5 :: KDA, Korean Diabetes Association ::
Subject    :    [2018 Jun;42(3)] The Evidence for an Obesity Paradox in Type 2 Diabetes Mellitus
Writer KDA
Date 2019-03-05 18:05:25 Hit 458
Diabetes Metab J. 2018 Jun;42(3):179-187. English.
Published online May 31, 2018.  https://doi.org/10.4093/dmj.2018.0055 
Copyright © 2018 Korean Diabetes Association
   
The Evidence for an Obesity Paradox in Type 2 Diabetes Mellitus
Seung Jin Han,1 and Edward J. Boyko2
1Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
2Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA.

Corresponding author: Edward J. Boyko. Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, 1660 S. Columbian Way (S-123-PCC), Seattle, WA 98108, USA. Email: eboyko@uw.edu 
 
Received April 03, 2018; Accepted May 16, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Abstract

Although overweight/obesity is a major risk factor for the development of type 2 diabetes mellitus, there is increasing evidence that overweight or obese patients with type 2 diabetes mellitus experience lower mortality compared with patients of normal weight. This paradoxical finding, known as the “obesity paradox,” occurs in other chronic diseases, and in type 2 diabetes mellitus is particularly perplexing given that lifestyle intervention with one goal being weight reduction is an important feature of the management of this condition. We summarize in this review the findings from clinical and epidemiologic studies that have investigated the association between overweight and obesity (usually assessed using body mass index [BMI]) and mortality in type 2 diabetes mellitus and discuss potential causes of the obesity paradox. We conclude that most studies show evidence of an obesity paradox, but important conflicting findings still exist. We also evaluate if potential bias might explain the obesity paradox in diabetes, including, for example, the presence of confounding factors, measurement error due to use of BMI as an index of obesity, and reverse causation.

   
Keywords:
BiasBody mass indexDiabetes mellitus, type 2EpidemiologyMortalityObesitySurvival
 

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