Abstract
BackgroundRecent studies report the importance of metabolic health beyond obesity. The aim of this study is to compare the risk for diabetes development according to different status of metabolic health and obesity over a median follow-up of 48.7 months.Methods6,748 non-diabetic subjects (mean age 43 years) were divided into four groups according to the baseline metabolic health and obesity status: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUHNO) and metabolically unhealthy obese (MUHO). Being metabolically healthy was defined by having less than 2 components among the 5 components, that is, high blood pressure, high fasting blood glucose, high triglyceride, low high-density lipoprotein cholesterol and being in the highest decile of homeostasis model assessment-insulin resistance (HOMA-IR) index. Obesity status was assessed by body mass index (BMI) higher than 25 kg/m2. The development of diabetes was assessed annually from self-questionnaire, fasting glucose and HbA1c.ResultsAt baseline, 45.3% of the subjects were MHNO, 11.3% were MHO, 21.7% were MUHNO, and 21.7% were MUHO. During a median follow-up of 48.7 months, 277 subject (4.1%) developed diabetes. The hazard ratio for diabetes development was 1.338 in MHO group (95% CI 0.67–2.672), 4.321 in MUHNO group (95% CI 2.702–6.910) and 5.994 in MUHO group (95% CI 3.561–10.085) when MHNO group was considered as the reference group. These results were similar after adjustment for the changes of the risk factors during the follow-up period.ConclusionThe risk for future diabetes development was higher in metabolically unhealthy subgroups compared with those of metabolically healthy subjects regardless of obesity status.
Highlights
It has been known that adipose tissue is a gathering of fat cells, and an active endocrine organ that secretes various adipocytokines that influences the energy expenditure and metabolism of our body [1]
3055 (45.3%) subjects were in metabolically healthy non-obese (MHNO) group, 762 (11.3%) subjects in metabolically healthy obese (MHO) group, 1464 (21.7%) subjects in metabolically unhealthy non-obese (MUHNO) group, and 1467 (21.7%) subjects in metabolically unhealthy obese (MUHO) group
1,845 subjects (27.3%) were in impaired fasting glucose (IFG) status, and the proportion of subjects who were in IFG status was higher in metabolically unhealthy groups compared with metabolically healthy groups
Summary
It has been known that adipose tissue is a gathering of fat cells, and an active endocrine organ that secretes various adipocytokines that influences the energy expenditure and metabolism of our body [1]. Proposed concept of ‘‘metabolically healthy obesity’’ suggests that there is a subset of obese subjects with metabolically healthy phenotype [4,5,6]. These subjects seem to be protected against obesity-induced deterioration of metabolism, such as dyslipidemia, diabetes, hypertension and cardiovascular risk. Adelade Healthy Study showed that metabolically healthy obese subjects were more likely to develop incident diabetes compared with normal-weight peers [7]. They reported that the protective phenotype of ‘‘healthy obesity’’ was only seen in certain subset of subjects and not maintained in whole patients. The aim of this study is to compare the risk for diabetes development according to different status of metabolic health and obesity over a median follow-up of 48.7 months
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
