Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Dec 9;130(24):2143-51.
doi: 10.1161/CIRCULATIONAHA.114.009098. Epub 2014 Nov 5.

Body mass index and the risk of all-cause mortality among patients with type 2 diabetes mellitus

Wenhui Zhao  1 , Peter T Katzmarzyk  1 , Ronald Horswell  1 , Yujie Wang  1 , Weiqin Li  1 , Jolene Johnson  1 , Steven B Heymsfield  1 , William T Cefalu  1 , Donna H Ryan  1 , Gang Hu  2
Affiliations
Comparative Study

Body mass index and the risk of all-cause mortality among patients with type 2 diabetes mellitus

Wenhui Zhao et al. Circulation. .

Abstract

Background: Several prospective studies have evaluated the association between body mass index (BMI) and death risk among patients with diabetes mellitus; however, the results have been inconsistent.

Methods and results: We performed a prospective cohort study of 19 478 black and 15 354 white patients with type 2 diabetes mellitus. Cox proportional hazards regression models were used to estimate the association of different levels of BMI stratification with all-cause mortality. During a mean follow-up of 8.7 years, 4042 deaths were identified. The multivariable-adjusted (age, sex, smoking, income, and type of insurance) hazard ratios for all-cause mortality associated with BMI levels (18.5-22.9, 23-24.9, 25-29.9, 30-34.9 [reference group], 35-39.9, and ≥40 kg/m(2)) at baseline were 2.12 (95% confidence interval [CI], 1.80-2.49), 1.74 (95% CI, 1.46-2.07), 1.23 (95% CI, 1.08-1.41), 1.00, 1.19 (95% CI, 1.03-1.39), and 1.23 (95% CI, 1.05-1.43) for blacks and 1.70 (95% CI, 1.42-2.04), 1.51 (95% CI, 1.27-1.80), 1.07 (95% CI, 0.94-1.21), 1.00, 1.07 (95% CI, 0.93-1.23), and 1.20 (95% CI, 1.05-1.38) for whites, respectively. When stratified by age, smoking status, patient type, or the use of antidiabetic drugs, a U-shaped association was still present. When BMI was included in the Cox model as a time-dependent variable, the U-shaped association of BMI with all-cause mortality risk did not change.

Conclusions: The present study indicated a U-shaped association of BMI with all-cause mortality risk among black and white patients with type 2 diabetes mellitus. A significantly increased risk of all-cause mortality was observed among blacks with BMI <30 kg/m(2) and ≥35 kg/m(2) and among whites with BMI <25 kg/m(2) and ≥40 kg/m(2) compared with patients with BMI of 30 to 34.9 kg/m(2).

Keywords: body mass index; cohort studies; death; diabetes mellitus, type 2.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Hazard ratios for all-cause mortality based on different levels of BMI at baseline and during follow-up among African American and white patients with type 2 diabetes. Adjusted for age, sex, type of insurance, income, and smoking.
Figure 1
Figure 1
Hazard ratios for all-cause mortality based on different levels of BMI at baseline and during follow-up among African American and white patients with type 2 diabetes. Adjusted for age, sex, type of insurance, income, and smoking.
Figure 1
Figure 1
Hazard ratios for all-cause mortality based on different levels of BMI at baseline and during follow-up among African American and white patients with type 2 diabetes. Adjusted for age, sex, type of insurance, income, and smoking.
Figure 1
Figure 1
Hazard ratios for all-cause mortality based on different levels of BMI at baseline and during follow-up among African American and white patients with type 2 diabetes. Adjusted for age, sex, type of insurance, income, and smoking.
See this image and copyright information in PMC

Comment in

References

    1. Cheng YJ, Imperatore G, Geiss LS, Wang J, Saydah SH, Cowie CC, Gregg EW. Secular changes in the age-specific prevalence of diabetes among u.S. Adults: 1988–2010. Diabetes Care. 2013;36:2690–2696. Epub 2013 May 1. - PMC - PubMed
    1. Kodama S, Horikawa C, Fujihara K, Heianza Y, Hirasawa R, Yachi Y, Sugawara A, Tanaka S, Shimano H, Iida KT, Saito K, Sone H. Comparisons of the strength of associations with future type 2 diabetes risk among anthropometric obesity indicators, including waist-to-height ratio: A meta-analysis. Am J Epidemiol. 2012;176:959–969. - PubMed
    1. Carnethon MR, De Chavez PJ, Biggs ML, Lewis CE, Pankow JS, Bertoni AG, Golden SH, Liu K, Mukamal KJ, Campbell-Jenkins B, Dyer AR. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308:581–590. - PMC - PubMed
    1. Doehner W, Erdmann E, Cairns R, Clark AL, Dormandy JA, Ferrannini E, Anker SD. Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co-morbidity: An analysis of the proactive study population. Int J Cardiol. 2012;162:20–26. - PubMed
    1. Kokkinos P, Myers J, Faselis C, Doumas M, Kheirbek R, Nylen E. Bmi-mortality paradox and fitness in african american and caucasian men with type 2 diabetes. Diabetes Care. 2012;35:1021–1027. - PMC - PubMed

Publication types