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‘Obesity paradox’ in diabetes does not exist, say US researchers

Contrary to previous research, patients with type 2 diabetes who are overweight or obese have a higher mortality rate than those with a healthy weight, suggests a recent US study.

The  so-called ‘obesity paradox’ – an association between obesity and reduced mortality – has been shown in small trials in patients with hypertension, heart failure, kidney disease and – most recently – type 2 diabetes. But the trials have come under criticism for suboptimal control for factors such multimorbidity and smoking.

Now US researchers have studied the effect of BMI on 11, 427 patients with type 2 diabetes who were free of CV disease and cancer at the time of diagnosis.

Over a follow-up of around 16 years there were 3083 deaths during a mean period of 15.8 years of follow-up. Those in the highest BMI categories (BMI of 30.0 to 34.9) had a 24% increased risk of mortality compared with those with a normal BMI of (22.5 to 24.9).

The researchers note that: ‘the maintenance of a healthy body weight should remain the cornerstone of diabetes management, irrespective of smoking status’.

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