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Association of Weight Status With Mortality in Adults With Incident Diabetes
Open accessAbstract
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.
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“the case is strong that such a paradoxical relation exists in the elderly, 7 and accompanying a broad range of illnesses, including diabetes mellitus, 8 chronic heart failure, 9,10 acute heart failure, 11 coronary artery disease, 12 and percutaneous coronary artery interventions.13”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [8]
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Metadata
- Authors
- Carnethon, M. R., De Chavez, P. J. D., Biggs, M. L., Lewis, C. E., Pankow, J. S., Bertoni, A. G., Golden, S. H., Liu, K., Mukamal, K. J., Campbell-Jenkins, B., & Dyer, A. R.
- Affiliations
- Northwestern University (US)
- University of Washington (US)
- University of Alabama (US)
- University of Minnesota (US)
- Wake Forest University Health Sciences (US)
- Johns Hopkins University (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Carnethon, Mercedes R.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-08-08
- Volume
- 308
- Issue
- 6
- Pages
- 581-90
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3467944
- OpenAlex
- W2040767736
- Cited by
- 567
- References
- 36
- Citations by year
- 2026: 16 · 2025: 18 · 2024: 32 · 2023: 36 · 2022: 26 · 2021: 31 · 2020: 38 · 2019: 36 · 2018: 47 · 2017: 41 · 2016: 54 · 2015: 45 · 2014: 70 · 2013: 59 · 2012: 16
- FWCI
- 48.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95095-66-0-1, n01hc95164-17-0-1, n01hc085082-026, n01hc085081-021, n01hc045133-001, n01hc48050-59-0-1, n01hc085079-024, n01hc015103-009, n01hc48048-58-0-1, n01hc085084-005, n01hc55021-47-0-1, n01hc085085-011, n01hc085083-027, n01hc95165-34-0-1, n01hc48047-55-0-1, n01hc55020-39-0-0, n01hc085080-026, n01hc55016-37-0-0, n01hc055022-024, n01hc95161-24-0-1, n01hc095169-003, n01hc085086-022, n01hc48049-61-0-1, n01hc95162-31-0-1, n01hc55019-35-0-1, n01hc95160-18-0-1, n01hc55018-38-0-1, n01hc95163-22-0-1, n01hc55222-0-0-0, n01hc95159-40-0-1, n01hc075150-004, n01hc035129-010, n01hc55015-48-0-1)
- National Institute on Aging (AG 20098, R56AG023629, R01AG020098, AG023629, AG027058, R56AG020098, R01AG023629, R01AG015928, R01AG027058)
- National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01-HC55022, N01 HC085086, N01HC48050, N01HC-85083, N01 HC-95159, N01-HC-95160, N01 HC055016, N01-HC-55018, N01-HC095169, N01-HC-095165, N0-1-HC-85239, N01 HC 95095, N01 HC 55020, N01 HC085079, (N01-HC-95163, N01 HC 55019, N01HC85082, N01HC‐75150, N01 HC85086, N01 HC-95161, N01 HC95165, N01HC95164, N01 HC048048, N01 HC055020, N01 HC035129, N01-HC-048049, N01HC85080, N01-HC-095159, N01 HC055018, N01 HC015103, N01 HC095095, N01 HC55222, N01 HC048050, N01-HC48048, N01-HC55016, N01 HC055022, N01-HC-48-049, U01HL080295, N01 HC055019, N01 HC055222, N01 HC048047, N01-HC-480-47, HL080295, R01HL080295, N01‐HC‐55015, N01 HC-95162, N01-HC55021, N01 HC075150, N01 HC055021, N01 HC055015, N01 HC045133, R01HL078972, N01-HC85079, N01-HC85084, N01 HC95169)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079637, R21DK082903)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- type 2 diabetes, normal-weight individuals, body mass index, weight status, mortality, cardiovascular mortality, non-cardiovascular mortality, new-onset diabetes, overweight and obesity, diabetes duration, weight loss, cardiovascular risk factors, sex differences, racial and ethnic differences, socioeconomic status, alcohol consumption, physical activity
- MeSH terms
- Adult, Aged, Aged, 80 and over, Body Weight, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 2, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, United States, Body Mass Index, Overweight
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