BACKGROUND Being obese or underweight, and having diabetes are important risk factors for new-onset atrial fibrillation (AF). However, it is unclear whether there is any interaction between body weight and diabetes in regard to development of new-onset AF. We aimed to evaluate the role of body weight status and various stage of diabetes on new-onset AF. METHODS This was a nationwide population based study using National Health Insurance Service (NHIS) data. A total of 9,797,418 patients who underwent national health check-ups were analyzed. Patients were classified as underweight [body mass index (BMI) < 18.5], normal reference group (18.5 ≤ BMI < 23.0), upper normal (23.0 ≤ BMI < 25.0), overweight (25.0 ≤ BMI < 30.0), or obese (BMI ≥ 30.0) based on BMI. Diabetes were categorized as non-diabetic, impaired fasting glucose (IFG), new-onset diabetes, diabetes < 5 years, and diabetes ≥ 5 years. Primary outcome end point was new-onset AF. New-onset AF was defined as one inpatient or two outpatient records of International Classification of Disease, Tenth Revision (ICD-10) codes in patients without prior AF diagnosis. RESULTS During 80,130,161 patient*years follow-up, a total of 196,136 new-onset AF occurred. Obese [hazard ration (HR) = 1.327], overweight (HR = 1.123), upper normal (HR = 1.040), and underweight (HR = 1.055) patients showed significantly increased risk of new-onset AF compared to the normal reference group. Gradual escalation in the risk of new-onset AF was observed along with advancing diabetic stage. Body weight status and diabetes were independently associated with new-onset AF and at the same time, had synergistic effects on the risk of new-onset AF with obese diabetic patients having the highest risk (HR = 1.823). CONCLUSIONS Patients with obesity, overweight, underweight, and diabetes had significantly increased risk of new-onset AF. Body weight status and diabetes had synergistic effects on the risk of new-onset AF. The risk of new-onset AF increased gradually with advancing diabetic stage. This study suggests that maintaining optimal body weight and glucose homeostasis might prevent new-onset AF.

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体重和糖尿病对新发房颤的影响：一项基于全国人群的研究。

背景技术肥胖或体重不足以及患有糖尿病是新发房颤的重要危险因素。但是，目前尚不清楚体重和糖尿病在新发房颤的发生方面是否存在相互作用。我们旨在评估体重状况和糖尿病各个阶段对新发房颤的作用。方法这是一项使用全国健康保险服务（NHIS）数据在全国范围内进行的研究。总共对9,797,418例接受了国家健康检查的患者进行了分析。患者分为体重不足[体重指数（BMI）<18.5]，正常参考组（18.5≤BMI <23.0），高正常人群（23.0≤BMI <25.0），超重（25.0≤BMI <30.0）或肥胖（BMI）。 ≥30.0）。糖尿病归类为非糖尿病，空腹血糖受损（IFG），新发糖尿病，糖尿病<5年和糖尿病≥5年。主要结局终点是新发房颤。新发房颤定义为未经房颤诊断的患者的国际疾病分类第十次修订（ICD-10）代码的一住院或两门诊记录。结果在80,130,161例患者*年的随访期间，共发生196,136例新发房颤。与正常参考组相比，肥胖[危险度（HR）= 1.327]，超重（HR = 1.123），高正常（HR = 1.040）和体重不足（HR = 1.055）患者显示新发房颤的风险显着增加。随着糖尿病的发展，新发房颤的风险逐渐升高。体重状态和糖尿病与新发房颤独立相关，同时，对具有最高风险的肥胖糖尿病患者，新发房颤的风险具有协同作用（HR = 1.823）。结论肥胖，超重，体重不足和糖尿病患者的新发房颤风险显着增加。体重状况和糖尿病对新发房颤的风险具有协同作用。随着糖尿病阶段的进展，新发房颤的风险逐渐增加。这项研究表明，保持最佳体重和葡萄糖动态平衡可能会预防新发房颤。随着糖尿病阶段的进展，新发房颤的风险逐渐增加。这项研究表明，保持最佳体重和葡萄糖动态平衡可能会预防新发房颤。随着糖尿病阶段的进展，新发房颤的风险逐渐增加。这项研究表明，保持最佳体重和葡萄糖动态平衡可能会预防新发房颤。