Original Research
5 May 2015

The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis: A Cohort Study

Publication: Annals of Internal Medicine
Volume 162, Number 9

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 normal-weight 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.

Primary Funding Source:

National Institute for Health Research and University of Hull.

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 162Number 95 May 2015
Pages: 610 - 618

History

Published online: 5 May 2015
Published in issue: 5 May 2015

Keywords

Authors

Affiliations

Pierluigi Costanzo, MD, MSc
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
John G.F. Cleland, MD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Pierpaolo Pellicori, MD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Andrew L. Clark, MD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
David Hepburn, MD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Eric S. Kilpatrick, MD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Pasquale Perrone-Filardi, MD, PhD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Jufen Zhang, MSc, PhD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Stephen L. Atkin, MD, PhD
From Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom; Castle Hill Hospital, Cottingham, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom; and Federico II University, Naples, Italy.
Grant Support: By the National Institute for Health Research, the academic cardiology unit of the Hull York Medical School at the University of Hull, and Imperial College London.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Costanzo (e-mail, [email protected]). Data set: Not available.
Corresponding Author: Pierluigi Costanzo, MD, MSc, Academic Cardiology Unit, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham HU16 5JQ, United Kingdom; e-mail, [email protected].
Current Author Addresses: Drs. Costanzo, Pellicori, and Zhang and Prof. Clark: Academic Cardiology Unit, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham HU16 5JQ, United Kingdom.
Prof. Cleland: National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, Hill End Road, Harefield, London UB9 6JH, United Kingdom.
Dr. Hepburn: The Michael White Centre for Diabetes and Endocrinology, H.S. Brocklehurst Building, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom.
Prof. Kilpatrick: Department of Clinical Biochemistry, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom.
Prof. Perrone-Filardi: Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini 5, Naples, Italy 80131.
Prof. Atkin: Weill Cornell Medical College Qatar, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar.
Author Contributions: Conception and design: P. Costanzo, J.G.F. Cleland, S.L. Atkin.
Analysis and interpretation of the data: P. Costanzo, J.G.F. Cleland, A.L. Clark, J. Zhang, S.L. Atkin.
Drafting of the article: P. Costanzo, J.G.F. Cleland, A.L. Clark, S.L. Atkin.
Critical revision of the article for important intellectual content: J.G.F. Cleland, P. Pellicori, A.L. Clark, D. Hepburn, P. Perrone-Filardi, S.L. Atkin.
Final approval of the article: P. Costanzo, J.G.F. Cleland, P. Pellicori, A.L. Clark, D. Hepburn, E.S. Kilpatrick, P. Perrone-Filardi, J. Zhang, S.L. Atkin.
Provision of study materials or patients: P. Costanzo, D. Hepburn, E.S. Kilpatrick, S.L. Atkin.
Statistical expertise: P. Costanzo, J. Zhang.
Obtaining of funding: P. Costanzo, J.G.F. Cleland, S.L. Atkin.
Administrative, technical, or logistic support: P. Costanzo, S.L. Atkin.
Collection and assembly of data: P. Costanzo, D. Hepburn, E.S. Kilpatrick, S.L. Atkin.

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Pierluigi Costanzo, John G.F. Cleland, Pierpaolo Pellicori, et al. The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis: A Cohort Study. Ann Intern Med.2015;162:610-618. [Epub 5 May 2015]. doi:10.7326/M14-1551

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