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


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).
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Wenhui
W
Zhao
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Peter T
PT
Katzmarzyk
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Ronald
R
Horswell
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Yujie
Y
Wang
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Weiqin
W
Li
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Jolene
J
Johnson
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Steven B
SB
Heymsfield
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
William T
WT
Cefalu
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.).
Donna H
DH
Ryan
From the Pennington Biomedical Research Center, Baton Rouge, LA (W.Z., PT.K., R.H., Y.W., W.L., S.B.H., W.T.C., D.H.R., G.H.); China Japan Friendship Hospital, Beijing, China (W.Z.); Tianjin Women's and Children's Health Center, Tianjin, China (W.L.); and LSU Health Baton Rouge, Baton Rouge, LA (J.J.). gang.hu@pbrc.edu.
Gang
G
Hu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D044465:White People / Q000208:ethnology
body mass index; cohort studies; death; diabetes mellitus, type 2