European Journal of Epidemiology

, Volume 30, Issue 1, pp 35–45 | Cite as

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

  • Xue-ming Liu
  • Yu-jian Liu
  • Jian Zhan
  • Qi-qiang He


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.


BMI 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.

Supplementary material

10654_2014_9973_MOESM1_ESM.doc (70 kb)
Supplementary material 1 (DOC 70 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Xue-ming Liu
    • 1
  • Yu-jian Liu
    • 2
    • 3
  • Jian Zhan
    • 2
  • Qi-qiang He
    • 2
    • 4
  1. 1.The Second School of Clinical Medicine (Zhongnan Hospital)Wuhan UniversityWuhanPeople’s Republic of China
  2. 2.School of Public HealthWuhan UniversityWuhanPeople’s Republic of China
  3. 3.FengHe (ShangHai) Information Technology Co., LtdShanghaiPeople’s Republic of China
  4. 4.Global Health InstituteWuhan UniversityWuhanPeople’s Republic of China

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