Martin Lajous1, Anne Bijon, Guy Fagherazzi, Marie-Christine Boutron-Ruault, Beverley Balkau, Françoise Clavel-Chapelon, Miguel A Hernán. 1. From the aDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; bCenter for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico; cNational Institute of Health and Medical Research (Inserm), Center for Research in Epidemiology and Population Health (CESP), U1018, Gustave-Roussy Cancer Institute, Villejuif, France; dParis-South University, UMRS 1019, Villejuif, France; eDepartment of Biostatistics, Harvard School of Public Health, Boston, MA; fHarvard-MIT Division of Health Sciences and Technology, Boston, MA.
Abstract
BACKGROUND: Obesity is associated with increased mortality in the general population but, paradoxically, with decreased mortality in persons with diabetes. METHODS: Among 88,373 French women participating in the E3N-EPIC study who were free of diabetes in 1990, we estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality for body mass index (BMI) levels by diabetes status. RESULTS: During an average 16.7 years of follow-up, 2421 cases of diabetes were identified and 3750 deaths occurred. For overweight/obese versus normal-weight women, the HR of mortality was 1.42 (95% CI = 1.32-1.53) in women without diabetes and 0.69 (0.40-1.18) in women with incident diabetes. As BMI increased, mortality among women without diabetes increased and that among women with diabetes decreased. CONCLUSIONS: We found the obesity "paradox" among women with and without incident diabetes in the same population. Selection bias may be a simple explanation for this "paradox."
BACKGROUND:Obesity is associated with increased mortality in the general population but, paradoxically, with decreased mortality in persons with diabetes. METHODS: Among 88,373 French women participating in the E3N-EPIC study who were free of diabetes in 1990, we estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality for body mass index (BMI) levels by diabetes status. RESULTS: During an average 16.7 years of follow-up, 2421 cases of diabetes were identified and 3750 deaths occurred. For overweight/obese versus normal-weight women, the HR of mortality was 1.42 (95% CI = 1.32-1.53) in women without diabetes and 0.69 (0.40-1.18) in women with incident diabetes. As BMI increased, mortality among women without diabetes increased and that among women with diabetes decreased. CONCLUSIONS: We found the obesity "paradox" among women with and without incident diabetes in the same population. Selection bias may be a simple explanation for this "paradox."
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