Skip to main content

Advertisement

SpringerLink
Log in

Overweight, obesity and risk of all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus: a dose–response meta-analysis of prospective cohort studies

  • META-ANALYSIS
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Overweight and obese individuals with type 2 diabetes are recommended to lose weight, but the associations between excess body weight and all-cause and cardiovascular mortality in patients with type 2 diabetes remain controversial. Therefore, we performed a dose–response meta-analysis to investigate this association. We searched PubMed and Embase through 19th October 2014 and examined the references of retrieved articles to identify relevant prospective cohort studies. A random-effect model was used to calculate the summary risk estimates. Nine studies including 13 cohorts with 161,984 participants were identified. The relative risks (RRs) of all-cause mortality in overweight and obese patients with type 2 diabetes were 0.81 (95 % confidence interval (CI) 0.74–0.90) and 0.72 (95 % CI 0.63–0.81) respectively, compared with the normal or non-overweight patients. Furthermore, a 5 kg/m2 increase in body mass index was associated with a significantly reduced risk of all-cause mortality by 5 % (RR 0.95, 95 % CI 0.93–0.97). However, no significant association was found between obese and/or overweight and the risk of cardiovascular mortality in type 2 diabetic patients (RR 0.89; 95 % CI 0.66–1.20 for overweight and RR 0.77; 95 % CI 0.54–1.10 for obesity, respectively). The findings from the present meta-analysis indicate that excess body weight may be a protective factor for all-cause mortality among patients with type 2 diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.

    Article  PubMed  Google Scholar 

  2. Sluik D, Boeing H, Montonen J, et al. Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus. Am J Epidemiol. 2011;174(1):22–34. doi:10.1093/aje/kwr048.

    Article  PubMed  Google Scholar 

  3. Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American diabetes association. Diabetes Care. 2008;31:S61–78.

    Article  CAS  PubMed  Google Scholar 

  4. Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol. 2006;26(5):968–76.

    Article  CAS  PubMed  Google Scholar 

  5. McEwen LN, Karter AJ, Waitzfelder BE, et al. Predictors of mortality over 8 years in type 2 diabetic patients: translating research into action for diabetes (TRIAD). Diabetes Care. 2012;35(6):1301–9. doi:10.2337/dc11-2281.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23). BMJ (Clin Res ed.). 1998;316(7134):823–8.

    Article  CAS  Google Scholar 

  7. Jackson CL, Yeh HC, Szklo M, et al. Body mass index and all-cause mortality in US adults with and without diabetes. J Gen Intern Med. 2014;29(1):25–33. doi:10.1007/s11606-013-2553-7.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Zoppini G, Verlato G, Leuzinger C, et al. Body mass index and the risk of mortality in type II diabetic patients from Verona. Int J Obes Relat Metab Disord. 2003;27(2):281–5. doi:10.1038/sj.ijo.802199.

    Article  CAS  PubMed  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  PubMed  Google Scholar 

  10. National Heart L, Institute B. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, MD: US Department of Health and Human Services Public Health Service, National Institutes of Health. In. 2000.

  11. Panel NOEIE. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. 1998;6(suppl 2):51S–209S.

    Google Scholar 

  12. Winter JE, MacInnis RJ, Wattanapenpaiboon N, et al. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014;99(4):875–90.

    Article  CAS  PubMed  Google Scholar 

  13. Czernichow SI, Kenge AP, Stamatakis E, et al. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82864 participants from nine cohort studies. Obes Rev. 2011;12(9):680–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  14. Wells G, Shea B, O’connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.

  15. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156(1):13–22. doi:10.1016/j.ahj.2008.02.014.

    Article  PubMed  Google Scholar 

  16. Wolf HT, Owe KM, Juhl M, Hegaard HK. Leisure time physical activity and the risk of pre-eclampsia: a systematic review. Matern Child Health J. 2014;18(4):899–910. doi:10.1007/s10995-013-1316-8.

    Article  CAS  PubMed  Google Scholar 

  17. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.

  19. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clin Res ed.). 1997;315(7109):629–34.

    Article  CAS  Google Scholar 

  20. Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135(11):1301–9.

    CAS  PubMed  Google Scholar 

  21. Weiss A, Boaz M, Beloosesky Y, Kornowski R, Grossman E. Body mass index and risk of all-cause and cardiovascular mortality in hospitalized elderly patients with diabetes mellitus. Diabet Med. 2009;26(3):253–9. doi:10.1111/j.1464-5491.2009.02672.x.

    Article  CAS  PubMed  Google Scholar 

  22. Waring ME, Saczynski JS, McManus D, et al. Weight and mortality following heart failure hospitalization among diabetic patients. Am J Med. 2011;124(9):834–40. doi:10.1016/j.amjmed.2011.04.030.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Tseng CH. Obesity paradox: differential effects on cancer and noncancer mortality in patients with type 2 diabetes mellitus. Atherosclerosis. 2013;226(1):186–92. doi:10.1016/j.atherosclerosis.2012.09.004.

    Article  CAS  PubMed  Google Scholar 

  24. Perotto M, Panero F, Gruden G, et al. Obesity is associated with lower mortality risk in elderly diabetic subjects: the Casale Monferrato study. Acta Diabetol. 2013;50(4):563–8. doi:10.1007/s00592-011-0338-1.

    Article  CAS  PubMed  Google Scholar 

  25. Mulnier HE, Seaman HE, Raleigh VS, Soedamah-Muthu SS, Colhoun HM, Lawrenson RA. Mortality in people with type 2 diabetes in the UK. Diabet Med. 2006;23(5):516–21. doi:10.1111/j.1464-5491.2006.01838.x.

    Article  CAS  PubMed  Google Scholar 

  26. Eeg-Olofsson K, Cederholm J, Nilsson PM, et al. Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients. Diabetologia. 2009;52(1):65–73. doi:10.1007/s00125-008-1190-x.

    Article  CAS  PubMed  Google Scholar 

  27. Church TS, Cheng YJ, Earnest CP, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004;27(1):83–8.

    Article  PubMed  Google Scholar 

  28. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71–82.

    Article  CAS  PubMed  Google Scholar 

  29. Carnethon MR, de Chavez PJ, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308(6):581.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Doehner W, Erdmann E, Cairns R, et al. Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co-morbidity: an analysis of the PROactive study population. Int J Cardiol. 2012;162(1):20–6. doi:10.1016/j.ijcard.2011.09.039.

    Article  PubMed  Google Scholar 

  31. Amadou A, Ferrari P, Muwonge R, et al. Overweight, obesity and risk of premenopausal breast cancer according to ethnicity: a systematic review and dose-response meta-analysis. Obes Rev. 2013;14(8):665–78. doi:10.1111/obr.12028.

    Article  CAS  PubMed  Google Scholar 

  32. Discacciati A, Orsini N, Wolk A. Body mass index and incidence of localized and advanced prostate cancer—a dose–response meta-analysis of prospective studies. Ann Oncol. 2012;23(7):1665–71.

    Article  CAS  PubMed  Google Scholar 

  33. Wells JC. The evolution of human fatness and susceptibility to obesity: an ethological approach. Biol Rev. 2006;81(2):183–205.

    Article  PubMed  Google Scholar 

  34. McAuley PA, Kokkinos PF, Oliveira RB, Emerson BT, Myers JN. Obesity paradox and cardiorespiratory fitness in 12,417 male veterans aged 40 to 70 years. Mayo Clin Proc. 2010;85(2):115–21. doi:10.4065/mcp.2009.0562.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Schmidt DS, Salahudeen AK. Obesity-survival paradox-still a controversy? Semin Dial. 2007;20(6):486–92. doi:10.1111/j.1525-139X.2007.00349.x.

    Article  PubMed  Google Scholar 

  36. Lavie CJ, Milani RV, Ventura HO. Obesity and Cardiovascular DiseaseRisk Factor, Paradox, and Impact of Weight Loss. J Am Coll Cardiol. 2009;53(21):1925–32.

    Article  PubMed  Google Scholar 

  37. Ioannides-Demos LL, Proietto J, Tonkin AM, McNeil JJ. Safety of drug therapies used for weight loss and treatment of obesity. Drug Saf. 2006;29(4):277–302.

    Article  CAS  PubMed  Google Scholar 

  38. Stommel M, Schoenborn C. Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001–2006. BMC Public Health. 2009;9(1):421.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from the National Natural Science Foundation of China (81372973). Special thanks are extended to Dr. Philayrath Phongsavan from the University of Sydney for her assistance in the review and preparation of this manuscript.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. The Second School of Clinical Medicine (Zhongnan Hospital), Wuhan University, Wuhan, People’s Republic of China

    Xue-ming Liu

  2. School of Public Health, Wuhan University, Wuhan, People’s Republic of China

    Yu-jian Liu, Jian Zhan & Qi-qiang He

  3. FengHe (ShangHai) Information Technology Co., Ltd, Shanghai, People’s Republic of China

    Yu-jian Liu

  4. Global Health Institute, Wuhan University, Wuhan, People’s Republic of China

    Qi-qiang He

Authors
  1. Xue-ming Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu-jian Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jian Zhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qi-qiang He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qi-qiang He.

Additional information

Xue-ming Liu and Yu-jian Liu have contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 70 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, Xm., Liu, Yj., Zhan, J. et al. Overweight, obesity and risk of all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus: a dose–response meta-analysis of prospective cohort studies. Eur J Epidemiol 30, 35–45 (2015). https://doi.org/10.1007/s10654-014-9973-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-014-9973-5

Keywords

Search

Navigation