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Obesity paradox

Overweight patients live longer than less heavy T2DM patients

Study adds further to the co-called ‘obesity paradox’ debate

Patients with type 2 diabetes who are overweight but not obese live longer than those who are underweight or normal-weight, according to a study is published in Annals of Internal Medicine. The adds further to the co-called ‘obesity paradox’ debate, which some researchers believe that overweight patients with cardiovascular disease live longer than normal-weight patients with cardiovascular disease.

To determine if the same could be true about patients with diabetes, researchers from the University of Hull, Castle Hill Hospital, Imperial College, London, United Kingdom and Federico II University, Naples, Italy, followed more than 10,500 patients with type 2 diabetes and no known cardiovascular disease for a median of 10.6 years and collected information about cardiovascular events and all-cause mortality. The median age was 63 years (interquartile range, 55 to 71), and 54% of patients were men.

Overweight or obese patients had a higher rate of cardiac events (such as the acute coronary syndrome and heart failure) than those of normal weight. However, being overweight was associated with a lower mortality risk, whereas obese patients had a mortality risk similar to that of normal-weight persons. Patients with low body weight had the worst prognosis.

The authors offer a few possible reasons for the obesity paradox in type 2 diabetes. First, type 2 diabetes induced by the metabolic stress of obesity may fundamentally differ from that which develops in the absence of obesity.

Second, patients with type 2 diabetes and a low BMI might have higher tobacco and alcohol consumption, contributing to both the development of diabetes and a lower BMI. Finally, obese patients may be more likely to be checked for diabetes, leading to earlier diagnosis.

The researchers caution that these results do not suggest an ideal BMI and should not discourage patients from adopting a healthy lifestyle.

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