Metabolic Health Is a More Important Determinant for Diabetes Development than Simple Obesity: A 4-Year Retrospective Longitudinal Study

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.

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

“…However, some obese people do not suffer from the common metabolic disturbances related to obesity, adopting the concept of metabolically healthy obesity (MHO) . Similarly, some non‐obese people are at risk of NAFLD‐related outcomes in opposite to other non‐obese subjects with a few metabolic factors . There is no general agreement on the criteria to define the metabolically healthy status, although most of the studies focus on subjects with two or fewer metabolic components.…”

“…11 Similarly, some non-obese people are at risk of NAFLD-related outcomes in opposite to other non-obese subjects with a few metabolic factors. 12 There is no general agreement on the criteria to define the metabolically healthy status, although most of the studies focus on subjects with two or fewer metabolic components. Hence, these concepts have been evaluated for vascular function, 13 ischaemic stroke, 14 myocardial ischaemia, 15 or chronic kidney disease.…”

Therapeutic effects of acupuncture on obesity and HbA1c

“…Metabolic health is a more important determinant for diabetes development than simple obesity [43]. Diabetes was the most common metabolic condition in our patients, present in 38% of subjects.…”

Impact of Body Mass Index on Vascular Calcification and Pericardial Fat Volume Among Patients with Suspected Coronary Artery Disease

“…19,20 Rhee et al compared CAC scores assessed by MDCT among 24,000 participants with different metabolic health and obesity statuses; CAC levels were similar for both non-obese but metabolically unhealthy individuals and metabolically unhealthy obese paticipants. 12 This finding suggests that metabolic health is more closely associated with CAC than obesity via a complex pathway. 12 Recently, after studying the CT scans of 276 participants scoring multiple arteries, including the coronary arteries and aorta, Takx et al reported the systemic nature of cardiovascular calcifications, with a weak link between BMI and cardiovascular calcifications among different arterial beds.…”

“…12 This finding suggests that metabolic health is more closely associated with CAC than obesity via a complex pathway. 12 Recently, after studying the CT scans of 276 participants scoring multiple arteries, including the coronary arteries and aorta, Takx et al reported the systemic nature of cardiovascular calcifications, with a weak link between BMI and cardiovascular calcifications among different arterial beds. 21 With regards to the relationship between PFV, vascular calcification and obesity, considerable evidence supports the vital role of pericardial fat accumulation in the coronary atherosclerosis process via the secretion of hormones and cytokines that modulate coronary artery haemostasis.…”