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Diabetes Care. 2020 Jan 16. pii: dc191673. doi: 10.2337/dc19-1673. [Epub ahead of print]

Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort.

Author information

1
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD seamus.whelton@jhmi.edu.
2
Department of Health, Physical Education and Sport Studies, Winston-Salem State University, Winston-Salem, NC.
3
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD.
4
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.
5
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.

Abstract

OBJECTIVE:

To determine the effect of fitness on the association between BMI and mortality among patients with diabetes.

RESEARCH DESIGN AND METHODS:

We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford ExercIse Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6-9.9), and high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable.

RESULTS:

Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ∼50% (6-9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001).

CONCLUSIONS:

Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality.

PMID:
31949085
DOI:
10.2337/dc19-1673

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