Association Between Obesity and Diabetes Mellitus in Veterans With Spinal Cord Injuries and Disorders

Objectives: To examine the association between body mass index (BMI) and clinically diagnosed diabetes in veterans with spinal cord injuries and disorders. We also sought to determine whether there is evidence to support a 10% reduction in BMI cut points, which would lower the upper limit of normal BMI from 24.99 to 22.49 kg/m(2), for persons with spinal cord injuries and disorders. Design: Cross-sectional analysis using clinical data on 1938 male veterans. Prevalence ratios (95% confidence intervals) were calculated using a generalized linear model and adjusted for age, race, tobacco use, and paraplegia/tetraplegia status. Results: Compared with the National Heart Lung Blood Institute normal BMI category (18.5-24.99 kg/m(2)), the prevalence of diabetes was 50% higher (adjusted prevalence ratio: 1.50, 95% CI: 1.11-2.01) in the overweight category (25-29.99 kg/m(2)) and similar to 3-fold higher (for obese classes 1-3, adjusted prevalence ratio: 2.74-3.03) in the obese category (BMI >= 30 kg/m(2)). Compared with the World Health Organization low-normal category (BMI, 18.5-22.99 kg/m(2)), there was no significant difference in the prevalence of diabetes for those in the high normal weight (BMI, 23-24.99 kg/m(2)) or low overweight (BMI, 25-27.49 kg/m(2)) categories. However, the prevalence of diabetes was 2-fold higher among those in the high overweight category (BMI, 27.5-29.99 kg/m(2); adjusted prevalence ratio: 2.00, 95% CI: 1.33-2.99). Conclusions: BMI >= 25 kg/m(2) was associated with significantly higher diabetes prevalence in male veterans with spinal cord injuries and disorders, and this risk was especially pronounced at BMI >= 27.5 kg/m(2). These findings do not support the need to create spinal cord injuries and disorder-specific BMI definitions of overweight for purposes of determining diabetes risk.