Given Diabetes, Is Fat Better Than Thin?

Abstract

OBJECTIVE To evaluate the association between BMI and mortality in women and men with type II diabetes. RESEARCH DESIGN AND METHODS Fasting plasma glucose (FPG), height and weight measurements, and medical history were obtained from 4,483 community-dwelling adults, aged 40–79 years, in 1972–1974. A total of 373 persons with either a history of diabetes or FPG ≥ 7.77 mmol/l were studied. Subjects were grouped into four sex-specific weight categories based on U.S. population data. Vital status after 14 years was known for 99.9% of the patients studied. Cox models were used to assess relative survival by weight category. RESULTS Diabetic men and women of average weight had the lowest mortality. A J-shaped relative risk curve by weight category was found, with a poorer survival rate for those who were thin, overweight, or obese. This effect was not explained by early mortality or cigarette smoking. CONCLUSIONS Being thin may not provide a mortality benefit for diabetic men and women. Average weight appears to be desirable.