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To the Editor.—Dr Purnell and colleagues1 found that weight gain is associated with increased cardiovascular risk in the group treated with intensive insulin therapy. However, weight gain was associated with a greater increase in total cholesterol and low-density lipoprotein (LDL) cholesterol in the conventional therapy group than in the intensive therapy group, suggesting that treatment and weight gain may have an interactive effect on cholesterol. For example, in the highest quartiles of weight gain, a 13% increase in body mass index (BMI) was associated with a 12% increase in LDL cholesterol in the conventional therapy group. In comparison, a 29% increase in BMI was associated with only a 6.8% increase in LDL cholesterol in the intensive therapy group. However, the authors stated, "Weight gain with conventional therapy resulted in smaller increases in BMI, lipids, and systolic blood pressure."
In the original analysis of the Diabetes Control and Complications Trial (DCCT), the intensive therapy group had greater improvements in total cholesterol, LDL cholesterol, and triglycerides (P<.01) and had a 43% lower rate of macrovascular complications (P=.08) than the conventional therapy group, despite the greater amount of weight gain in the intensive therapy group.2 - 3 The interaction of weight gain and cholesterol levels may result from different intensities of glycemia controls between conventional and intensive therapy groups.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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