Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Ste 1400, Chicago, IL 60611, USA.
JAMA. 2012 Aug 8;308(6):581-90. doi: 10.1001/jama.2012.9282.
Type 2 diabetes in normal-weight adults (body mass index [BMI] <25) is a representation of the metabolically obese normal-weight phenotype with unknown mortality consequences.
To test the association of weight status with mortality in adults with new-onset diabetes in order to minimize the influence of diabetes duration and voluntary weight loss on mortality.
DESIGN, SETTING, AND PARTICIPANTS: Pooled analysis of 5 longitudinal cohort studies: Atherosclerosis Risk in Communities study, 1990-2006; Cardiovascular Health Study, 1992-2008; Coronary Artery Risk Development in Young Adults, 1987-2011; Framingham Offspring Study, 1979-2007; and Multi-Ethnic Study of Atherosclerosis, 2002-2011. A total of 2625 participants with incident diabetes contributed 27,125 person-years of follow-up. Included were men and women (age >40 years) who developed incident diabetes based on fasting glucose 126 mg/dL or greater or newly initiated diabetes medication and who had concurrent measurements of BMI. Participants were classified as normal weight if their BMI was 18.5 to 24.99 or overweight/obese if BMI was 25 or greater.
Total, cardiovascular, and noncardiovascular mortality.
The proportion of adults who were normal weight at the time of incident diabetes ranged from 9% to 21% (overall 12%). During follow-up, 449 participants died: 178 from cardiovascular causes and 253 from noncardiovascular causes (18 were not classified). The rates of total, cardiovascular, and noncardiovascular mortality were higher in normal-weight participants (284.8, 99.8, and 198.1 per 10,000 person-years, respectively) than in overweight/obese participants (152.1, 67.8, and 87.9 per 10,000 person-years, respectively). After adjustment for demographic characteristics and blood pressure, lipid levels, waist circumference, and smoking status, hazard ratios comparing normal-weight participants with overweight/obese participants for total, cardiovascular, and noncardiovascular mortality were 2.08 (95% CI, 1.52-2.85), 1.52 (95% CI, 0.89-2.58), and 2.32 (95% CI, 1.55-3.48), respectively.
Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese.
正常体重成年人（体重指数 [BMI] <25）的 2 型糖尿病代表了具有未知死亡率后果的代谢肥胖正常体重表型。
检测体重状态与新发糖尿病成年人死亡率之间的关联，以尽量减少糖尿病病程和自愿减肥对死亡率的影响。
设计、地点和参与者：对 5 项纵向队列研究进行汇总分析：社区动脉粥样硬化风险研究，1990-2006 年；心血管健康研究，1992-2008 年；年轻人动脉粥样硬化风险发展研究，1987-2011 年；弗雷明汉后代研究，1979-2007 年；和多民族动脉粥样硬化研究，2002-2011 年。共有 2625 名新发糖尿病患者参与了研究，共随访 27125 人年。纳入标准为空腹血糖≥126mg/dL 或新开始使用糖尿病药物且同时测量 BMI 的男性和女性（年龄>40 岁）。BMI 为 18.5 至 24.99 的参与者被归类为正常体重，BMI 为 25 或更高的参与者被归类为超重/肥胖。
总死亡率、心血管死亡率和非心血管死亡率。
新发糖尿病时正常体重的成年人比例为 9%-21%（总体 12%）。随访期间，有 449 名参与者死亡：178 例死于心血管原因，253 例死于非心血管原因（18 例未分类）。正常体重参与者的总死亡率、心血管死亡率和非心血管死亡率均高于超重/肥胖参与者（分别为 284.8、99.8 和 198.1/10000 人年，152.1、67.8 和 87.9/10000 人年）。在校正人口统计学特征和血压、血脂水平、腰围和吸烟状况后，正常体重参与者与超重/肥胖参与者的总死亡率、心血管死亡率和非心血管死亡率的风险比分别为 2.08（95%CI，1.52-2.85）、1.52（95%CI，0.89-2.58）和 2.32（95%CI，1.55-3.48）。
新发糖尿病时正常体重的成年人死亡率高于超重或肥胖成年人。
