Given Diabetes, Is Fat Better Than Thin?

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Abstract
OBJECTIVE: To evaluate the association between BMI and mortality in women and men with type II diabetes. RESEARCH DESIGN AND METHODS: Fasting plasma glucose (FPG), height and weight measurements, and medical history were obtained from 4,483 community-dwelling adults, aged 40–79 years, in 1972–1974. A total of 373 persons with either a history of diabetes or FPG ≥ 7.77 mmol/l were studied. Subjects were grouped into four sex-specific weight categories based on U.S. population data. Vital status after 14 years was known for 99.9% of the patients studied. Cox models were used to assess relative survival by weight category. RESULTS: Diabetic men and women of average weight had the lowest mortality. A J-shaped relative risk curve by weight category was found, with a poorer survival rate for those who were thin, overweight, or obese. This effect was not explained by early mortality or cigarette smoking. CONCLUSIONS: Being thin may not provide a mortality benefit for diabetic men and women. Average weight appears to be desirable.

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