Association between weight changes and infective endocarditis in patients with diabetes: A nationwide population-based cohort study

The association between weight change in patients with diabetes, and the development of infective endocarditis (IE) has never been studied. Therefore, we evaluated the associations of weight changes in patients with diabetes with the development of IE.

In this Korean population-based cohort study, we included patients with diabetes aged ≥20 years who underwent health screenings twice in a 2-year interval between 2009 and 2012. Patients were categorized into five groups according to the degree of weight change between the two health screenings and were followed up until December 2018. A patient with a weight change of ≤-10% was designated to the severe weight loss group, −10 to ≤−5% to the moderate weight loss group, −5 to ≤5% to the stable weight group, 5 to ≤10% to the moderate weight gain group, and ≥10% to the severe weight gain group. The primary outcome was the incidence of IE.

A total of 1,762,108 patients with diabetes were included. There were 67,580 (3.9%) individuals with severe weight loss, 247,969 (14.1%) with moderate weight loss, 1,267,849 (72.0%) with stable weight, 135,774 (7.7%) with moderate weight gain, 42,936 (2.4%) with severe weight gain. During the follow-up (median, 5.21 years), 828 cases of IE occurred. After adjusting for covariates, both weight loss (HR: 2.41, 95% CI: 1.87–3.12 for the severe weight loss group; HR: 1.28, 95% CI: 1.05–1.55 for the moderate weight loss group) and weight gain (HR: 1.17, 95% CI: 0.91–1.50 for the moderate weight gain group; HR: 1.59, 95% CI: 1.11–2.28 for the severe weight gain group) were associated with an increased risk of IE compared to those for the stable weight group.

Both weight gain and weight loss are associated with an increased incidence of IE, and the greater the degree of weight change, the greater the risk.