Key result
Among patients with type 2 diabetes, a non-linear U-shaped association exists between BMI and all-cause mortality, with the lowest mortality risk observed at a BMI nadir of 28-30 kg/m2.
Why the study?
Does body mass index affect all-cause and cardiovascular mortality in patients with type 2 diabetes?
Meta-Analysis (n=445,125)
Does body mass index affect all-cause and cardiovascular mortality in patients with type 2 diabetes?
Effect estimate: HR 0.99 (95% CI 0.97-1.00)
p-value: p=0.04
An obesity paradox exists in patients with type 2 diabetes, where a BMI of 28-30 kg/m2 is associated with the lowest risk of all-cause mortality.
Questions strict normal-weight targets in T2D; leaves open whether BMI causally affects mortality in prospective trials.
OBJECTIVE: We conducted a systematic review and meta-analysis of studies to quantify the association between body mass index (BMI) and the risks of all-cause and cardiovascular mortality in patients with type 2 diabetes. METHODS: We included studies assessing the impact of BMI on all-cause and cardiovascular mortality in patients with type 2 diabetes. Data were combined using a random-effects dose-response model. RESULTS: Sixteen cohort studies on all-cause mortality (n = 445,125) and two studies on cardiovascular mortality (n = 92,841) were evaluated in the meta-analysis. A non-linear association was observed between BMI and all-cause mortality among patients with type 2 diabetes. With a BMI nadir of 28-30 kg/m2, the risk of all-cause mortality displayed a U-shaped increase. With a BMI nadir of 29-31 kg/m2, the risk of cardiovascular mortality exhibited a gradual non-linear increase for BMI > 31 kg/m2. Subgroup analyses suggested that study location, diabetes duration, and smoking history may have contributed to heterogeneity among the studies. CONCLUSIONS: An obesity paradox exists for patients with type 2 diabetes with respect to all-cause and cardiovascular mortality. Study location, diabetes duration, and smoking history might contribute to heterogeneity among obesity paradox studies of patients with type 2 diabetes.
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Kwon et al. (2017) conducted a meta-analysis in Type 2 diabetes (n=445,125). Body Mass Index (BMI) vs. Reference BMI category was evaluated on All-cause mortality (linear trend per 5 kg/m2 increase) (HR 0.99, 95% CI 0.97-1.00, p=0.04). Among patients with type 2 diabetes, a non-linear U-shaped association exists between BMI and all-cause mortality, with the lowest mortality risk observed at a BMI nadir of 28-30 kg/m2.
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