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The risk of Dupuytren's disease is lower in obese individuals
Jacques Henri Hacquebord, MD1; Patrick Reavey, MD, MA1; Neil Gregory Harness, MD2
1University of California Irvine, Orange, CA; 2Kaiser Permanente Orange County, Anaheim, CA

Introduction: Dupuytren’s contracture is a benign fibroproliferative disorder causing contracture of the palmar fascia of the hand. The exact etiology of the disease is unclear but known risk factors such as increased age, male gender and northern European ethnicity have been established. Other risk factors such as diabetes, alcohol, occupation, and phenobarbital usage remain speculative. A previous study with a homogenous patient population showed affected males to have statistically significant lower body mass index (BMI) compared to unaffected males. No other studies have investigated the link between BMI and Dupuytren’s disease. The purpose of the study was to test the hypothesis that lower BMI is associated with increased rates of Dupuytren’s disease.
Methods: After obtaining IRB approval, a retrospective review using the electronic medical record and administrative database was performed to identify all patients in our healthcare system diagnosed with Dupuytren’s disease (ICD-9-CM diagnosis code 728.6) from 2007-2014. Basic demographic data including age, sex, ethnicity and BMI were collected. Univariate and multivariate logistical regression analyses were performed to evaluate for associations between Dupuytren’s disease and BMI.
Results: 2,049,803 patients aged 18 and older were enrolled in the healthplan from 2007-2014. 14,844 patients were identified with Dupuytren’s disease during this time period. Our data was consistent with well-defined demographic trends with increased rates of Dupuytren’s disease seen in males, caucasians, and patients aged 50+. The multivariate analysis, when controlling for age, race, and gender, showed the risk of Dupuytren’s disease was inversely proportional to BMI. Using a BMI of 18.9-25.0 as the normal reference the odds of Dupuytren’s disease was 0.748, P<0.0001 for BMI 30.0-34.9, 0.642 P < 0.0001 for BMI 35.0-39.9 and 0.526 P < 0.0001 for BMI 40+.
Conclusion: Previous studies have shown diabetes and increased age to be a risk factor for Dupuytren’s disease. An Icelandic study with a limited patient population showed that decreased BMI could potentially be a risk factor for Dupuytren’s disease. Our study, with a much larger and ethnically diverse patient population, clearly shows higher BMI to be associated with decreased odds of Dupuytren's diagnosis. Given previous findings that diabetes may be a risk factor, the findings of lower BMI as a risk factor is unexpected. While we found an association between BMI and Dupuytren’s disease, we have not shown definitive causation. Further work is required to determine the physiologic factors related to obesity, which may be protective against the development of Dupuytren’s disease.

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