All Title Author
Keywords Abstract

PLOS ONE  2014 

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

DOI: 10.1371/journal.pone.0098369

Full-Text   Cite this paper   Add to My Lib


Background Recent 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. Methods 6,748 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. Results At 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. Conclusion The risk for future diabetes development was higher in metabolically unhealthy subgroups compared with those of metabolically healthy subjects regardless of obesity status.


[1]  Galic S, Oakhill JS, Steinberg GR (2010) Adipose tissue as an endocrine organ. Mol Cell Endocrinol 316: 129–139. doi: 10.1016/j.mce.2009.08.018
[2]  McLaughlin T, Lamendola C, Liu A, Abbasi F (2011) Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity. J Clin Endocrinol Metab 96: E1756–E1760. doi: 10.1210/jc.2011-0615
[3]  Yu JH, Yim SH, Yu SH, Lee JY, Kim JD, et al. (2013) The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults. . Endocrinol Metab. 28: 33–40. doi: 10.3803/enm.2013.28.2.155
[4]  Blüher M (2012) Are there still healthy obese patients? Curr Opin Endocrinol Diabetes Obes 19: 341–346. doi: 10.1097/med.0b013e328357f0a3
[5]  Hamer M, Stamatakis E (2012) Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab 97: 2482–2488. doi: 10.1210/jc.2011-3475
[6]  Calori G, Lattuada G, Piemonti LGarancini MP, Ragogna F, et al. (2011) Prevalence, metabolic features, and prognosis of metabolically healthy obese Italian individuals: the Cremona Study. Diabetes Care 34: 210–215. doi: 10.2337/dc10-0665
[7]  Appleton SL, Seaborn CJ, Visvanathan R, Hill CL, Gill TK, et al. (2013) Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Diabetes Care 36: 2388–2394. doi: 10.2337/dc12-1971
[8]  Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriat Soc 50: 889–896. doi: 10.1046/j.1532-5415.2002.50216.x
[9]  List of NGSP Certified Methods. Available at Lastly accessed 2012 November 26
[10]  Schwartz KL, Monsur JC, Bartoces MG, West PA, Neale AV (2005) Correlation of same-visit HbA1c test with laboratory-based measurements: a MetroNet study. BMC Fam Pract 6: 28.
[11]  American Diabetes Association (2013) Standards of medical care in diabetes—2013. Diabetes Care 36 Suppl 1S11–S66. doi: 10.2337/dc13-s011
[12]  Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 289: 2560–2572. doi: 10.1001/jama.289.19.2560
[13]  Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, et al. (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28: 412–419. doi: 10.1007/bf00280883
[14]  Steering Committee of the WHO Western Pacific Region, IASO & IOTF (2000) The Asia–Pacific perspective: redefining obesity and its treatment, Australia.
[15]  Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, et al. (2008) The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med 168: 1617–1624. doi: 10.1097/01.ogx.0000338100.83483.58
[16]  Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International diabetes Federation Task Force on epidemiology and prevention; National heart, Lung, and blood Institute; American heart association; World heart Federation; International atherosclerosis Society; and International association for the study of obesity. Circulation 120: 1640e5. doi: 10.1161/circulationaha.109.192644
[17]  Samocha-Bonet D, Chisholm DJ, Tonks K, Campbell LV, Greenfield JR (2012) Insulin-sensitive obesity in humans - a 'favorable fat' phenotype? Trends Endocrinol Metab 23: 116–124. doi: 10.1016/j.tem.2011.12.005
[18]  Ortega FB, Lee DC, Katzmarzyk PT, Ruiz JR, Sui X, et al. (2013) The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J 34: 389–397. doi: 10.1093/eurheartj/ehs174
[19]  Kl?ting N, Fasshauer M, Dietrich A, Kovacs P, Sch?n MR, et al. (2010) Insulin-sensitive obesity. Am J Physiol Endocrinol Metab 299: E506–E515. doi: 10.1152/ajpendo.00586.2009
[20]  Phillips CM, Dillon C, Harrington JM, McCarthy VJ, Kearney PM, et al. (2013) Defining metabolically healthy obesity: role of dietary and lifestyle factors. PLoS One 8: e76188. doi: 10.1371/journal.pone.0076188
[21]  Seo MH, Bae JC, Park SE, Rhee EJ, Park CY, et al. (2011) Association of lipid and lipoprotein profiles with future development of type 2 diabetes in nondiabetic Korean subjects: a 4-year retrospective, longitudinal study. J Clin Endocrinol Metab 96: E2050–E2054. doi: 10.1210/jc.2011-1857
[22]  Alqahtani N, Khan WA, Alhumaidi MH, Ahmed YA (2013) Use of Glycated Hemoglobin in the Diagnosis of Diabetes Mellitus and Pre-diabetes and Role of Fasting Plasma Glucose, Oral Glucose Tolerance Test. Int J Prev Med 4: 1025–1029.
[23]  Velho S, Paccaud F, Waeber G, Vollenweider P, Marques-Vidal P (2013) Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr 64: 1043–1051. doi: 10.1038/ejcn.2010.114
[24]  Majka DS, Chang RW, Vu TH, Palmas W, Geffken DF, et al. (2009) Physical activity and high-sensitivity C-reactive protein: the multi-ethnic study of atherosclerosis. Am J Prev Med 36: 56–62.
[25]  Poulsen P, Kyvik KO, Vaag A, Beck-Nielsen H (1999) Heritability of type II (non-insulin-dependent) diabetes mellitus and abnormal glucose tolerance—A population-based twin study. Diabetologia 42: 139–145. doi: 10.1007/s001250051131
[26]  North KE, Williams JT, Welty TK, Best LG, Lee ET, et al. (2003) Evidence for joint action of genes on diabetes status and CVD risk factors in American Indians: The strong heart family study. Int J Obes Relat Metab Disord 27: 491–497. doi: 10.1038/sj.ijo.0802261
[27]  Sladek R, Rocheleau G, Rung J, Dina C, Shen L, et al. (2007) A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature 445: 881–885. doi: 10.1038/nature05616
[28]  Hinnouho GM, Czernichow S, Dugravot A, Batty GD, Kivimaki M, et al. (2013) Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter? Diabetes Care 36: 2294–2300. doi: 10.2337/dc12-1654


comments powered by Disqus