Abstract
AimsObesity is a heterogeneous disease in terms of body mass index (BMI) and metabolic status. The purpose of this study was to investigate the risk of type 2 diabetes mellitus (T2DM) in subjects with metabolically abnormal but normal weight (MANW) in China.Materials and MethodsA prospective cohort with a total of 17,238 participants of the Zhejiang metabolic syndrome cohort was recruited. According to the standard of the Working Group on Obesity in China, general obesity is defined. Metabolic abnormality was defined as two or more abnormal components (elevated triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) or use of antihypertensive therapy, and elevated fasting plasma glucose or antidiabetic treatment). The hazard ratio (HR) and its 95% CI were calculated using a multiple regression model, adjusted for the potential confounding factors.ResultsCompared with metabolically normal and normal weight (MNNW) subjects, the metabolically abnormal and obesity/overweight (MAO) subjects had the highest risk of T2DM disease, with an HR of 4.67 (95% CI: 3.23–6.76), followed by MANW subjects (HR = 2.61, 95% CI: 1.74–3.92) and metabolically normal but obesity/overweight (MNO) subjects (HR = 2.09, 95% CI: 1.29–3.38) after adjusting for age, sex, smoking, drinking, physical activity, and family history of diabetes. Compared with that in the MNNW subjects, the HR in MANW subjects was significantly higher than that in MNO subjects. In normal-weight subjects, the HR of T2DM was significantly positively correlated with the number of components with metabolic abnormalities.ConclusionsMANW subjects had a higher risk of T2DM. MANW subjects should be given more attention in the prevention and control of common chronic diseases.
Highlights
Over the past few decades, the prevalence of overweight and obesity has risen rapidly around the world and has become a serious public health concern [1]
Consistent results were found when the analysis was performed without adjustment, when adjusting for sex and age only or when making additional adjustments for smoking, drinking, physical activity, and family history of diabetes (Tables 2, 3). In this prospective cohort study, we found that metabolically abnormal but normal weight (MANW) subjects had a higher type 2 diabetes mellitus (T2DM) risk than the metabolically normal and normal weight (MNNW) subjects
These inconsistencies raised the debate of metabolically normal but obesity/overweight (MNO) regarding whether Metabolic health but obesity (MHO) is a health status or a transitional status to Metabolically abnormal and obesity/overweight (MAO) [7, 14]. In this prospective study with a relatively large sample, we found that MNO increased the risk of T2DM compared with MNNW counterparts but had less risk than MAO participants
Summary
Over the past few decades, the prevalence of overweight and obesity has risen rapidly around the world and has become a serious public health concern [1]. Obesity increases the risks of cardiovascular disease, type 2 diabetes mellitus (T2DM), and allcause mortality [2]. According to the metabolic status, obesity can be divided into metabolic normality and abnormality obesity [3]. Subjects who are obese without metabolic abnormalities are called metabolically normal but obesity/overweight (MNO) and account for about 18%–44%. About 5%–45% of individuals with normal weight have abnormal metabolic profiles [4, 5], which are known as metabolically abnormal but normal weight (MANW) population, and this group is relatively easy to ignore. Many studies have been conducted on the relationship between MNO and the risk of developing diabetes, the findings are inconsistent [6,7,8]. There are relatively few studies on the risk of diabetes in MANW
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