BACKGROUND/OBJECTIVES: There is controversy regarding the existence of a body mass index (BMI) mortality paradox in\ndiabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality\nparadox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons.\nSUBJECTS/METHODS: We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI\n(kgm? 2) category (underweight, o20; normal weight, 20 to o25; overweight, 25 to o30; obese, 30 to o35; severely obese ? 35)\nin adult diabetic and non-diabetic respondents to the 2000ââ?¬â??2011 United States national Medical Expenditure Panel Surveys\n(N = 119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity,\ngeographic region and survey year.\nRESULTS: In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight\ncategory, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted\ndifference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight\ncategory = 0.8 points, 95% confidence interval; CI 0.1, 1.6; P = 0.03). This paradoxical pattern was not evident for the MCS-12, and the\nadjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese\npersons was not significant (?0.3 points, 95% CI ? 0.9, 0.4; P = 0.43). The findings were not significantly moderated by smoking\nstatus, cancer diagnosis or time period.\nCONCLUSIONS: The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than\nnon-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality\nparadox.
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