Body mass index, diabetes, and mortality in french women: Explaining away a "paradox"

Martin Lajous, Anne Bijon, Guy Fagherazzi, Marie Christine Boutron-Ruault, Beverley Balkau, Françoise Clavel-Chapelon*, Miguel A. Hernán

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

69 Citations (Scopus)


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."

Original languageEnglish
Pages (from-to)10-14
Number of pages5
Issue number1
Publication statusPublished - Jan 2014
Externally publishedYes


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