Obesity and Life Expectancy with and without Diabetes in Adults Aged 55 Years and Older in the Netherlands: A Prospective Cohort Study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Overweight and obesity are associated with increased risk of type 2 diabetes. Limited evidence
exists regarding the effect of excess weight on years lived with and without diabetes.
We aimed to determine the association of overweight and obesity with the number of years
lived with and without diabetes in a middle-aged and elderly population.
Methods and Findings
The study included 6,499 individuals (3,656 women) aged 55 y and older from the population-based
Rotterdam Study. We developed a multistate life table to calculate life expectancy
for individuals who were normal weight, overweight, and obese and the difference in
years lived with and without diabetes. For life table calculations, we used prevalence, incidence
rate, and hazard ratios (HRs) for three transitions (healthy to diabetes, healthy to
death, and diabetes to death), stratifying by body mass index (BMI) at baseline and adjusting
for confounders. During a median follow-up of 11.1 y, we observed 697 incident diabetes
events and 2,192 overall deaths. Obesity was associated with an increased risk of developing
diabetes (HR: 2.13 [p < 0.001] for men and 3.54 [p < 0.001] for women). Overweight
and obesity were not associated with mortality in men and women with or without diabetes.
Total life expectancy remained unaffected by overweight and obesity. Nevertheless, men
with obesity aged 55 y and older lived 2.8 (95% CI −6.1 to −0.1) fewer y without diabetes
than normal weight individuals, whereas, for women, the difference between obese and normal
weight counterparts was 4.7 (95% CI −9.0 to −0.6) y. Men and women with obesity lived
2.8 (95% CI 0.6 to 6.2) and 5.3 (95% CI 1.6 to 9.3) y longer with diabetes, respectively, compared
to their normal weight counterparts. Since the implications of these findings could be limited to middle-aged and older white European populations, our results need confirmation
in other populations.
Conclusions
Obesity in the middle aged and elderly is associated with a reduction in the number of years
lived free of diabetes and an increase in the number of years lived with diabetes. Those extra
years lived with morbidity might place a high toll on individuals and health care systems.
Overweight and obesity are associated with increased risk of type 2 diabetes. Limited evidence
exists regarding the effect of excess weight on years lived with and without diabetes.
We aimed to determine the association of overweight and obesity with the number of years
lived with and without diabetes in a middle-aged and elderly population.
Methods and Findings
The study included 6,499 individuals (3,656 women) aged 55 y and older from the population-based
Rotterdam Study. We developed a multistate life table to calculate life expectancy
for individuals who were normal weight, overweight, and obese and the difference in
years lived with and without diabetes. For life table calculations, we used prevalence, incidence
rate, and hazard ratios (HRs) for three transitions (healthy to diabetes, healthy to
death, and diabetes to death), stratifying by body mass index (BMI) at baseline and adjusting
for confounders. During a median follow-up of 11.1 y, we observed 697 incident diabetes
events and 2,192 overall deaths. Obesity was associated with an increased risk of developing
diabetes (HR: 2.13 [p < 0.001] for men and 3.54 [p < 0.001] for women). Overweight
and obesity were not associated with mortality in men and women with or without diabetes.
Total life expectancy remained unaffected by overweight and obesity. Nevertheless, men
with obesity aged 55 y and older lived 2.8 (95% CI −6.1 to −0.1) fewer y without diabetes
than normal weight individuals, whereas, for women, the difference between obese and normal
weight counterparts was 4.7 (95% CI −9.0 to −0.6) y. Men and women with obesity lived
2.8 (95% CI 0.6 to 6.2) and 5.3 (95% CI 1.6 to 9.3) y longer with diabetes, respectively, compared
to their normal weight counterparts. Since the implications of these findings could be limited to middle-aged and older white European populations, our results need confirmation
in other populations.
Conclusions
Obesity in the middle aged and elderly is associated with a reduction in the number of years
lived free of diabetes and an increase in the number of years lived with diabetes. Those extra
years lived with morbidity might place a high toll on individuals and health care systems.
Date Issued
2016-07-19
Date Acceptance
2016-06-10
Citation
PLoS Medicine, 2016, 13 (7)
ISSN
1549-1277
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS Medicine
Volume
13
Issue
7
Copyright Statement
© 2016 Dhana et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited.
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited.
License URL
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
BODY-MASS INDEX
CARDIOVASCULAR-DISEASE
PHYSICAL-ACTIVITY
TABLE ANALYSIS
US ADULTS
RISK
ROTTERDAM
MORTALITY
TRENDS
LOST
Publication Status
Published
Article Number
e1002086