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Meta-Analysis
. 2017 Jan 3;12(1):e0168247.
doi: 10.1371/journal.pone.0168247. eCollection 2017.

Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis

Yeongkeun Kwon  1   2 , Hyun Jung Kim  3 , Sungsoo Park  2   4 , Yong-Gyu Park  5 , Kyung-Hwan Cho  1
Affiliations
Meta-Analysis

Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis

Yeongkeun Kwon et al. PLoS One. .

Abstract

Objective: We conducted a systematic review and meta-analysis of studies to quantify the association between body mass index (BMI) and the risks of all-cause and cardiovascular mortality in patients with type 2 diabetes.

Methods: We included studies assessing the impact of BMI on all-cause and cardiovascular mortality in patients with type 2 diabetes. Data were combined using a random-effects dose-response model.

Results: Sixteen cohort studies on all-cause mortality (n = 445,125) and two studies on cardiovascular mortality (n = 92,841) were evaluated in the meta-analysis. A non-linear association was observed between BMI and all-cause mortality among patients with type 2 diabetes. With a BMI nadir of 28-30 kg/m2, the risk of all-cause mortality displayed a U-shaped increase. With a BMI nadir of 29-31 kg/m2, the risk of cardiovascular mortality exhibited a gradual non-linear increase for BMI > 31 kg/m2. Subgroup analyses suggested that study location, diabetes duration, and smoking history may have contributed to heterogeneity among the studies.

Conclusions: An obesity paradox exists for patients with type 2 diabetes with respect to all-cause and cardiovascular mortality. Study location, diabetes duration, and smoking history might contribute to heterogeneity among obesity paradox studies of patients with type 2 diabetes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram for the selection of studies.
Fig 2
Fig 2. Dose-response associations between body mass index (BMI) and mortality among patients with type 2 diabetes.
(A) Non-linear dose-response relationship between BMI and all-cause mortality (P < 0.001). (B) Non-linear dose-response relationship between BMI and cardiovascular mortality (P < 0.001). Non-linear and linear plots are displayed with continuous and medium-dashed black lines, respectively. Long-dashed black lines depict 95% confidence intervals. The log-scale of the hazard ratios are presented on the vertical axes.
Fig 3
Fig 3. Subgroup analysis plots displaying non-linear dose-response relationships between body mass index (BMI) and all-cause mortality among patients with type 2 diabetes using pooled data from studies performed in (A) Western countries or (B) Asia, as well as those involving (C) patients with incident diabetes and (D) patients without smoking histories.
See this image and copyright information in PMC

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