{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:17:21Z","timestamp":1790061441267,"version":"4.0.1"},"reference-count":27,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T00:00:00Z","timestamp":1582156800000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To determine the effect of fitness on the association between BMI and mortality among patients with diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>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 &amp;lt;18.5 kg\/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (&amp;lt;6), moderate (6\u20139.9), or high (\u226510). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5\u201324.9), overweight (25\u201329.9), and obese (\u226530). Adjusted splines centered at 22.5 kg\/m2 were used to examine BMI as a continuous variable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Patients had a mean age of 58 \u00b1 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 \u00b1 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P &amp;lt; 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI \u226530 kg\/m2. Compared with the lowest fitness group, patients with higher fitness had an \u223c50% (6\u20139.9 METs) and 70% (\u226510 METs) lower mortality hazard regardless of BMI (P &amp;lt; 0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc19-1673","type":"journal-article","created":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T04:19:22Z","timestamp":1579234762000},"page":"677-682","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":16,"title":["Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort"],"prefix":"10.2337","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5914-0735","authenticated-orcid":false,"given":"Seamus P.","family":"Whelton","sequence":"first","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"McAuley","sequence":"additional","affiliation":[{"name":"Department of Health, Physical Education and Sport Studies, Winston-Salem State University, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeina","family":"Dardari","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6858-1057","authenticated-orcid":false,"given":"Olusola A.","family":"Orimoloye","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clinton A.","family":"Brawner","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan K.","family":"Ehrman","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Keteyian","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouaz","family":"Al-Mallah","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart & Vascular Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5138-9683","authenticated-orcid":false,"given":"Michael J.","family":"Blaha","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2020,1,16]]},"reference":[{"key":"2022031300313286800_B1","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1001\/jama.2012.9282","article-title":"Association of weight status with mortality in adults with incident diabetes (vol 308, pg 581, 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