The obesity paradox in type 2 diabetes mellitus

Relationship of body mass index to prognosis a cohort study

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

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Abstract

Background: Whether obesity is associated with a better prognosis in patients with type 2 diabetes mellitus is controversial. Objective: To investigate the association between body weight and prognosis in a large cohort of patients with type 2 diabetes followed for a prolonged period. Design: Prospective cohort. Setting: National Health Service, England. Patients: Patients with diabetes. Measurements: The relationship between body mass index (BMI) and prognosis in patients with type 2 diabetes without known cardiovascular disease at baseline was investigated. Information on all-cause mortality and cardiovascular morbidity (such as the acute coronary syndrome, cerebrovascular accidents, and heart failure) was collected. Cox regression survival analysis, corrected for potential modifiers, including cardiovascular risk factors and comorbid conditions (such as cancer, chronic kidney disease, and lung disease), was done. Results: 10 568 patients were followed for a median of 10.6 years (interquartile range, 7.8 to 13.4). Median age was 63 years (interquartile range, 55 to 71), and 54% of patients were men. Overweight or obese patients (BMI>25 kg/m2) had a higher rate of cardiac events (such as the acute coronary syndrome and heart failure) than those of normal weight (BMI, 18.5 to 24.9 kg/ m2). However, being overweight (BMI, 25 to 29.9 kg/m2) was associated with a lower mortality risk, whereas obese patients (BMI>30 kg/m2) had a mortality risk similar to that of normalweight persons. Patients with low body weight had the worst prognosis. Limitation: Data about cause of death were not available. Conclusion: In this cohort, patients with type 2 diabetes who were overweight or obese were more likely to be hospitalized for cardiovascular reasons. Being overweight was associated with a lower mortality risk, but being obese was not.

Original languageEnglish
Pages (from-to)610-618
Number of pages9
JournalAnnals of Internal Medicine
Volume162
Issue number9
DOIs
Publication statusPublished - 5 May 2015
Externally publishedYes

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Type 2 Diabetes Mellitus
Body Mass Index
Cohort Studies
Obesity
Mortality
Acute Coronary Syndrome
Heart Failure
Body Weight
Kidney Neoplasms
National Health Programs
Survival Analysis
Chronic Renal Insufficiency
England
Lung Diseases
Cause of Death
Cardiovascular Diseases
Stroke
Regression Analysis
Morbidity
Weights and Measures

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Costanzo, P., Cleland, J. G. F., Pellicori, P., Clark, A. L., Hepburn, D., Kilpatrick, E. S., ... Atkin, S. (2015). The obesity paradox in type 2 diabetes mellitus: Relationship of body mass index to prognosis a cohort study. Annals of Internal Medicine, 162(9), 610-618. https://doi.org/10.7326/M14-1551

The obesity paradox in type 2 diabetes mellitus : Relationship of body mass index to prognosis a cohort study. / Costanzo, Pierluigi; Cleland, John G F; Pellicori, Pierpaolo; Clark, Andrew L.; Hepburn, David; Kilpatrick, Eric S.; Perrone-Filardi, Pasquale; Zhang, Jufen; Atkin, Stephen.

In: Annals of Internal Medicine, Vol. 162, No. 9, 05.05.2015, p. 610-618.

Research output: Contribution to journalArticle

Costanzo, P, Cleland, JGF, Pellicori, P, Clark, AL, Hepburn, D, Kilpatrick, ES, Perrone-Filardi, P, Zhang, J & Atkin, S 2015, 'The obesity paradox in type 2 diabetes mellitus: Relationship of body mass index to prognosis a cohort study', Annals of Internal Medicine, vol. 162, no. 9, pp. 610-618. https://doi.org/10.7326/M14-1551
Costanzo, Pierluigi ; Cleland, John G F ; Pellicori, Pierpaolo ; Clark, Andrew L. ; Hepburn, David ; Kilpatrick, Eric S. ; Perrone-Filardi, Pasquale ; Zhang, Jufen ; Atkin, Stephen. / The obesity paradox in type 2 diabetes mellitus : Relationship of body mass index to prognosis a cohort study. In: Annals of Internal Medicine. 2015 ; Vol. 162, No. 9. pp. 610-618.
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