Body mass index and the risk of mortality in type II diabetic patients from Verona

Abstract

OBJECTIVE:The relation between body weight and mortality in type II diabetic patients has not been fully elucidated. The aim of the present study was to evaluate the impact of body weight on mortality in a well-characterized type II diabetic cohort. RESEARCH DESIGN AND METHODS:We examined a cohort of 3398 type II diabetic patients, alive on December 1986 and followed up for 10 years, to assess mortality and its causes and to investigate the relationship between body mass index (BMI) and mortality from all and specific causes. For this purpose, survival in the different quartiles of BMI was evaluated by a Cox model, controlling for sex, age, treatment, smoking, duration of diabetes, hypertension, and fasting plasma glucose. The Cox model was applied either excluding (model 1) or including (model 2) the last three variables. RESULTS: During the 10 ys of follow-up, 1212 deaths (639 women, 573 men) occurred in the cohort under study. Since the interaction between BMI and age was statistically significant (P = 0.002), survival was studied separately in people aged o65 and Z65 y (median age of the cohort = 65.9 y). Under 65 y, a significantly higher all-cause mortality was observed in obese patients, that is, in the IV quartile (BMIZ30.9 kg/m 2 ; RR = 1.74; CI 95% = 1.26-2.40), in model 1. The inclusion of hypertension, duration of diabetes, and fasting plasma glucose in the model (model 2) slightly decreased the relative risk (RR = 1.52; CI 95% = 1.10-2.11). After 65 y, higher body weight was associated with a better outcome, especially in patients belonging to the IV quartile of BMI (RR = 0.74; CI 95% = 0.62-0.90). CONCLUSIONS: In older type II diabetic patients, a moderate excess weight predicts a better survival, while obesity is a negative prognostic factor in patients younger than 65 y. In the latter patients, the effect of obesity on mortality seems to be partly mediated by hypertension, duration of diabetes, and fasting plasma glucose.

Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients

“…Obesity also significantly increased the risk of total mortality as well as the risk of a fatal CVD event. The results of our study, with obesity increasing the risk of total mortality by 71% (model 1), are supported by an observational study from Italy that followed 3,398 type 2 diabetic patients for 10 years, showing that obesity increased the risk of overall mortality by 74% in younger patients (<65 years old) (adjustment as in model 1), whereas excess weight predicted better survival in older patients [16]. An increased risk for total mortality with obesity was seen in the large UK General Practice Research Database (GPRD) study on type 2 diabetic patients (N=44,230, age 35-89 years, followed from 1992 to 1998), showing 13% and 43% increases in risk for BMI 30-34 kg/m 2 and 35-54 kg/m 2 compared with 20-24 kg/m 2 , respectively (adjustment as in model 1) [28].…”

“…Overweight and obesity are associated with increased risks of cardiovascular morbidity and mortality in the general population [8][9][10][11][12][24][25][26][27], but only a few previous studies of type 2 diabetic patients have addressed the topic, and with somewhat conflicting results [13][14][15][16][28][29][30][31]. Our large observational study clearly shows an increased risk of fatal/non-fatal CHD (15%), stroke (11%), CVD (13%) and total mortality (27%) with a 5 unit increase in BMI at baseline after adjustment for age, sex, diabetes duration, type of hypoglycaemic treatment and smoking (model 1), and the risks were attenuated, but remained significant (except for stroke), when also adjusted for additional cardiovascular risk factors (e.g.…”

“…Studies have reported inverse, no or positive associations between increasing BMI and CVD and mortality [13][14][15][16]. Overweight and obesity are highly prevalent among diabetic patients [17][18].…”

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

“…1). Following detailed assessments, and after the inclusion of three articles identified from manual searches, 21 articles were included in the quantitative analysis (21 studies and 24 unique cohorts; Table 1) [7,8,11,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Study characteristics and the NOS scores are provided in ESM Tables 1-3.…”

Body mass index and risk of all‐cause and cardiovascular mortality in hospitalized elderly patients with diabetes mellitus

“…The association between BMI and survival in patients with Type 2 diabetes is complex and modified by age. Specifically, among individuals younger than 65 years of age, obesity (BMI > 30.9 kg ⁄ m 2 ) appears to increase risk of all-cause mortality, while, among individuals older than 65 years, obesity was associated with improved survival [17]. In a cohort of community-dwelling individuals with Type 2 diabetes, low BMI (< 26 kg ⁄ m 2 ) was associated with increased risk of all-cause, cardiovascular and non-cardiovascular mortality [18].…”