title: Association of weight status with mortality in adults with incident diabetes.
abstract: BACKGROUND
  Type 2 diabetes in normal-weight adults (body mass index [BMI] <25) is a representation of the metabolically obese normal-weight phenotype with unknown mortality consequences.
  
  
  OBJECTIVE
  To test the association of weight status with mortality in adults with new-onset diabetes in order to minimize the influence of diabetes duration and voluntary weight loss on mortality.
  
  
  METHODS
  Pooled analysis of 5 longitudinal cohort studies: Atherosclerosis Risk in Communities study, 1990-2006; Cardiovascular Health Study, 1992-2008; Coronary Artery Risk Development in Young Adults, 1987-2011; Framingham Offspring Study, 1979-2007; and Multi-Ethnic Study of Atherosclerosis, 2002-2011. A total of 2625 participants with incident diabetes contributed 27,125 person-years of follow-up. Included were men and women (age >40 years) who developed incident diabetes based on fasting glucose 126 mg/dL or greater or newly initiated diabetes medication and who had concurrent measurements of BMI. Participants were classified as normal weight if their BMI was 18.5 to 24.99 or overweight/obese if BMI was 25 or greater.
  
  
  METHODS
  Total, cardiovascular, and noncardiovascular mortality.
  
  
  RESULTS
  The proportion of adults who were normal weight at the time of incident diabetes ranged from 9% to 21% (overall 12%). During follow-up, 449 participants died: 178 from cardiovascular causes and 253 from noncardiovascular causes (18 were not classified). The rates of total, cardiovascular, and noncardiovascular mortality were higher in normal-weight participants (284.8, 99.8, and 198.1 per 10,000 person-years, respectively) than in overweight/obese participants (152.1, 67.8, and 87.9 per 10,000 person-years, respectively). After adjustment for demographic characteristics and blood pressure, lipid levels, waist circumference, and smoking status, hazard ratios comparing normal-weight participants with overweight/obese participants for total, cardiovascular, and noncardiovascular mortality were 2.08 (95% CI, 1.52-2.85), 1.52 (95% CI, 0.89-2.58), and 2.32 (95% CI, 1.55-3.48), respectively.
  
  
  CONCLUSIONS
  Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Ste 1400, Chicago, IL 60611, USA. carnethon@northwestern.edu
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.forename: Peter John D
authors.initials: PJ
authors.lastname: De Chavez
authors.forename: Mary L
authors.initials: ML
authors.lastname: Biggs
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: Sherita H
authors.initials: SH
authors.lastname: Golden
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: Brenda
authors.initials: B
authors.lastname: Campbell-Jenkins
authors.forename: Alan R
authors.initials: AR
authors.lastname: Dyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D014481:United States / Q000453:epidemiology