Department of Pharmacoepidemiology (Sh.T., Sa.T.), Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Biostatistics (S.I., Y.O.), School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; The Institute for Adult Diseases (Y.A.), Asahi Life Foundation, Tokyo 100-0005, Japan; Department of Internal Medicine (N.Y.), University of Tsukuba Institute of Clinical Medicine, Tsukuba, Ibaraki 305-8577, Japan; Tokyo Metropolitan Geriatric Hospital (A.A., H.I.), Tokyo 173-0015, Japan; and Department of Hematology, Endocrinology, and Metabolism (H.S.), Niigata University Faculty of Medicine, Chuo-ku, Niigata 951-8510, Japan.
J Clin Endocrinol Metab. 2014 Dec;99(12):E2692-6. doi: 10.1210/jc.2014-1855.
Previous studies on the association between body mass index (BMI) and mortality in diabetes do not necessarily provide a comprehensive view in terms of the global population because of the exclusion of individuals with a BMI less than 18.5 kg/m(2).
The objective of the study was to examine the association between BMI and mortality.
DESIGN, SETTING, AND PARTICIPANTS: We analyzed pooled data from 2 cohorts of 2620 Japanese patients with type 2 diabetes followed up for 6.3 years. Patients with a history of cardiovascular disease or cancer were excluded.
The end point was all-cause mortality. Hazard ratios were estimated by Cox regression adjusted for age, smoking, leisure-time physical activity, and other confounders.
An analysis using BMI categories of 14.4-18.5 (5.2%), 18.5-22.4 (37.3%), 22.5-24.9 (31.0%), and 25.0-37.5 kg/m(2) (26.6%) revealed no significant trend in mortality among patients with a BMI of 18.5 kg/m(2) or greater (trend P = .69). In contrast, the hazard ratio of patients with a BMI less than 18.5 kg/m(2) vs 22.5-24.9 kg/m(2) was 2.58 (95% confidence interval 1.38-4.84; P < .01). Exclusion of deaths in the first 4 years of follow-up decreased the hazard ratio only slightly.
The lowest mortality rate was observed among patients with a BMI of 18.5-24.9 kg/m(2), and obesity had no benefits regarding mortality. Further research is needed in lean patients, especially among aging populations in East Asia.
既往关于体重指数（BMI）与糖尿病患者死亡率之间关联的研究，由于排除了 BMI 低于 18.5kg/m²的个体，因此不一定能全面反映全球人群的情况。
本研究旨在探讨 BMI 与死亡率之间的关系。
设计、地点和参与者：我们分析了 2 个队列中 2620 例日本 2 型糖尿病患者的汇总数据，这些患者随访了 6.3 年。排除了有心血管疾病或癌症病史的患者。
终点是全因死亡率。使用 Cox 回归调整年龄、吸烟、休闲时间体力活动和其他混杂因素后，估计了危险比。
对 BMI 类别（14.4-18.5kg/m²[5.2%]、18.5-22.4kg/m²[37.3%]、22.5-24.9kg/m²[31.0%]和 25.0-37.5kg/m²[26.6%]）进行分析后发现，BMI 为 18.5kg/m²或更高的患者死亡率无明显趋势（趋势 P =.69）。相比之下，BMI 低于 18.5kg/m²的患者与 BMI 为 22.5-24.9kg/m²的患者的危险比为 2.58（95%置信区间为 1.38-4.84；P <.01）。仅排除前 4 年随访期间的死亡事件，略微降低了危险比。
BMI 为 18.5-24.9kg/m²的患者死亡率最低，肥胖对死亡率没有益处。需要进一步研究瘦患者，尤其是东亚老年人群中的瘦患者。
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