Letter to the Editor

Body Mass Index, Mortality, and the Obesity Paradox in Type 2 Diabetes Mellitus: The Effect of Hypertension

Authors: Prasanna Santhanam, MD, Yanal Masannat, MD


To the Editor:The article by Tobias et al provided new insight into the relation between body mass index (BMI) and mortality in people with incident type 2 diabetes mellitus.1 Their study suggested that a linear relation exists between BMI and mortality in nonsmokers (increasing BMI associated with increased hazard ratio for death) and a J-shaped relation in former or current smokers. Carnethon and colleagues alluded to the ‘‘obesity paradox’’ and showed that normal BMI was associated with increased mortality as compared with people with incident diabetes mellitus in the overweight/obese category.2 The rate of total mortality was higher in normal-weight participants than in overweight/obese participants.2 These studies did not explore the incidence of new-onset hypertension in different groups, which may explain the discrepancy in mortality rates.

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1. Tobias DK, Pan A, Jackson CL, et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med 2014;370:233-244.
2. Carnethon MR, De Chavez PJ, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA 2012;308:581-590.
3. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey data. http://wwwn.cdc.gov/nchs/nhanes/search/nhanes11_12.aspx. Accessed April 21, 2014.
4. Gaba A, Pridalova M, Zajac-Gawlak I. Evaluation of accuracy of body mass index in diagnosing of obesity in relation to body fat percentage in female aged 55-84 years.Cas Lek Cesk 2014;153:22-27.
5. Perreault M, Zulyniak MA, Badoud F, et al. A distinct fatty acid profile underlies the reduced inflammatory state of metabolically healthy obese individuals. PLoS One 2014;9:e88539.