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Body mass index and the all-cause mortality rate in patients with type 2 diabetes mellitus

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Abstract

Aims

The relationship between obesity and mortality rate among diabetic patients is a controversial topic. The aim of this study was to investigate the association between obesity and all-cause mortality risk in patients with type 2 diabetes.

Methods

In this retrospective database study, 2383 patients with type 2 diabetes, who had been registered in the Isfahan Endocrine and Metabolism Research Center, Iran, were enrolled between 1992 and 2010. The mean (SD) of diabetes duration and follow-up period was 15.5 (8.0) and 7.8 (3.9) years. The main outcome was all-cause mortality. All-cause mortality rates were calculated for the body mass index (BMI) categories of underweight, normal, overweight and class I, II and III obese. Cox proportional hazard models were used to estimate the adjusted hazard ratio for BMI as categorical variable using BMI of 18.5–24.9 kg/m2 as the reference group.

Results

The mortality rate in patients with normal weight was higher than overweight patients (59.11 vs. 33.17 per 1000 person-years). The adjusted hazard ratios of all-cause mortality were 0.82 [95%CI 0.68–0.99; P = 0.037], 0.79 [95%CI 0.61–1.02; P = 0.069], 0.71 [95%CI 0.42–1.19; P = 0.191] and 1.36 [95%CI 0.55–3.33; P = 0.507] for overweight, class I, II and III obesity, respectively. When BMI was included in the Cox model as a time-dependent variable, the U-shaped relationship between BMI and all-cause mortality did not change.

Conclusions

The results show a U-shaped association of BMI with all-cause mortality in patients with type 2 diabetes with the lowest risk observed among the overweight patients.

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Acknowledgements

We would like to thank Mr. Majid Abyar for technical computer assistance and all the patients for participation in this study.

Funding

The study was funded by Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Author information

Authors and Affiliations

  1. Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Sedigheh Tahereh Medical Research Complex, Khorram Street, Isfahan, 8187698191, Iran

    Rezvan Salehidoost, Massoud Amini & Ashraf Aminorroaya

  2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Asieh Mansouri

  3. Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield, S1 1WB, UK

    Sima Aminorroaya Yamini

Authors
  1. Rezvan Salehidoost
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  2. Asieh Mansouri
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  3. Massoud Amini
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  4. Sima Aminorroaya Yamini
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  5. Ashraf Aminorroaya
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Contributions

Dr. Rezvan Salehidoost designed the study, wrote the manuscript and contributed to discussion. Dr. Asieh Mansouri contributed to the statistical analysis and interpretation of data. Prof. Massoud Amini contributed to conducting the research, interpreting the data and reviewed the manuscript. Dr. Sima Aminorroaya contributed to writing the manuscript and discussion. Prof. Ashraf Aminorroaya contributed to conducting the research, interpreting the data and reviewed the manuscript.

Corresponding authors

Correspondence to Massoud Amini or Ashraf Aminorroaya.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Isfahan University of Medical Sciences.

Informed consent

Informed consent was obtained from all patients for precipitation and registration.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Managed by Antonio Secchi.

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Salehidoost, R., Mansouri, A., Amini, M. et al. Body mass index and the all-cause mortality rate in patients with type 2 diabetes mellitus. Acta Diabetol 55, 569–577 (2018). https://doi.org/10.1007/s00592-018-1126-y

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  • DOI: https://doi.org/10.1007/s00592-018-1126-y

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