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Higher BMI in type 2 diabetes did not improve all-cause mortality risk
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Recent data suggest that there is no protective effect of overweight or obesity on mortality compared with those of normal weight in patients with type 2 diabetes.
“These data dispel the notion that being overweight or obese confers survival advantage among diabetic patients,” Frank Hu, MD, MPH, PhD, professor of nutrition and epidemiology at Harvard School of Public Health, said in a press release. “Clearly, weight management is an important therapeutic strategy for overweight or obese individuals with type 2 diabetes.”
Those with incident diabetes from the Nurses’ Health Study (n=8,970) and Health Professionals Follow-up Study (n=2,457) were evaluated during a 15.8-year follow-up; and 3,083 patients died within that period.
Frank Hu
The researchers reported a J-shaped association across all BMI categories for all-cause mortality:
- 18.5-22.4 (HR=1.29; 95% CI, 1.05-1.59);
- 22.5-24.9 (HR=1 for reference);
- 25-27.4 (HR=1.12; 95% CI, 0.98-1.29);
- 27.5-29.9 (HR=1.09; 95% CI, 0.94-1.26);
- 30-34.9 (HR=1.24; 95% CI, 1.08-1.42); and
- ≥35 (HR=1.33; 95% CI, 1.14-1.55).
They also observed that the association was linear among participants who had never smoked, but found the interaction to be nonlinear among patients who smoked (P=.04) according to data.
“In most studies of BMI and mortality, ‘normal weight’ reference groups are comprised of not only those who are lean and healthy, but also smokers as well as people with existing or undiagnosed illnesses. This can skew the relationship between weight and mortality to make the normal weight group seem worse off than the overweight and obese groups. As a result, people with higher BMIs might have artificially improved survival rates,” Deirdre K. Tobias, ScD, a research fellow in the department of nutrition at Harvard School of Public Health, said in the press release. “After carefully controlling for many of these factors in our analysis, we observed that excess weight in those with diabetes was not advantageous for survival. These findings underscore the importance of addressing methodological biases in the analysis of BMI and mortality.”
Age presented a direct linear relationship between BMI and all-cause mortality among patients younger than 65 years at the time of diabetes diagnosis, according to researchers. Conversely, data indicate this was not the case among patients aged at least 65 years at the time of diagnosis (P<.001).
“Further evidence is needed to corroborate our findings in other populations,” researchers wrote.
Disclosure: Hu reports financial ties with Novo Nordisk. All other researchers report no relevant financial disclosures.
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