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
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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.
KeywordsBMI Mortality Type 2 diabetes Meta-analysis
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.
- 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.Google Scholar
- 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
- 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.PubMedCentralPubMedGoogle 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.
- 18.Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.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.CrossRefPubMedGoogle Scholar