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Title: Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies
Authors: Zaccardi, Francesco
Dhalwani, NN
Papamargaritis, Dimitris
Webb, David R.
Murphy, Gavin J.
Davies, Melanie J.
Khunti, Kamlesh
First Published: 25-Nov-2016
Publisher: Springer Verlag (Germany)
Citation: Diabetologia, 2016, pp. 1-9
Abstract: Aims/hypothesis: The relationship between BMI and mortality has been extensively investigated in the general population; however, it is less clear in people with type 2 diabetes. We aimed to assess the association of BMI with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Methods: We searched electronic databases up to 1 March 2016 for prospective studies reporting associations for three or more BMI groups with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Study-specific associations between BMI and the most-adjusted RR were estimated using restricted cubic splines and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis. Results: We included 21 studies including 24 cohorts, 414,587 participants, 61,889 all-cause and 4470 cardiovascular incident deaths; follow-up ranged from 2.7 to 15.9 years. There was a strong nonlinear relationship between BMI and all-cause mortality in both men and women, with the lowest estimated risk from 31–35 kg/m2 and 28–31 kg/m2 (p value for nonlinearity <0.001) respectively. The risk of mortality at higher BMI values increased significantly only in women, whilst lower values were associated with higher mortality in both sexes. Limited data for cardiovascular mortality were available, with a possible inverse linear association with BMI (higher risk for BMI <27 kg/m2). Conclusions/interpretation: In type 2 diabetes, BMI is nonlinearly associated with all-cause mortality with lowest risk in the overweight group in both men and women. Further research is needed to clarify the relationship with cardiovascular mortality and assess causality and sex differences.
DOI Link: 10.1007/s00125-016-4162-6
ISSN: 0012-186X
eISSN: 1432-0428
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Description: The online version of this article (doi:10.1007/s00125-016-4162-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. Statistical codes and datasets are available from the corresponding author.
Appears in Collections:Published Articles, College of Medicine, Biological Sciences and Psychology

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