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Body Mass Index and the Risk of All-Cause Mortality Among Patients With Type 2 Diabetes | Journal Scan
Study Questions:
Is there an association between body mass index (BMI) and death risk among patients with diabetes mellitus?
Methods:
A cohort of 19,478 black and 15,354 white patients with type 2 diabetes mellitus was included in a prospective analysis. Cox proportional hazard regression models were used to estimate the association of different levels of BMI stratification with all-cause mortality.
Results:
During a mean follow-up of 8.7 years, 4,042 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/m2) 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 revealed a U-shaped association between BMI and 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/m2 and ≥35 kg/m2, and among whites with BMI <25 kg/m2 and ≥40 kg/m2 compared with patients with BMI of 30-34.9 kg/m2.
Perspective:
This is an important study that used administrative data from the Louisiana State University Health Care Services Division (which covers ~35% of the population of the state of Louisiana). It reveals a U-shaped all-cause mortality curve among patients with diabetes mellitus, with a risk nadir at ~30-35 kg/m2 for blacks and ~25-40 kg/m2 for whites. Although weight reduction should be of benefit in reducing all-cause mortality among obese patients with diabetes, this study, and others like it, raises the question of how to counsel, with respect to body weight, thin patients with diabetes.
Keywords: African Americans, Body Mass Index, Diabetes Mellitus, Type 2, European Continental Ancestry Group, Hypoglycemic Agents, Louisiana, Obesity, Smoking, Weight Loss
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