Association between changes in obesity status and neuropsychiatric health and brain structure in different glucose status

The incidence of early-onset colorectal cancer (EO-CRC, diagnosed before 50 years of age) has increased in recent decades. The aim of this study was to investigate the association between changes in obesity status and EO-CRC risk. From a nationwide population-based cohort, individuals <50 years old who participated in the national health checkup program in both 2009 and 2011 were included. Obesity was defined as a body mass index ≥25 kg/m2. Abdominal obesity was defined as a waist circumference ≥ 90 cm in men and ≥ 85 cm in women. Participants were classified into 4 groups according to the change in obesity (normal/normal, normal/obese, obese/normal, persistent obese) and abdominal obesity (normal/normal, normal/abdominal obesity, abdominal obesity/normal, persistent abdominal obesity) status. Participants were followed up until 2019 and censored when they became 50 years old. Among 3,340,635 participants, 7,492 patients were diagnosed with EO-CRC during 7.1 years of follow-up. The risk of EO-CRC was higher in the persistent obesity and persistent abdominal obesity groups than in the normal/normal groups (hazard ratio (HR) [95% confidence interval (CI)] = 1.09 [1.03-1.16] and 1.18 [1.09-1.29], respectively). Participants with both persistent obesity and abdominal obesity had a higher EO-CRC risk than those in the normal/normal groups for both [HR (95% CI) = 1.19 (1.09-1.30)]. Persistent obesity and persistent abdominal obesity before the age of 50 are associated with a slightly increased risk of EO-CRC. Addressing obesity and abdominal obesity in young individuals might be beneficial in reducing the risk of EO-CRC.

Objectives: To evaluate whether regression from impaired glucose regulation (IGR) to normal glucose regulation (NGR) after one year of a lifestyle intervention reduces diabetes risk in American Indians and Alaska Natives (AI/ANs). Additionally, we sought to identify predictors for regression to NGR and understand possible mechanisms for the association between NGR and future diabetes risk. Research Design and Methods: Data from participants enrolled from 2006 to 2009 in the Special Diabetes Program for Indians Diabetes Prevention Program with IGR at baseline and an oral glucose tolerance test (OGTT) at year 1 were analyzed (N = 1443). Based on OGTT results, participants were classified into four categories: NGR; isolated IFG (iIFG); isolated IGT (iIGT); or both IFG and IGT (IFG/IGT). Cox regression models were used to estimate the subsequent diabetes risk (year 1 to year 3) by year 1 glucose status. Mediation analysis was employed to estimate the proportions of the association between year 1 glycemic status and diabetes risk explained by specific factors. Results: Those who reverted to NGR at year 1 (38%) had lower diabetes risk than those with sustained IGR (adjusted hazard ratio (HR) = 0.28, 95% CI: 0.12-0.67). Compared to the NGR group at year 1, IFG/IGT carried the highest risk of developing diabetes with an adjusted HR of 4.72 (95% CI: 1.84-12.07), followed by the iIGT group (HR=3.26, 95% CI: 0.96-11.12; p-value=0.059) and the iIFG group (HR=3.13, 95% CI: 1.27-7.31). The lower risk associated with regression to NGR was explained by both baseline risk factors and differences in weight loss. Metformin use, weight loss, and increase in exercise were modifiable risk factors associated with a higher odds of regression to NGR. Conclusions: AI/AN patients with prediabetes who reverted to NGR had a reduced risk of developing type 2 diabetes over the next two years; modifiable risk factors explained a major proportion of risk reduction associated with NGR. Disclosure K.A. Pratte: None. A. Johnson: None. J. Beals: None. A. Bullock: None. S.M. Manson: None. L. Jiang: None. Funding Indian Health Service (HHSI242200400049C to S.M.M.); National Institute of Diabetes and Digestive and Kidney Diseases (1P30DK092923 to S.M.M), (R21DK108187 to L.J.)

Regression to normal glucose regulation (NGR) has been reported in response to lifestyle modification and medications. In this secondary analysis of the D2d study, a randomized trial of 4,000 IU/d of vitamin D3 vs. placebo, we determined whether vitamin D increased regression to NGR in people with prediabetes. Eligible participants met at least 2-of-3 ADA glycemic criteria for prediabetes (n=2423) and the two groups were similar at baseline. During follow-up, glycemic status was assessed semi-annually with FG and HbA1c and annually with 2-hour glucose after 75-g glucose load (2hPG) . In exploratory analyses that censored follow up at initiation of diabetes/weight-loss medication, stopping trial pills, taking vitamin D above the trial limit, death or withdrawal, we tested for an effect of vitamin D on new-onset NGR, which was defined as the first occurrence of 2 or 3 glycemic criteria in the normal range and none in the diabetes range. Over a median follow-up of 2.5 years, the NGR outcome occurred in 343/12 participants in the vitamin D group and 295/1212 in the placebo group; hazard ratio (95%CI) for time-to-NGR for vitamin D was 1.16 (0.99-1.36) . Among those who never met NGR during follow-up (n=1785) , 29% developed diabetes compared to 8.2% among those who met NGR at some point during the study (p&amp;lt;0.01) . At the last encounter, the NGR outcome was observed in 133/1069 participants in the vitamin D group and 102/1050 in the placebo group; incidence rate ratio (95%CI) for vitamin D was 1.26 (0.97-1.63) . When we used the NGR definition from other studies to include only those with normal FG and 2hPG regardless of HbA1c, 90/1037 participants in the vitamin D group and 63/1050 in the placebo group at the last encounter had NGR; incidence rate ratio (95%CI) for vitamin D 1.39 (1.01-1.91) . In conclusion, vitamin D supplementation increased the likelihood of regression to NGR at the last visit, and those who met NGR during the study were less likely to subsequently develop diabetes. Disclosure D.S.Hsia: None. A.G.Pittas: None. D2d research group: n/a. J.P.Nelson: None. E.Vickery: None. N.Rasouli: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Allergan, Eli Lilly and Company, Novo Nordisk. E.S.Leblanc: n/a. S.H.Kim: Advisory Panel; GI Dynamics, Consultant; Aligos, Research Support; Fractyl Health, Inc. I.Brodsky: None. R.E.Pratley: Other Relationship; Bayer AG, Corcept Therapeutics, Dexcom, Inc., Hanmi Pharm. Co., Ltd., Merck &amp; Co., Inc., Metavention, Novo Nordisk, Pfizer Inc., Poxel SA, Sanofi, Scohia Pharma Inc., Sun Pharmaceutical Industries Ltd. B.Dawson-hughes: None. Funding American Diabetes Association (1-14-D2d-01) ; National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases and Office of Dietary Supplements (U01DK098245)

Introduction: Environmental causes have been a focus of efforts to address the US obesity epidemic. Spouses share a similar environment and should therefore experience similar changes in body mass index (BMI) and obesity status over time. Existing longitudinal studies of spouses have not examined whether associations of BMI change within pairs are similar by gender. Methods: We analyzed spouse pairs from the community-based ARIC cohort, recruited from 1986 to 1989 at ages 45-64. We used linear mixed models to assess the association of changes in spousal BMI with changes in individual BMI assessed at 5 clinic visits during 25 years of follow-up. We used survival models accounting for interval censoring to evaluate the association between one spouse becoming obese (BMI&gt;30 kg/m2) and the other becoming obese. Analyses controlled for time-varying demographic, lifestyle, and clinical factors, pre-existing illness, and spousal CVD risk factors and illness. We assessed similarity of the results by gender. Results: We included 4,003 spouse pairs with information on BMI at more than one visit. Mean BMI in men at baseline was 27.5 kg/m2, increasing to 28.6 in 2011-13. For women, baseline BMI was 27.1 kg/m2, increasing to 28.1 in 2011-13. Baseline BMI correlation within spouses was 0.18 (p &lt;0.001). Among women, mean annual BMI change increased by 0.17 kg/m2 per unit increase in spousal annual BMI change (95% CI: 0.14 - 0.19); this association was lower in men: 0.11 kg/m2 (0.09 - 0.13) (Figure). Non-obese women whose husbands became obese were more likely to become obese themselves compared to women whose husbands stayed non-obese (HR 1.52, 1.09- 2.11). Results for men were similar (HR 1.59, 1.14-2.21). Conclusions: Our results suggest that changes in BMI and obesity status in spouse pairs are related, with change in men’s BMI having a somewhat stronger influence on their wives’ BMI. This finding was robust to adjustment for individual and spousal characteristics and suggests weight control strategies might benefit from addressing both spouses.

Objective: This study was to analyze the association of lipid parameters with insulin resistance of Chinese elderly population in different glycemic status. Methods: Data were from China National Chronic Diseases and Nutrition Survey (2015). A total of 15 535 participants aged 60 and above who had completed survey questionnaire, physical examination, fasting blood biochemistry and insulin measurements were included in this study. According to the American Diabetes Association (2010) criteria, the participants were divided into normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes. Multivariable logistic regression was preformed to assess the effects of lipid parameters on insulin resistance in different glycemic among the elderly population. Results: The proportion of normal glucose regulation, pre-diabetes, newly-diagnosed diabetes and previously-diagnosed diabetes was 50.46% (n=7 839), 22.19% (n=3 448), 12.46% (n=1 937) and 14.88% (n=2 311), respectively. The risk of insulin resistance increased with the elevated per quartile of triglycerides (TG) (OR=1.48,95%CI: 1.35-1.62), non-high-density lipoprotein cholesterol (Non-HDL)/HDL-C (OR=1.23, 95%CI: 1.12-1.35) and TG/HDL-C (OR=1.50, 95%CI: 1.36-1.65) and decreased with the elevated per quartile of HDL-C (OR=0.83, 95%CI: 0.76-0.90) after multivariate adjustment among normal glucose regulation participants. As for pre-diabetes participants, the risk of insulin resistance increased with the elevated per quartile of TG (OR=1.26, 95%CI: 1.14-1.39) and TG/HDL-C (OR=1.38, 95%CI: 1.24-1.54) and decreased with the elevated per quartile of HDL-C (OR=0.79, 95%CI: 0.71-0.87). The risk of insulin resistance increased with the elevated per quartiles of TG/HDL-C (OR=1.29, 95%CI: 1.12-1.48) among newly-diagnosed diabetes. As for previously-diagnosed diabetes, the risk of insulin resistance increased with the elevated per quartile of TG, Non-HDL/HDL-C and TG/HDL-C with adjusted OR(95%CI) about 1.28 (1.16-1.41), 1.37(1.21-1.55) and 1.51 (1.33-1.72) repsectivley and decreased with the elevated per quartile of HDL-C (OR=0.77, 95%CI: 0.67-0.87). Conclusion: The relationship between lipid parameters and insulin resistance presented diversely in different glycemic status. The elderly with normal glucose regulation and previously-diagnosed diabetes should pay close attention to the change of TG/HDL-C, TG, HDL-C and Non-HDL/HDL-C. As for prediabetes participants, the TG/HDL-C, TG and HDL-C level change should be focused.

Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study

Studies indicate lower, comparable, and higher cardiovascular risks in women vs men in normal glucose regulation (NGR), prediabetes, and diabetes, respectively. However, this sex difference is uncertain and aging might play a part. We aimed to estimate sex differences in arterial stiffness in NGR, prediabetes, or diabetes and the potential modifications by age. We used baseline data of 9618 participants aged ≥40 years in a large community-based cohort study in Shanghai. Glycemic status was determined by history of diabetes, fasting and 2-h post-load glucose levels, and hemoglobin A1c levels. Arterial stiffness was examined by brachial-ankle pulse wave velocity (ba-PWV). Multivariable linear regression analysis was conducted to examine the associations between sex and ba-PWV levels in glycemic and age categories. Before adjustment for age, women had lower, comparable, and higher ba-PWV vs men in the NGR, prediabetes, and diabetes groups, respectively. In participants aged 40-59 years, women were associated with lower ba-PWV levels in generally all glycemic strata after adjustment for age and other confounders. In participants aged ≥60 years, women were associated with significantly higher ba-PWV levels (β coefficient=71.5; 95% confidence interval=23.4, 119.7) and the sex difference was attenuated in the groups of prediabetes and diabetes with a borderline significant interaction between sex and glycemic status (p for interaction=.068). The sex difference in cardiovascular risks in adults with NGR, prediabetes, or diabetes was dependent on age. Our findings provide new evidence for prioritizing preventive treatment against atherosclerosis in men vs women with different glycemic status.

This study evaluated whether regression from impaired glucose regulation (IGR) to normal glucose regulation (NGR) after 1 year of a lifestyle intervention reduces diabetes risk in American Indians and Alaska Natives (AI/ANs). In addition, we sought to identify predictors for regression to NGR and understand possible mechanisms for the association between NGR and future diabetes risk. Data from participants enrolled from 2006 to 2009 in the Special Diabetes Program for Indians Diabetes Prevention Program with IGR at baseline and an oral glucose tolerance test at year 1 were analyzed (N = 1,443). Cox regression models were used to estimate the subsequent diabetes risk (year 1 to year 3) by year 1 glucose status. Mediation analysis was used to estimate the proportions of the association between year 1 glycemic status and diabetes risk explained by specific factors. Those who reverted to NGR at year 1 (38%) had lower diabetes risk than those with sustained IGR (adjusted hazard ratio 0.28, 95% CI 0.12-0.67). The lower risk associated with regression to NGR was explained by both baseline risk factors and differences in weight loss. Metformin use, weight loss, and an increase in exercise were modifiable risk factors associated with higher odds of regression to NGR. Patients with prediabetes who reverted to NGR had a reduced risk of developing type 2 diabetes over the next 2 years. Both baseline and modifiable risk factors explained the risk reduction associated with NGR.

Limited and partly controversial data are available regarding the relationship of arterial pulse wave velocity and childhood cardiovascular risk factors. We studied how risk factors identified in childhood and adulthood predict pulse wave velocity assessed in adulthood. The study cohort consisted of 1691 white adults aged 30 to 45 years who had risk factor data available since childhood. Pulse wave velocity was assessed noninvasively by whole-body impedance cardiography. The number of conventional childhood and adulthood risk factors (extreme quintiles for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, body mass index, and smoking) was directly associated with pulse wave velocity in adulthood (P=0.005 and P<0.0001, respectively). In multivariable regression analysis, independent predictors of pulse wave velocity were sex (P<0.0001), age (P<0.0001), childhood systolic blood pressure (P=0.002) and glucose (P=0.02), and adulthood systolic blood pressure (P<0.0001), insulin (P=0.0009), and triglycerides (P=0.003). Reduction in the number of risk factors (P<0.0001) and a favorable change in obesity status (P=0.0002) from childhood to adulthood were associated with lower pulse wave velocity in adulthood. Conventional risk factors in childhood and adulthood predict pulse wave velocity in adulthood. Favorable changes in risk factor and obesity status from childhood to adulthood are associated with lower pulse wave velocity in adulthood. These results support efforts for a reduction of conventional risk factors both in childhood and adulthood in the primary prevention of atherosclerosis.

Objective: To analyze the influence of obesity status on the development of cardiometabolic disorders in school-age children. Methods: Information about children's body weight, body height and cardiovascular risk factors were collected in baseline survey in 2017 and follow-up survey in 2019. The school-age children were divided into four groups based on their baseline and follow-up obesity status, i.e. sustained non-obesity group, restored obesity group, newly classified obesity group, and persistent obesity group. Analysis of covariance was used to compare the difference of change in levels of cardiometabolic factors among the four groups. The multivariate logistic regression model was used to analyze the relationship between obesity status and the incidence risk of cardiometabolic disorders. Results: The present study included 11 379 school-age children (boys accounting for 49.6%). During the 2 years, the incidence of obesity was 3.2% (95%CI: 2.9%-3.5%) with the restoration ratio of obesity of 4.4% (95%CI: 4.0%-4.8%). Compared with the sustained non-obesity group, increases in SBP, DBP, TG, LDL-C and non-HDL-C were much higher in newly classified obesity group and persistent obesity group, but lower in restored obesity groups except for DBP (all P<0.05). In addition, the incidence risk of hypertension, high glucose, dyslipidemia and cardiometabolic disorders (≥2 risks) were much higher in newly classified and persistent obese children than in sustained non-obese children. No difference was found in incidence risks of most cardiovascular disorders between restored obese children and sustained non-obese children, except for hypertension and cardiometabolic risks. Conclusion: Both newly classified obesity and persistent obesity increased the incidence risks for multi cardiovascular disorders, while these risks could be reduced when non-obese status restore.

OBJECTIVE To evaluate coronary artery stenosis in early diabetes or prediabetes asymptomatic of myocardial ischemia in community-dwelling Chinese adults.RESEARCH DESIGN AND METHODS Age- and sex-matched participants with normal glucose regulation (NGR), prediabetes, or diabetes diagnosed within 5 years, asymptomatic of coronary artery disease (CAD), were randomly selected from a community-dwelling Chinese population aged 40–60 years. Dual-source computed tomography coronary angiography was used to evaluate the existence and extent of coronary stenosis, which was considered significant if >50% narrowing of vessel lumen was detected.RESULTS After excluding uninterpretable segments attributable to motion artifacts, a total of 135 participants with NGR, 132 with prediabetes, and 134 with diabetes participated in data analysis. Significant coronary stenosis was detected in 10 (7.4%), 10 (7.6%), and 22 (16.4%) individuals with NGR, prediabetes, and diabetes, respectively (P for trend = 0.029). Diabetes, rather than prediabetes, was associated with a significant 2.34-fold elevated risk [odds ratio (OR) 2.34 (95% CI 1.01–5.43); P = 0.047] of significant coronary stenosis as compared with that associated with NGR. Levels of glucose evaluation were independently and significantly associated with risks of significant coronary stenosis in diabetes. Each 1-SD increase in fasting plasma glucose, 2-h postload plasma glucose, and HbA1c conveyed 2.11-fold, 1.73-fold, and 1.81-fold higher risks of significant coronary stenosis, respectively, after adjustment for other conventional cardiovascular risk factors.CONCLUSIONSUsing a noninvasive CAD diagnostic modality such as dual-source computed tomography coronary angiography, we detected a markedly elevated risk of significant coronary stenosis with early diabetes in asymptomatic Chinese adults.

OBJECTIVEParticipants in the Diabetes Prevention Program (DPP) randomized to intensive lifestyle modification (ILS) or metformin had a significantly reduced incidence of diabetes compared with those randomized to placebo, yet most were still at risk because they had pre-diabetes. We explored the effect of baseline characteristics, weight change, ILS, and metformin on regression from pre-diabetes to the lowest-risk state of normal glucose regulation (NGR) defined by American Diabetes Association criteria.RESEARCH DESIGN AND METHODSThe DPP was a prospective randomized trial. Cox proportional hazards modeling was used to identify predictors of regression from pre-diabetes to NGR over 3 years of follow-up.RESULTSLower baseline fasting (hazard ratio 1.52, P < 0.01) and 2-h (1.24, P < 0.01) glucose predicted regression to NGR, as did younger age (1.07, P < 0.01) and greater insulin secretion (1.09, P = 0.04). ILS (2.05, P < 0.01) and weight loss (1.34, P < 0.01) had significant and independent effects on regression. A nonsignificant trend for regression was also observed for metformin (1.25, P = 0.06), male sex (1.17, P = 0.08), and insulin sensitivity (1.07, P = 0.09). In those entering the study with both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), male sex and insulin sensitivity predicted regression to isolated IFG, whereas ILS, metformin, female sex, and greater insulin secretion predicted regression to isolated IGT.CONCLUSIONSInsulin secretion, and other biologic processes retained with younger age, are key in restoring NGR in people with pre-diabetes. However, NGR may also be attained through weight loss and additional aspects of ILS.

The relationship between obesity and back pain in older populations is poorly understood. This study aimed to examine (a) the impacts of changes in obesity status on back pain risk and (b) the heterogeneity in the influence of changes in obesity status according to muscle strength. We analyzed 6868 participants in waves 4 (2008-2009), 6 (2012-2013), and 7 (2014-2015) of the English Longitudinal Study of Ageing. The exposure comprised continuous body mass index (BMI) values, whereas the outcome comprised self-reported moderate or severe back pain. The targeted minimum loss-based estimator was used to estimate the impacts of hypothetical changes in BMI in each wave under 10 scenarios encompassing a 5%-25% hypothetical reduction/increase in BMI. We also performed stratified analysis using handgrip strength at the baseline. For the hypothetical reduction scenarios, a 10% (relative risk [RR]; 95% confidence interval [CI]=0.82 [0.73-0.92], p=.001) reduction in BMI estimated a significantly lower back pain risk compared to the observed data. For the hypothetical increase scenarios, a 5% (RR [95% CI]=1.11 [1.04-1.19], p=.002) increase in BMI estimated a significantly higher back pain risk. Increased BMI had a higher risk of back pain among those with weak strength when stratified by handgrip strength but not among those with strong strength. Our study confirmed that weight gain leads to a greater risk of back pain as well as heterogeneity in the influence of changes in obesity status according to the handgrip strength.

ObjectiveC-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, the association between CTI and the risk of stroke, particularly in individuals with different glycemic status, remains unclear.MethodsA total of 10,443 middle-aged and elderly participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. The CTI was calculated using the formula 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2. The Kaplan–Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between CTI and the risk of stroke according to gender, age and glycemic status.ResultsDuring a median follow-up of 9 years, 960 (9.2%) participants experienced a stroke. Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association was similar between male and female, despite the HR tended to be higher in females (HR 1.22, 95% CI 1.09, 1.36) than males (HR 1.15, 95% CI 1.02, 1.29), and similar in middle-aged (HR 1.25, 95% CI 1.11, 1.41) and elderly participants (HR 1.12, 95% CI 1.00, 1.26). In different glycemic status, high levels of CTI were found to be linked to an increased risk of stroke in individuals with normal glucose regulation (NGR) (HR 1.33, 95% CI 1.11, 1.59) and prediabetes mellitus (Pre-DM) (HR 1.20, 95% CI 1.04, 1.39). However, this association was not observed in individuals with diabetes mellitus (DM).ConclusionsOur findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association between CTI and stroke was similar between male and female, and similar in middle-aged and elderly participants. In different glycemic status, the association was significant in individuals with NGR and Pre-DM.Graphical abstract

Background and aimThis cohort study investigated the potential association between dietary fat intakes and returning to normal glucose regulation (NGR) in different prediabetes (Pre-DM) phenotypes.MethodsA total of 1587 Pre-DM subjects consisting of 60.2% isolated impaired fasting glucose (iIFG), 21% isolated impaired glucose tolerance (iIGT), and 18.8% combined IFG–IGT, were recruited for baseline dietary assessment and were followed for changes in glycemic status (i.e., returned to NGR, remained Pre-DM, or progressed to diabetes) over 9 years. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for returning to NGR across categories of fat intake (< 20%, 20–30%, and > 30% of total energy intake), and tertiles of major fat patterns identified through principal component analysis (PCA).ResultsThe mean age of the participants was 47.2 ± 12.9 years, and 52.2% were men. Over a median of 5.8 years of follow-up, 46.8% of Pre-DM subjects regressed to NGR. Low-fat diet (LFD) was associated with an increased chance of returning to NGR in the iIGT phenotype (HR = 1.44, 95% CI 1.05–1.98). Two major dietary fat patterns, i.e., Mixed Fat Pattern (MFP, whit a higher load of saturated fat, cholesterol, oleic, linoleic, and trans fatty acids) and ω3FP (i.e., loaded heavily on docosahexaenoic, eicosapentaenoic, and α-linolenic acids), extracted by PCA, were corresponded to 58.4% of the total variance of fat intake. In both iIFG and iIGT phenotypes, highest MFP score was inversely associated with NGR (HR = 0.71, 95% CI 0.50–0.99 and HR = 0.60, 95% CI 0.37–0.97), while the highest ω3FP score was associated with an elevated incidence of NGR in subjects with combined IFG–IGT phenotype by twofold (HR = 2.29, 95% CI 1.00–5.29).ConclusionsSubjects with iIGT phenotype may take more advantage from adhering a LFD. Dietary fat patterns may differentially affect chance of returning to NGR across Pre-DM phenotypes.