI) with all-cause and cardiovascular disease (CVD)-related mortality has been the most widely studied. A high BMI and increased risk of all-cause and CVD-related mortality have been reported in both Western [5] and Asian [6] healthy populations. However, the same relationship is unclear in people with chronic diseases such as T2DM. BMI has been reported to exhibit inverse [7], pos- itive [8], null [9], and U-shaped [10] associations with all-cause http://dx.doi.org/10.1016/j.diabet.2014.12.003 1262-3636/© 2014 Elsevier Masson SAS. All rights reserved.