Association of weight status with mortality in adults with incident diabetes.

Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE

Original Publication: Chicago : American Medical Association, 1960-

Body Weight*; Cardiovascular Diseases/*mortality ; Diabetes Mellitus, Type 2/*mortality; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Cause of Death ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Obesity/epidemiology ; Overweight/epidemiology ; United States/epidemiology

Context: 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.
Design, Setting, and Participants: 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.
Main Outcome Measures: 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.
Conclusion: Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese.

Erratum in: JAMA. 2012 Nov 28;308(20):2085.
Comment in: JAMA. 2012 Aug 8;308(6):619-20. (PMID: 22871873)
Comment in: Nat Rev Endocrinol. 2012 Oct;8(10):567. (PMID: 22926099)
Comment in: Dtsch Med Wochenschr. 2012 Oct;137(42):2140. (PMID: 23055352)
Comment in: JAMA. 2012 Nov 28;308(20):2079; author reply 2080-1. (PMID: 23188014)
Comment in: JAMA. 2012 Nov 28;308(20):2079-80; author reply 2080-1. (PMID: 23188015)
Comment in: JAMA. 2012 Nov 28;308(20):2080; author reply 2080-1. (PMID: 23188016)

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Date Created: 20120809 Date Completed: 20120809 Latest Revision: 20220408

20240628

PMC3467944

10.1001/jama.2012.9282

22871870