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Metabolically healthy obesity does not prevent diabetes
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Even without a diagnosis of nonalcoholic fatty liver disease, adults with metabolically healthy obesity are nearly twice as likely to develop diabetes as those considered to have metabolically healthy normal weight, according to data published in Diabetes Metabolism Research Reviews.
“[Metabolically healthy obesity] was associated with increased incidence of diabetes, and the association did not differ by the presence or absence of [nonalcoholic fatty liver disease],” Meian He, PhD, of department of occupational and environmental health and state key laboratory of environmental health for incubating at the School of Public Health at Tongji Medical College of Huazhong University of Science and Technology in Wuhan, China, and colleagues wrote. “Our findings support that [metabolically healthy obesity] is not a harmless condition and highlight the importance of weight management in individuals with overweight and obesity.”
Using data from 17,801 participants in the Dongfeng-Tongii study (mean age, 63.2 years; 55.1% women), He and colleagues identified cases of diabetes across an average follow-up period of 4.6 years. Participants underwent medical examinations upon enrollment from September 2008 to June 2010, and data from these exams allowed the researchers to calculate BMI and categorize participants using Chinese standards that define obesity as a BMI of at least 28 kg/m2, overweight as between 24 kg/m2 and 27.9 kg/m2 and normal weight as between 18.5 kg/m2 and 23.9 kg/m2.
The researchers also collected blood samples and administered questionnaires that provided information on triglycerides, blood pressure, antihypertensive medication use, glucose levels and cholesterol — factors used to quantify metabolic health status.
The researchers observed 1,453 cases of diabetes during follow-up and noted that when including all adjustments, those with metabolically healthy overweight were 1.5 times more likely to be diagnosed with the condition compared with those with metabolically healthy normal weight (HR = 1.5; 95% CI, 1.14-1.96). The odds were even higher when comparing those with metabolically healthy obesity with those with metabolically healthy normal weight (HR = 1.74; 95% CI, 1.16-2.59). Diabetes was also more likely for participants who were considered metabolically unhealthy, regardless of whether they had normal weight (HR = 1.39; 95% CI, 1.09-1.77), overweight (HR = 1.93; 95% CI, 1.53-2.42) or obesity (HR = 2.15; 95% CI, 1.65-2.81).
Having nonalcoholic fatty liver disease (NAFLD) more than doubled the risk for diabetes among participants with metabolically healthy obesity compared with those with metabolically heathy normal weight and no NAFLD (HR = 2.24; 95% CI, 1.36-3.69), but not having NAFLD in addition to metabolically healthy obesity yielded similar results, according to the researchers (HR = 2.71; 95% CI, 1.47-5). Regardless of NAFLD, participants with metabolically unhealthy overweight, metabolically unhealthy normal weight, and metabolically unhealthy obesity all were more likely to be diagnosed with diabetes.
“Our findings... showed that obese and overweight individuals without metabolic risk factors are at intermediate diabetes risk between [metabolically healthy normal weight] and metabolically unhealthy individuals,” the researchers wrote. “Our findings that NAFLD did not change the association between [metabolically healthy obesity] and diabetes incidence were in line with some, but not all, previous studies.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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