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Epidemiology. 2014 Jan;25(1):10-4. doi: 10.1097/EDE.0000000000000031.

Body mass index, diabetes, and mortality in French women: explaining away a "paradox".

Author information

1
From the aDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; bCenter for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico; cNational Institute of Health and Medical Research (Inserm), Center for Research in Epidemiology and Population Health (CESP), U1018, Gustave-Roussy Cancer Institute, Villejuif, France; dParis-South University, UMRS 1019, Villejuif, France; eDepartment of Biostatistics, Harvard School of Public Health, Boston, MA; fHarvard-MIT Division of Health Sciences and Technology, Boston, MA.

Abstract

BACKGROUND:

Obesity is associated with increased mortality in the general population but, paradoxically, with decreased mortality in persons with diabetes.

METHODS:

Among 88,373 French women participating in the E3N-EPIC study who were free of diabetes in 1990, we estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality for body mass index (BMI) levels by diabetes status.

RESULTS:

During an average 16.7 years of follow-up, 2421 cases of diabetes were identified and 3750 deaths occurred. For overweight/obese versus normal-weight women, the HR of mortality was 1.42 (95% CI = 1.32-1.53) in women without diabetes and 0.69 (0.40-1.18) in women with incident diabetes. As BMI increased, mortality among women without diabetes increased and that among women with diabetes decreased.

CONCLUSIONS:

We found the obesity "paradox" among women with and without incident diabetes in the same population. Selection bias may be a simple explanation for this "paradox."

PMID:
24270963
PMCID:
PMC4122290
DOI:
10.1097/EDE.0000000000000031
[Indexed for MEDLINE]
Free PMC Article

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