Search results for “Body Mass Index (BMI)”

RETRACTED: Association of Body Mass Index (BMI) and Severity of COVID- 19: A Multicentric Study from Maharashtra, India

This article has been retracted on 30 August 2025. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2379-7835.ijn-25-5842) Objective The COVID-19 pandemic has led to the global research efforts to identify the risk factors which would lead to severe COVID-19 disease. This study aimed to investigate the relationship between body mass index (BMI) and severity of coronavirus disease 2019 (COVID-19). Methods A total of 2820 patients hospitalized with COVID-19 disease in nine Government Medical Colleges, COVID hospitals or COVID care centers of Maharashtra were included in the study. Interviews were conducted on the telephone and counselling was done. Results Among 2820, 2442 (86.60%) were asymptomatic or had a mild or moderate illness. More than half of the total COVID- 19 positive cases, 1591 (56.41%), were in the normal BMI range, and of these only 183 (11.50%) had severe COVID-19 disease. On the other hand, 647 (22.94%) patients were overweight and 106 (16.38%) had Severe COVID- 19 disease. Similarly, the patients who were obese, 363 (84.03%) were asymptomatic and 69 (15.97%) had severe COVID- 19 disease. Odds ratio for this association was found as 1.5, which indicates that patients who were obese (BMI ≥ 27.5) had one and half times increased odds of progression to severity as compared to patients having normal BMI. This association was found to be statistically significant (p- value < 0.05). Conclusion Our findings highlight the significant role of BMI in clinical progression of COVID-19 disease. Patients with underweight and obesity experienced more severe outcomes than those of normal weight when being hospitalized with COVID-19 disease.

Retraction Note: Association of Body Mass Index (BMI) and Severity of COVID- 19: A Multicentric Study from Maharashtra, India

Dose Body Mass Index (BMI) Fit to Muscular Individual?

Body mass index (BMI) seemingly is an important scale for the body types determination in individual with different ethnicity. Accordingly, individual with BMI< 18.5 are classified as slim or underweight and people with BMI between 18.5 -24.9 are called normal body types. Subsequently, those individual with BMI between 25-29.9 are categorized as overweight and people with BMI > 30 are classified as obese people. Nonetheless, important question is where the muscular individual are located in this BMI scale ? Macular induvial also called overweight or obese in BMI scale which can create kind of confusion for induvial because the might try to lose weight whilst they do not actually need it. Thus ,it seems BMI measure is not sensible measure for muscular induvial as otherwise the can be at risk of health problems in various ways. Uses of the another apparatus such an ordinary weight scale or computational devices which could estimate the body type according to the BMI more accurately can be helpful.

Arm Span is an Alternative to Standing Height for Calculation of Body Mass Index (BMI) amongst Older Adults

Objectives: Accurate measurement of height is difficult in older adults because of the reduction in height that occurs during the ageing process. Therefore, several western studies have demonstrated the arm span as an alternative anthropometric measurement to height among older adults, as the length of arm span is less affected by aging. The aim of the study was to use arm span as an alternative to standing height for calculation of body mass index (BMI) amongst older adults. Methodology: A community-based cross sectional study was carried out during 2011-12 among 400 (Men: 180; Women: 220) urban geriatric population (age 60-years and over)of the town of Khammam. Weight, height and arm span were measured with standard procedures. Nutritional status of older adults was calculated by body mass index (BMI) classification using both height and arm span. Key Results: The mean (SD) height and arm span among men were 164.5 cm (6.6) and 175.3cm (7.9), respectively, while among women were 149.5cm (5.8) and 158.7cm (8.6). The mean difference between arm span and height was 10.8cm (10.1,11.4)in men and 9.2cm (8.3,10.0) in women (p<0.001). Similarly, significant (p<0.001) differences were observed between the BMIs derived using both height and arm span among both the genders. Conclusion: The conventional height is not a reliable anthropometric measurement for the assessment of nutritional status of older adults, where the BMI-height model over estimated the nutritional status of older adults compared to the BMI- arm span model. Therefore, arm span is the best alternative to height for calculation of body mass index (BMI) in older adults.

A New Model of Body Composition: Concept and Design Features of the DBA-Model

Indices, based on data such as height and weight in general and in particularly the body mass index (BMI), are often used to assess overweight. However, there is limited capacity to differentiate the amount of fat mass between individuals. This review refers to an anthropometric model called Dahlmann-Body-Analysis (DBA), which uses simple anthropometric parameters to define a Reference Weight (Ref-Wt). It is based on hand circumference as a proxy for the skeletal frame and, in addition, the circumference of the abdomen as a proxy for central obesity. Processed through a network of algorithms, the DBA model enabled to differentiate the Difference Weight – that means the difference between the Actual Weight and the Reference Weight – into fat mass and skeletal muscle mass. The DBA-model resembles the 2-component model of Albert R. Behnke, which he considered as a living functional construct including essential fat. The DBA-model matches with Behnke`s 2-component model insofar, as the essential fat is replaced by a physiological amount of fat tissue. The review summarizes studies to compare DBA-derived data with Metropolitan Life Insurance tables, evaluates DBA-derived fat tissue mass with bioelectrical impedance analysis (BIA) derived results and analyses the meaning of the DBA model in clinical settings to uncover the underlying mechanisms of metabolic syndrome (MetS) pathogenesis with increasing amounts of fat mass. The model offers the opportunity to calculate changes in fat or muscle tissue in an absolute (kg) or relative (%) amount on individuals. The data suggest that the DBA-model has satisfactory prediction qualities for use as a practical tool in public health care.

Total Daily Energy Expenditure is Overestimated by Dietary References Intake Equations Compared with Doubly Labeled Water in A Sample of Brazilian Adolescents

Objective This report aimed to compare the total daily energy expenditure (TDEE) of adolescents measured by doubly labeled water (DLW) with the 2005 and 2023 dietary reference intake (DRI) equations proposed by the Institute of Medicine (IOM) in a sample of Brazilian adolescents. Methodology: This is a cross-sectional and observational study with a convenience sample of 15 obese and eutrophic adolescents, aged between 11 and 14 years, from public schools and the obesity outpatient clinic of the Clinics Hospital of the Ribeirão Preto Medical School – University of São Paulo (HC FMRP-USP) in Brazil. Were obtained stature and weight by conventional methods and used to calculate the body mass index (BMI) to determine the nutritional status. Fat-free mass (FFM) was measured using dual-energy X-ray absorptiometry. Energy expenditure was determined by DLW and estimated by the 2005 and 2023 DRI equations. The level of physical activity was measured with the ActivPAL™ accelerometer to classify adolescents within the equations. Results: Forty-seven percent of the sample were eutrophic and 53% were obese. The adolescents were classified as somewhat active according to the average number of daily steps. The DLW-derived TDEE and the TDEE derived from the 2005 and the 2023 predictive equations are presented as means, standard deviations, and 95% confidence intervals (CI). The 2005 and 2023 DRI equations produced significantly higher values than the DLW-determined TDEE (56.2% and 57.2%, respectively). Conclusion: Additional studies with Brazilian adolescents should be conducted to propose more accurate and specific predictive TDEE equations.

Impact of Environmental Sanitation and Hygienic Practices on Nutritional Status of Lodha Women and Children of West Bengal, India

Aim To assess the sanitation and hygienic practices of women and its effects on the nutritional status of the mother and preschool children of the Lodha tribal community in two districts of West Bengal. Methods A cross-sectional study was conducted during November, 2014 - December, 2018 of 941 Lodha mothers and 1043 of their preschool children in Paschim Medinipur and Jhargram districts. All information was collected by using KAP questionnaire following interview and group discussion. Mother nutritional status was assessed based on body mass index (BMI) and mid upper arm circumference (MUAC). A child was classified as underweight, stunting and wasting as weight-for-age, height-for-age and weight-of -height Z-score below -2 standard deviation of WHO standard. Results This study found 35% of the households used safe drinking water. Almost 97.2% of the mother had the low hand wash score and about 67.1% of them had an average WaSH score. Overall, 41.6% and 1.6% mothers were suffered from undernutrition (BMI <18.5 kg/m2) and overweight/obesity (BMI≥25kg/m2). Whereas, 48.9% women were undernourished based on MUAC<22.0cm. Moreover, the overall prevalence of wasting, stunting and underweight of preschool children was 31.9%, 62.1% and 61.3%, respectively. The WaSH score of family was significantly associated with child stunted and underweight. Conclusion There is a good association between poor household WaSH practices with child undernutrition and morbidity. Hence, there is an urgent need to develop the comprehensive knowledge, attitude and practice (KAP) guidelines in their language to educate them about appropriate water storage, retrieval methods, sanitation and hand washing practices.

Impact of Low Birth Weight on Early Vascular Aging and Cardiometabolic Phenotypes in Later Life Among Cameroonian Adults

Background Evidence suggests that low birth weight (LBW) is associated with increased cardiovascular and metabolic risk in adulthood, including increased arterial stiffness, a marker of early vascular aging (EVA) assessable by pulse wave velocity (PWV), obesity and glucose homeostasis abnormalities. The present study aimed to explore the late impact of LBW on PWV and cardiometabolic phenotypes among young adult Cameroonians. Methods The study evaluated 120 subjects (mean age: 26 ± 5 years; 54% male sex) at the Cameroon Heart Institute, Douala, Cameroon, between January and June 2018. Birth weight (BW) and gestational age, sociodemographic, anthropometrics and fasting capillary blood glucose were recorded in all participants. Blood pressure (BP) and PWV were measured using an automatic oscillometric device (Mobil-O-Graph®). Multiple-adjusted linear regression was used to determine predictive factors for PWV. For assessment of potential impact of BW on EVA, PWV was adjusted for age, sex, body mass index (BMI) and mean arterial pressure (MAP). Results 28 participants (23.3%) of the study sample had LBW (<3000g). There was no gender difference between LBW or normal birth weight patients (NBW; controls). Age- and MAP-adjusted PWV (aPWV) were higher in women with LBW compared to NBW (5.6 m/s and 5.3 m/s respectively, P = 0.038). In men, aPWV was similar in LBW and NBW. In this study population, aPWV was higher (on average +15 cm/s) in LBW than in controls, although the difference was not statistically significant (P=0.083). Multivariate regression analysis showed age, male sex, BMI and MAP were independent determinants of PWV, but not LBW. Compared to NBW controls, the prevalence of overweight/obesity, impaired glucose homeostasis and diabetes was higher in LBW: 42.9% vs 37%; 10.7% vs 3.3%, and 3.6 % vs 1.1%, respectively. Moreover, compared with controls, LBW individuals who were overweight/obese in adulthood had a much higher mean fasting capillary glucose (1.54 ±0.17 g/l vs 0.87 ±0.11 g/l in NBW, p=0.003). Conclusion This study suggests that although LBW is associated with increased aortic stiffness in young adulthood, mainly in women, the association was predominantly driven by aging, MAP, BMI and male sex. In adulthood, LBW subjects exhibited higher obesity indices and altered glucose homeostasis.

Identification of insulin-sensitive obese vs. insulin resistant obese postmenopausal women: Evaluation of surrogate indices of insulin sensitivity.

Introduction. Obesity often coexists with insulin resistance, which is related to cardiometabolic risk. However, some obese individuals exhibit comparable insulin sensitivity (IS) to that of normal-weight subjects, a state associated with a reduced cardiometabolic risk. We aimed to determine the efficacy of a panel of surrogate markers of insulin sensitivity (IS) for the identification of insulin sensitive obese (ISO) vs. insulin resistant obese (IRO) with similar total fat mass (FM) and body mass index (BMI). Methods. This is a cross-sectional analysis among 144 overweight and obese post-menopausal women. IS was determined by the hyperinsulinemic-euglycemic clamp (HEC) and by surrogate indices such as Matsuda index, the simple index assessing insulin sensitivity using oral glucose tolerance test (SIisOGTT), Abdul-Ghani liver IS index, HOMA-IR and Abdul-Ghani muscle IR index. Results. When using upper and lower quartiles values or the median as cut-off for IS determined by the reference HEC to define ISO vs. IRO, Matsuda index, SIisOGTT and Abdul-Ghani indices classification identified ISO vs. IRO individuals with similar FM and BMI. With HOMA-IR, the two groups were similar for FM and had borderline significant difference in BMI. Using, receiver operating characteristic curves, Matsuda index AUC was similar to that of SIisOGTT and both indices AUCs were significantly higher than Abdul-Ghani indices AUCs. The best cut-off value for the Matsuda index was 2.5 (83.1% specificity, 54.2% sensitivity) and 0.25 for SIisOGTT (64.8% specificity, 70.8% sensitivity). Conclusion. Whole body IS indices, Matsuda and SIisOGTT indices seem to be reliable indices for the identification of ISO vs. IRO individuals.

Venous Thromboembolism after Orthopaedic Surgery – How Long is the Patient at Risk?

Aim Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospital with orthopaedic surgery already an established risk factor. This study aims to establish the length of time that a patient is at risk of sustaining a VTE post orthopaedic surgery. Method A retrospective case series of all patients who underwent orthopaedic surgery between 2010 and 2014 whom re-presented with a VTE within one year of their initial operation. Demographic, operative and clinical information was obtained in order to identify potential risk factors. Results 53 patients were identified as having a VTE within one year of discharge. The majority (63.4%) underwent lower limb arthroplasty. 29% of the cohort had either a family or personal history of VTE, 79% had ischaemic heart disease (IHD), hypertension or both. The average body mass index (BMI) of the cohort was 31.4; above the UK national average. 56.6% of the cohort developed a pulmonary embolism (PE) and 49% developed a deep vein thrombosis (DVT). Co-occurring DVT and PE was diagnosed in 5.6% of patients. The average length of time for readmission for patients to re-present at hospital with a PE was 122 days (range 4-361) and 107 days (range 7 – 360) with a DVT. Conclusion This study confirms the existence of pre-established risk factors for developing VTE including obesity, personal and family history of DVT, cardiovascular disease and lower limb arthroplasty. These risk factors are recognised despite patients receiving post-operative thromboprophylaxis. The findings of this study extend the current research by suggesting that patients presenting with known risk factors of developing VTE may be at risk for longer than the current guidelines cover for the administration of thromboprophylaxis. We propose further studies are needed to identify any potential requirements for more extensive VTE prophylaxis in this population.

The Use of Predictive Markers for the Development of a Model to Predict Lowest Quartile Weight Loss following Roux-en-Y Gastric Bypass.

Introduction: The Roux-en-Y Gastric Bypass (RYGB) has been one of the most popular surgeries in the USA for years. While many models have been made to investigate the factors that affect weight loss, these factors are still highly debated. Objective: To create a model that predict performance of RYGB patients. Methods: 110 out of 344 patients who received a RYGB at a single institution between Jan 2010 and April 2014 were included in this study. Data was collected retrospectively. Patients were included if they had greater than 1 year follow up with at least three follow up points and could be modeled with r2>0.95. All patients were one year beyond surgery, while 40 were completely lost to follow up, 104 at 1 month, 138 at 3 months, 188 at 6 months, and 225 at one year. 9 patients were not included because they did not meet the criteria of the study. Patients were divided into quartiles based on percentage excess weight loss (%EWL) at one year. Multivariate analysis was performed to determine the significant factors that influence patients being in the first quartile of weight loss (17-60% %EWL). Results: Only males with a Body Mass Index (BMI) above 44 and females with a BMI above 64 were found to be predictive of patients being in the first quartile. Our model has Positive and Negative predictor values of 66% and 80% respectively with sensitivity and specificity of 29% and 95% respectively. Conclusions: An model to predict %EWL was created, only gender and pre-operative BMI were found to be significant factors. In general females have better outcomes with higher BMI’s than do males. This information should be discussed with patients when deciding a procedure. However, more studies are needed for validation of these results.

A Pilot Study Assessing the Impact of a High Protein Supplementation Diet on Fat Mass in Obese Adolescents with and without Type 2 Diabetes

Background: Obese adults with Type 2 Diabetes (T2D) have shown differences in body composition and response to varying diets when compared to obese adults without T2D. This difference in body composition affects management options for obesity. Such studies have not been done on adolescents thus far. Objectives: To estimate differences in fat mass at baseline as well as following a two-week high protein liquid diet in obese adolescents with and without T2D. Methods: Thiswas a pilot study using a non-randomized, unblinded pre/post intervention design without a control group. We planned to recruit 40 subjects (20 per group, with and without T2D) from ages 10 – 19 years, with Body mass index (BMI) ≥ 95 percentile. Body fat mass was measured via the Bod Pod® at baseline and after two weeks of following the diet with Ensure High Protein shakes. Change in fat mass is presented as mean differences and 95% confidence intervals. Results: We recruited 28 subjects, 19 completed the study and 12 were compliant with the diet. The mean difference in fat mass percent from baseline in subjects who completed the study (n=19) and without T2D was 1.4 (95% confidence interval (CI): -2.1 to -0.8) and in subjects with T2D was 1.2 (95% CI: -3.6 to 1.24). Conclusion: We did not find any meaningful difference in fat mass at baseline or after following a two-week high protein diet between the groups. High dropout rate and noncompliance with the diet were major limitations.

Clinical and Immunological Beneficial Effects of Phyto V7 Consumption by HIV-1 Seropositive Individuals

Phytochemicals (PHT) are a large group of biologically active plant chemicals that may have positive effects on human health such as immune system stimulation, down regulation of inflammatory responses, radical scavenging activities, cell repair function, and antibacterial and antiviral activity. In this proof of principle 6 months study, the effects of supplementing a PHT mix, Phyto V7, to HIV-1 seropositive individuals and AIDS patients were examined. Individuals with CD4+ T-cells below 350 counts/mm3were assigned to one of the following treatments: CG1 - no treatment, CG2 - only highly active antiretroviral treatment (HAART), TG1 - only Phyto V7, and TG2- both Phyto V7 and HAART. After 3 months of treatment there were approximately (-)1%, 1%, 2% and 4% increase in the mean weight of the CG1, CG2, TG1 and TG2 groups, respectively. The tendency for the body mass index (BMI) was similar. The CD4+ counts increased by 13%, 39%, 53% and 35%, respectively. Similar trends were noted after 6 months with 2%, 79%, 53% and 69% increases in the CD4+ counts, respectively. There was a significant reduction in viremia only in groups receiving HAART. Overall better results were obtained in the group of patients receiving both HAART and Phyto V7, in which the mean weight increased by 5.7% and the CD4+ T-cell counts increased by 69% after 6 months. This study indicates that providing Phyto V7 to HIV-1 seropositive individuals and AIDS patients, receiving or not receiving HAART, improves their physical wellbeing and CD4+ counts, enabling them to cope better with the viral infection.

The Lower Prevalence of Chronic Diseases Risk Factors in Vegetarian Brazilians Subjects – CARVOS Study

Objective: To investigate the association of meat consumption with self-reported chronic diseases (heart disease, hypertension, diabetes (type I or type II) and dyslipidemia), according to demographic, social and anthropometric variables. Methods: This was a cross sectional study, conducted at the Heart Institute, University of São Paulo, with 549 adults (≥ 18 years) who answered a questionnaire to select people for The CARVOS Study (Carotid Atherosclerosis, Aortic Stiffness and Risk Factors in Vegetarians and Omnivorous Subjects). The variables analyzed were: age, gender, education level, meat consumption, self-reported coronary heart disease, hypertension, diabetes (type I or type II) and dyslipidemia, smoking and body mass index (BMI) (kg/m2). Study subjects were classified as omnivorous (OMN=consumption of meat or fish four or more times/week) (n=228, 41.5 %), semi-vegetarians (SV=consumption of meat or fish 1-3 times/week) (n=97, 17.7%) and vegetarians (VEG=no consumption of meat or fish) (n=224, 40.8%). The differences between mean values was calculated by T-ANOVA test. To test the association between the variables, chi-square test and multiple logistic regression were used (p<0.05; CI = 95%). Results: There was a greater prevalence of smokers among OM than SV and VEG respectively 56.5%, 14% and 29.4 %, p=0.009, and a higher prevalence of overweight (41.7%) in OMN in comparison with SV (29.2%) and VEG (29.0%), p=0.008. Being OM significantly increased the risk of referring hypertension, regardless of sex and age (OR 2.19; CI 95% 1.08-4.46), and was also associated with dyslipidemia, regardless of body mass index, smoking, sex and age (OR 1.78; CI 95% 1.03-3.08). Conclusion: Higher meat consumption was associated with a greater prevalence of risk factors for hypertension and dyslipidemiachronic diseases.

What are the Risk Factors for ≥4500 g Macrosomia?

Objective: To identify risk factors for ≥4500 g macrosomic babies given that maternal and neonatal complications of macrosomia increase with birth weight. Design: Cross sectional analytical study. Setting: The Yaoundé University Teaching Hospital and Central Maternity, Cameroon from October 1st, 2012 to June 30th, 2013. Population: 42 women who delivered ≥4500 g babies and 126 women who delivered babies of 4000 to <4500 g were recruited. Methods: Data were analysed using SPSS 18.0. Analyses included the student t-test and the Fisher exact test. The level of significance was P<0.05. Main outcome measures: Fetal sex and birth weight, gestational age at delivery, maternal age at delivery, parity, mother's pre-gestational body mass index (BMI), weight gain during pregnancy, father's BMI and past history of ≥4000 g macrosomia. Results: Main risk factors for ≥4500 g macrosomic babies were maternal weight gain of ≥16 kg (OR 4.2, 95%CI 2.0-8.9), maternal age ≥30 (OR 3.8, 95%CI 1.8-8.2), post term (OR 2.3, 95%CI 0.9-5.6), past history of ≥4000 g macrosomia (OR 1.9, 95%CI 0.9-4.1) and male sex (OR 1.3, 95%CI 0.6-2.8). Conclusion: To reduce the risk of ≥4500 g macrosomic babies, women at risk should make efforts to gain less than 16 kg bodyweight during pregnancies. Moreover, post term pregnancies should be avoided.

High Prevalence of Obesity in a Saudi Community K.Aljabri, MD, FRCPC, S. Bokhari, MD.  A Cross Section, Single Centre Study

Objective: Obesity is a major public health problem worldwide. We designed this study to determine the prevalence of obesity among Saudis in the department of primary care at King Fahad Armed Forces Hospital. Methods: Cross section study of Saudis of both sexes, aged more than or equal to 12 years at the department of primary care at King Fahad Armed Forces Hospital between January 2008 and June 2009. Results: A total of 5968 were attending the department of primary care were included in this study. There were 2269 (38.0%) male and 3699 (62.0%) female. With age, a gradual increase was seen in the Body mass index (BMI) in both males and females, up to the age of 59 years, with a decrease occurring thereafter. In the females below 20 years of age, the BMI was lower than in the male group. Above 30 years, the BMI in females was higher than in the males of corresponding ages. The prevalence of BMI≥25 was 70.0%.The prevalence of BMI≥25 was non significantly higher in the male compared to the female,71% and 69.3% respectively, p=0.2.The prevalence of overweight ( BMI=25-29.9) was higher in the males compared to the females, while the reverse was true for obesity(≥30),where 62.0% of the total female population was obese compared to 49.7% of the total male population. The magnitude of the difference in prevalence of obesity in the males and females was significantly high ( p<0.0001). Conclusion: The prevalence of obesity is high among Saudi population at the primary care setting and represents a major clinical and might represent a public health problem. A national prevention program at community level should be implemented.

Vascular Damage in Newly Diagnosed Young Hypertensive Patients, Assessed by Carotid Intima Media Thickness: An Indian Perspective

Background: Western studies have shown that hypertension increases carotid intima media thickness (cIMT) as early as in childhood and adolescence. However, similar data from India is lacking. Indians have different genetic, racial, geographic, cultural and dietary patterns. Hence a similar trend may not be experienced among young Indian subjects. Methods: 46 young cases (age 16 – 35 years) of hypertension were recruited along with age, sex and BMI matched controls. Patients with body mass index (BMI) >25 kg/m2, diabetes mellitus and secondary causes of hypertension were ruled out. All patients underwent carotid ultrasonography for assessment of cIMT. Results: Mean age and BMI of cases was 25.4 years and 20.89 kg/m2 respectively. 67.4% were male. For all of the subjects combined (n=92), cIMT correlated with BMI (r = 0.244; P=0.019), office systolic blood pressure (SBP) (r = 0.556; p<0.001) and office diastolic blood pressure (DBP) (r =0.426; p<0.001). Among hypertensive subjects (n=46), there was a significant positive correlation between cIMT and SBP (r=0.611, p<0.001). In contrast to SBP, DBP correlated insignificantly with cIMT (r= 0.217; p = 0.14) in the hypertensive subjects. Conclusion: Elevated blood pressure, especially systolic, correlates with increased cIMT among young Indian hypertensives. This provides strong evidence that primary hypertension in early life also is associated with vascular pathology, independent of the effects of obesity and diabetes