BMI and Mortality in Patients With New-Onset Type 2 Diabetes: A Comparison With Age- and Sex-Matched Control Subjects From the General Population

Edqvist, Jon; Rawshani, Araz; Adiels, Martin; Björck, Lena; Lind, Marcus; Svensson, Ann‐Marie; Gudbjornsdottir, S.; Sattar, Naveed; Rosengren, Annika

doi:10.2337/dc17-1309

Cited by 33 publications

(27 citation statements)

References 30 publications

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“…Although the majority of research supports the existence of the obesity paradox, a growing body of literature suggests that this observation might be biased by reverse causality or unknown confounders. [9][10][11] Differences in the sample populations may be responsible for the inconsistent results. 12 Specifically, Lee et al 13 reported that the optimal body mass index (BMI) for survival depends on the patient's glucose regulation status.…”

Section: Introductionmentioning

confidence: 99%

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

Li¹,

Sheu²,

Lee³

2020

DMSO

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Purpose: An "obesity paradox" has been observed in patients with type 2 diabetes. However, the optimal body mass index (BMI) for survival may be influenced by the stage of diabetes. We examined the relationship between BMI and mortality in patients with type 2 diabetes and the influence of diabetic retinopathy (DR). Patients and Methods: This is a retrospective cohort composing patients with type 2 diabetes who were admitted due to poor glucose control. Presence of DR was confirmed by ophthalmologists. The primary outcome was all-cause mortality. The association between BMI and mortality was assessed using a Cox proportional hazards model with adjustment for age, sex, and traditional risk factors. Results: A total of 2053 patients were enrolled. Over median follow-up of 6.7 years, there were 1060 deaths. Patients were classified into five categories based on admission BMI (kg/m 2): <18.5, 18.5-23, 23-25, 25-27 (reference), 25-30 and >30. Mortality risk was significantly higher in the <18.5 kg/m 2 , 18.5-23 kg/m 2 , and 23-25 kg/m 2 categories than in the reference category (P <0.001). The similar obesity paradox was observed in the subgroup of patients without DR. However, in patients with DR, only patients with BMI <18.5 kg/m 2 had significantly increased mortality than those in the reference category. The presence of DR significantly modified the shape of the association between BMI and mortality (P = 0.019). Conclusion: The obesity paradox exists in patients with poorly controlled type 2 diabetes. The presence of DR appears to significantly influence the shape of the association between BMI and mortality.

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Section: Introductionmentioning

confidence: 99%

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

Li¹,

Sheu²,

Lee³

2020

DMSO

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“…This was done in part to prevent small cohort numbers, but the sensitivity of the effect of insulin treatment during pregnancy may have been lost, resulting in non-signi cant results. Studies show that the effects of BMI on health and mortality is heterogenous and becomes increasingly worse with increasing BMI class [40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

A Potential Role for Insulin Treatment During Pregnancy in Reducing Postpartum Psychological Distress in Maternal Obesity: An Administrative Population Health Study

Jarmasz

Anderson

Bock

et al. 2020

Preprint

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Background: Obesity in pregnancy carries significant risks on mother and child. Studies have found an association between obesity and increased risk for peripartum depression, which has also been linked to decreased placental lactogen levels. In addition, women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Treatment options exist for perinatal and postpartum depression however, they pose a risk to the developing offspring. Thus, prevention as well as markers for early identification of peripartum depression are needed. Methods: Administrative health data (2002/03-2018/19) housed at the Manitoba Centre for Health Policy were used to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD). This was effectuated in a cohort of women (age 15+ years) who gave birth (N=250,746) and had no pre-existing mood/anxiety disorders or diabetes (N=222,863 excluded). Women were then divided into two groups: lean (N=17,975) and with obesity (N=9,908), which was identified by a recorded maternal weight of >38 - <65.6 kg and ≥85 - <186 kg (respectively). The risk of PPD within one year after delivery with and without insulin treatment was assessed by Poisson regression analysis. Models were adjusted for maternal age group (at pregnancy start date) and area-level income (at delivery). Results: The unadjusted risk of PPD was higher in the obesity group (8.56%; 95% CI 8.00 - 9.15) than in the lean group (6.93%; 95% CI 6.56 - 7.33). When no insulin treatment was given during pregnancy, mothers with obesity had a significantly higher risk of PPD than the lean group (aRR 1.27; 95% CI 1.17-1.39; p<0.0001). However, when women with obesity and insulin treatment were compared to the lean group with no insulin treatment, no significant difference in the risk of PPD was observed between the groups (aRR 1.30; 95% CI 0.83-2.02; p=0.248). Conclusion: This is the first study to demonstrate a positive association between insulin treatment in pregnancy among women with obesity and reduced PPD rates, suggesting insulin as a preventative measure, and further supporting placental lactogen levels as a potential marker for early identification.

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“…The top three risk factors for women in 2016 were high blood pressure, high body-mass index (BMI) and high fasting plasma glucose [14]. The increasing BMI of the population is of major concern in Sweden [15] as well as in most other countries (including both high and low-income countries). Recent reports [16,17] from Sweden estimated the prevalence of overweight (BMI 25-29.9 kg/m 2 ) to be about 30% for women and about 45% among men.…”

Section: Introductionmentioning

confidence: 99%

From carbohydrates to fat: Trends in food intake among Swedish nutrition students from 2002 to 2017

et al. 2020

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Earlier studies have implied a change in dietary habits of the Swedish population towards a low carbohydrate, high fat diet. Questions have been raised about the development in recent years and potential health effects. We have investigated the dietary intake of Swedish female students enrolled in a university nutrition course between 2002 and 2017. The students carried out self-reporting of all food and drink intake over one weekday and one weekend day. Intake of macronutrients (E%) and micronutrients were calculated for the whole period while statistical analysis was performed for changes between 2009 and 2017 (729 women). Results showed significant changes in carbohydrate intake (from 47.0 to 41.4 E%) and fat intake (from 31.7 to 37.5 E%). Carbohydrate intake was significantly lower than the Nordic Nutrition Recommendations (45-60 E%). However, daily fiber intake remains high (3.0 g/MJ) in a national context, and intake of vitamin D and folate appears to increase during the period. The results suggest that the observed national transition from carbohydrate to fat intake persists, and that it might be especially evident among individuals interested in food and nutrition. Considering the fiber and micronutrient intake, the change is not necessarily unfavorable for this particular group.

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BMI and Mortality in Patients With New-Onset Type 2 Diabetes: A Comparison With Age- and Sex-Matched Control Subjects From the General Population

Cited by 33 publications

References 30 publications

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

A Potential Role for Insulin Treatment During Pregnancy in Reducing Postpartum Psychological Distress in Maternal Obesity: An Administrative Population Health Study

From carbohydrates to fat: Trends in food intake among Swedish nutrition students from 2002 to 2017

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