TY - JOUR
T1 - Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes.
AU - Jackson, Chandra L.
AU - Yeh, Hsin Chieh
AU - Szklo, Moyses
AU - Hu, Frank B.
AU - Wang, Nae Yuh
AU - Dray-Spira, Rosemary
AU - Brancati, Frederick Louis
N1 - Funding Information:
Acknowledgements: Drs. Brancati, Yeh and Wang were supported by a Diabetes Research and Training Center grant from NIDDK (P60 DK079637). Dr. Brancati was supported by a grant from NIDDK (K24 DK62222), Dr. Yeh was supported by a grant from NHLBI (P50HL105187) and Dr. Wang was supported by a grant from NCATS (UL1 RR025005). Drs. Hu and Jackson were supported by TREC (1U54CA155626-01). The funding sources were not involved in the data collection, data analysis, manuscript writing or publication. Our beloved colleague, Dr. Brancati, died before the final acceptance of this study.
PY - 2014/1
Y1 - 2014/1
N2 - Previous studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status. To determine if diabetes influences the BMI-mortality relationship. Using a prospective study design, we analyzed data from a nationally representative sample of US adults participating in the National Health Interview Survey from 1997 to 2002, and followed for mortality through 2006. Excluding those with heart disease or cancer, our final analytic sample included 74,710 (34,805 never smoker) adults. BMI was calculated from self-reported height and weight. Diabetes status was based on self-reported diagnosis from a health professional. We used direct age standardization to calculate all-cause mortality rates and adjusted Cox models for all-cause mortality hazard ratios by BMI quintile; this was done separately for adults with diabetes and without diabetes. Among never smokers, mean age was 50.1 years and 43 % were men. Mean BMI was 27.4 kg/m(2), 26 % were obese, and 2,035 (5 %) reported diagnosed diabetes. After 9 years, there were 4,355 deaths (754 of 4,740 with diabetes; 3,601 of 69,970 without) among 74,710 participants, and 1,238 (247 of 2,035 with diabetes; 991 of 32,770 without) among 34,805 never smokers. We observed a qualitative interaction with diabetes on the BMI-mortality relationship (p = 0.002). Death rates were substantially higher among participants with diabetes compared to those without diabetes across all BMI quintiles. However, death rates in participants with diabetes fell with increasing BMI quintile, while rates followed a J-shaped curve among those without diabetes. In adjusted Cox models, BMI was positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes. Mortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.
AB - Previous studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status. To determine if diabetes influences the BMI-mortality relationship. Using a prospective study design, we analyzed data from a nationally representative sample of US adults participating in the National Health Interview Survey from 1997 to 2002, and followed for mortality through 2006. Excluding those with heart disease or cancer, our final analytic sample included 74,710 (34,805 never smoker) adults. BMI was calculated from self-reported height and weight. Diabetes status was based on self-reported diagnosis from a health professional. We used direct age standardization to calculate all-cause mortality rates and adjusted Cox models for all-cause mortality hazard ratios by BMI quintile; this was done separately for adults with diabetes and without diabetes. Among never smokers, mean age was 50.1 years and 43 % were men. Mean BMI was 27.4 kg/m(2), 26 % were obese, and 2,035 (5 %) reported diagnosed diabetes. After 9 years, there were 4,355 deaths (754 of 4,740 with diabetes; 3,601 of 69,970 without) among 74,710 participants, and 1,238 (247 of 2,035 with diabetes; 991 of 32,770 without) among 34,805 never smokers. We observed a qualitative interaction with diabetes on the BMI-mortality relationship (p = 0.002). Death rates were substantially higher among participants with diabetes compared to those without diabetes across all BMI quintiles. However, death rates in participants with diabetes fell with increasing BMI quintile, while rates followed a J-shaped curve among those without diabetes. In adjusted Cox models, BMI was positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes. Mortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.
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U2 - 10.1007/s11606-013-2553-7
DO - 10.1007/s11606-013-2553-7
M3 - Article
C2 - 23929218
AN - SCOPUS:84898040671
SN - 0884-8734
VL - 29
SP - 25
EP - 33
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 1
ER -