People who are at a normal weight when they develop diabetes have higher rates of mortality than those who are overweight or obese when diagnosed, according to an analysis of five cohort studies in JAMA.
The studies included 2500 adults over age 40 with incident diabetes; roughly 10% were normal weight. During 27,000 person-years of follow-up, adjusted hazard ratios among normal-weight patients were significantly increased for total mortality (2.08) and noncardiovascular mortality (2.32), compared with the overweight and obese group. Cardiovascular mortality was also elevated (1.52), but not significantly so.
The mechanism for the paradoxical increase is unknown and may, according to editorialists, lie in a phenotype characterized as "metabolically obese normal weight."
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