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BACKGROUND: Disagreement exists regarding the relationship between body weight and foot ulceration risk among diabetic persons.
METHODS: We used a nested case-control design to estimate the association between body mass index (BMI) and one-year and five-year foot ulceration risk. We obtained data on all diabetic patients < 60 years old who were treated in the US Department of Veterans Affairs healthcare system in 2003. Patient characteristics and comorbidities were obtained at baseline. For each individual with an incident foot ulcer (case), up to four individuals were randomly selected who matched the case on age, sex, race, marital status, and calendar time.
RESULTS: Crude one-year and five-year incidence rates were 1.35% and 6.22% after a mean follow-up of 11.8 ± 1.2 months and 55.5 ± 12.8 months, respectively. Compared to individuals with BMI 25.0 - 29.9 kg/m(2) , those with BMI 40.0 - 44.9 kg/m(2) and those with BMI ≥ 45.0 kg/m(2) had 25% (Adjusted Odds Ratios [AOR] = 1.25; 95% Confidence Interval [CI], 1.00 - 1.56) and 83% (AOR = 1.83; 95% CI, 1.44 - 2.32) higher one-year risk and 1.4 (AOR = 1.39; 95% CI, 1.26 - 1.54) and 2.1 (AOR = 2.08; 95% CI, 1.86 - 2.32) times higher five-year risk. BMI < 25.0 kg/m(2) was associated with 30% higher risk at both one year (AOR = 1.28; 95% CI, 1.04 - 1.58) and five years (AOR = 1.27; 95% CI, 1.15 - 1.40).
CONCLUSIONS: Our data suggest a significant J-shaped association between body mass index and diabetic foot ulcers