Diabetes Mellitus in the Absence of Obesity

Despite the persistence of the obesity epidemic and its contribution to development of metabolic and cardiovascular diseases, a growing number of studies have described a paradoxically longer survival (the obesity paradox) among overweight and obese adults with and without chronic diseases.1 Whereas the obesity paradox has previously been observed among adults with chronic kidney disease, heart failure, and cancer, a growing number of studies have investigated this question in the setting of diabetes mellitus. Whether the obesity paradox is present in diabetes mellitus is of particular interest given the importance of obesity in the pathogenesis of diabetes mellitus and the development of complications. In this issue of Circulation , Zhao et al2 report a U-shaped association between weight status and mortality among adults with diabetes mellitus, whereby the lowest mortality rates are observed among adults who are overweight or obese. These findings are consistent with some3,4 but not all5 previous findings.Article see p 2143The present study was carried out using administrative data from the Louisiana State University Health Care Services Division, a healthcare plan that includes 7 public hospitals and affiliated clinics, which cover approximately 35% of the Louisiana population. Patients were studied as part of the Louisiana State University Hospital–Based Longitudinal Study (LSUHLS). Nearly 35 000 black and white adults with a new diagnosis of type 2 diabetes mellitus between 1999 and 2009 were followed for an average of 9 years for mortality. There are several unique features of the present study, including the use of administrative data, which included multiple measures of body mass index (BMI) captured over time, large samples of both blacks and whites, and adults with …