Acta Diabetologica

, Volume 55, Issue 6, pp 569–577 | Cite as

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

  • Rezvan Salehidoost
  • Asieh Mansouri
  • Massoud AminiEmail author
  • Sima Aminorroaya Yamini
  • Ashraf AminorroayaEmail author
Original Article



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.


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.


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.


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.


Mortality Diabetes mellitus Body mass index Obesity Death Overweight 



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

Authors’ contribution

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.


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

Compliance with ethical standards

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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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Isfahan Endocrine and Metabolism Research CenterIsfahan University of Medical SciencesIsfahanIran
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
  3. 3.Department of Engineering and MathematicsSheffield Hallam UniversitySheffieldUK

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