The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis

Costanzo, Pierluigi; Cleland, John G.F.; Pellicori, Pierpaolo; Clark, Andrew L.; Hepburn, David; Kilpatrick, Eric S.; Perrone‐Filardi, Pasquale; Zhang, Jufen; Atkin, Stephen L.

doi:10.7326/m14-1551

Cited by 163 publications

(177 citation statements)

References 46 publications

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“…In summary, the U-shaped relationship was reported in eleven studies (6)(7)(8)10,16,19,(21)(22)(23)(24)26). The lowest risk of mortality was found in patients with overweight in eight out of eleven studies (6)(7)(8)16,21,22,24,26), and in those with obesity in other three studies (10,19,23). In contrast, three studies found that an inverse rather than a U-shaped relationship between BMI and all-cause mortality (17,18,20).…”

Section: Discussionmentioning

confidence: 99%

“…The mean follow-up period was from 2.7 years (23) to 16 years (22). In all studies, the HRs were obtained by the adjustments for traditional vascular risk factors, and in some studies, the HRs were additionally controlled for other confounding factors, such as duration of diabetes (6,16,17,21,22,24,25), diabetic complications (9,21), menopause status (7,18), comorbid condition (16,18), and glomerular filtration rate (10).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Overall, 16 cohort studies with a total number of 385,925 patients were included in the analysis (6)(7)(8)(9)(10)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Study design, patients' characteristics, mean follow-up years, BMI category and its effect on mortality are summarized in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

Chang

Hsieh

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis. Methods:We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m 2 ) levels: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method.Results: As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32-1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78-0.96, and 0.88, 95% CI: 0.78-1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84-1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74-0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons.Conclusions: Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes. The significant heterogeneity among studies suggested that many confounders such as sex difference may affect the association.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

Chang

Hsieh

et al. 2016

Cardiovasc. Diagn. Ther.

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“…A recent study investigating the relationship between BMI and mortality in 10,568 people with type 2 diabetes found a lower mortality risk in overweight (BMI ≥25 kg/m 2 ), higher mortality risk in underweight (≤18.5 kg/m 2 ), and a similar mortality risk in obese (BMI ≥30 kg/m 2 ) people compared with those with normal weight, indicating a nonlinear association between BMI and all-cause mortality [12]. A recent systematic review including nine studies reported a reduced risk of all-cause mortality in overweight and obese people with type 2 diabetes when compared with normal or non-overweight people and a 5% progressive decrease in mortality for every 5 kg/m 2 increase in BMI [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Aims/hypothesis The relationship between BMI and mortality has been extensively investigated in the general population; however, it is less clear in people with type 2 diabetes. We aimed to assess the association of BMI with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Methods We searched electronic databases up to 1 March 2016 for prospective studies reporting associations for three or more BMI groups with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Study-specific associations between BMI and the most-adjusted RR were estimated using restricted cubic splines and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis. Results We included 21 studies including 24 cohorts, 414,587 participants, 61,889 all-cause and 4470 cardiovascular incident deaths; follow-up ranged from 2.7 to 15.9 years. There was a strong nonlinear relationship between BMI and all-cause mortality in both men and women, with the lowest estimated risk from 31-35 kg/m 2 and 28-31 kg/m 2 (p value for nonlinearity <0.001) respectively. The risk of mortality at higher BMI values increased significantly only in women, whilst lower values were associated with higher mortality in both sexes. Limited data for cardiovascular mortality were available, with a possible inverse linear association with BMI (higher risk for BMI <27 kg/m 2 ). Conclusions/interpretation In type 2 diabetes, BMI is nonlinearly associated with all-cause mortality with lowest risk in the overweight group in both men and women. Further research is needed to clarify the relationship with cardiovascular mortality and assess causality and sex differences.

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“…Obesity contributes to the etiologies of various comorbid conditions, such as cardiovascular disease, hypertension and type 2 diabetes (Wendel et al, 2008;Costanzo et al, 2015). In addition to storing lipid for energy, adipose secretes a variety of adipokines, many of which affect metabolism and inflammation in adipose and non-adipose tissues.…”

Section: Introductionmentioning

confidence: 99%

<i>In vitro</i> antioxidant and anti-adipogenic effects of slendesta, standard potato extracts containing 5% protease inhibitor II

Lee¹,

Park²,

Kang³

et al. 2016

Afr. J. Trad. Compl. Alt. Med.

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The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis

Abstract: National Institute for Health Research and University of Hull.

Cited by 163 publications

References 46 publications

Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

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

<i>In vitro</i> antioxidant and anti-adipogenic effects of slendesta, standard potato extracts containing 5% protease inhibitor II

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