More proof that muscle saves lives. While authors avoid the word muscle at all cost the take away is that those with NORMAL BMI who develop insulin resistance die sooner than those with frank obesity. If you have a normal BMI bit are skinny-fat you develop insulin resistance as well as other metabolic disorders. The percentage of muscle to fat ratio determines if you're suffering from normal weight obesity. Muscle saves lives. - Carl

Study compares rate of death following diabetes diagnosis among normal weight and overweight adults

CHICAGO – Participants in a study who were normal weight at the time of a diagnosis of diabetes experienced higher rates of total and noncardiovascular death compared with those who were overweight or obese at diabetes diagnosis, according to a study in the August 8 issue of JAMA.

"Type 2 diabetes in normal-weight adults is an understudied representation of the metabolically obese normal-weight phenotype that has become increasingly common over time. It is not known whether the 'obesity paradox' that has been observed in chronic diseases such as heart failure, chronic kidney disease, and hypertension extends to adults who are normal weight at the time of incident diabetes," according to background information in the article

Mercedes R. Carnethon, Ph.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues conducted a study to compare mortality between participants who were normal weight and overweight/obese at the time of new adult-onset diabetes. The study consisted of a pooled analysis of 5 longitudinal studies with a total of 2,625 participants with new diabetes. Included were men and women (older than 40 years of age) who developed incident diabetes based on fasting glucose 126 mg/dL or greater or newly initiated diabetes medication and who had concurrent measurements of body mass index (BMI). Participants were classified as normal weight if their BMI was 18.5 to 24.99 or overweight/obese if BMI was 25 or greater. Half (50 percent) of the participants were women, 36 percent were non-white.

The proportion of adults who were normal weight at the time of incident diabetes ranged from 9 percent to 21 percent (overall 12 percent). During follow-up, 449 participants died: 178 (6.8 percent) from cardiovascular causes and 253 (10.4 percent) from noncardiovascular causes; 18 causes of death were unidentified. In the pooled sample, total mortality and cardiovascular and noncardiovascular mortality were higher in normal-weight participants as compared with rates among overweight or obese participants. Following adjustment for certain variables, the researchers found that participants with normal-weight diabetes experienced a significantly elevated total mortality and noncardiovascular mortality. While cardiovascular mortality was elevated, the association was not statistically significant.

"These findings are relevant to segments of the U.S. population, including older adults and nonwhite persons (e.g., Asian, black), who are more likely to experience normal-weight diabetes."

The researchers write that mechanisms to explain their findings are unknown. "However, previous research suggests that normal-weight persons with diabetes have a different genetic profile than overweight or obese persons with diabetes. If those same genetic variants that predispose to diabetes are associated with other illnesses, these individuals may be 'genetically loaded' toward experiencing higher mortality. Future research in normal-weight persons with diabetes should test these genetic hypotheses, along with other plausible mechanisms to account for higher mortality, including inflammation, the distribution and action of adipose tissue, atherosclerosis burden and the composition of fatty plaques, and pancreatic beta-cell function."