BODY MASS INDEX, FITNESS, AND MORTALITY IN PATIENTS WITH DIABETES: EVALUATING THE FAT BUT FIT PARADOX IN THE FIT PROJECT COHORT
Whelton SP, McAuley P, Orimoloye O, Brawner C, Ehrman J, Keteyian S, Al-Mallah M, and Blaha M. BODY MASS INDEX, FITNESS, AND MORTALITY IN PATIENTS WITH DIABETES: EVALUATING THE FAT BUT FIT PARADOX IN THE FIT PROJECT COHORT. J Am Coll Cardiol 2019; 73(9):1486.
J Am Coll Cardiology
Background: There is conflicting evidence on the association of body mass index (BMI) and mortality in patients with diabetes and the effect of fitness on this association. Methods: We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford ExercIse Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was categorized as <6, 6-9.9, and ≥10 METs based on a physician-referred treadmill stress test. Adjusted hazard ratios for all-cause mortality were calculated using BMI cutoffs (18.5-24.9, 25-29.9, and ≥30 kg/m2) and BMI as a continuous variable in adjusted splines centered at 22.5 kg/m2. Results: Patients had a mean age of 58 ±11 years (49% women) with 1,319 deaths over a mean 10.0 ±4.1 years follow-up. Compared to the lowest fitness group, patients with higher fitness had an approximately 50% (6-9.9 METs) and 70% (≥10 METs) lower mortality hazard within each BMI group (p <0.001). Compared to normal weight patients, obese patients had an approximately 30% lower mortality hazard regardless of fitness (p <0.05). In adjusted linear spline modeling only patients in the lowest fitness group (<6 METs) had a consistent, significantly reduced mortality hazard with increasing BMI (Figure). Conclusion: A higher BMI was most consistently associated with reduced mortality at low fitness levels. However, higher fitness was consistently and more strongly associated with reduced mortality across all BMI. [Figure presented]
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