| Summary: | Abstract: The risk of type 2 diabetes associated with obesity appears
to be influenced by other metabolic abnormalities, and there is controversy
about the harmless condition of the metabolically healthy obese
(MHO) state. The aim of this study is to assess the risk of diabetes and
the impact of changes in weight and in triglyceride-glucose index (TyG
index), according to the metabolic health and obesity states.
We analyzed prospective data of the Vascular Metabolic CUN
cohort, a population-based study among a White European population
(mean follow-up, 8.9 years). Incident diabetes was assessed in 1923
women and 3016 men with a mean age at baseline of 55.33 13.68 and
53.78 12.98 years old.
A Cox proportional-hazard analysis was conducted to estimate the
hazard ratio (HR) of diabetes on metabolically healthy nonobese
(MHNO), metabolically healthy obese, metabolically unhealthy nonobese
(MUNO), and metabolically unhealthy obese (MUO). A continuous
standardized variable (z-score) was derived to compute the HR
for diabetes per 1-SD increment in the body mass index (BMI) and the
TyG index.
MHO, MUNO, and MUO status were associated with the development
of diabetes, HR of 2.26 (95% CI: 1.25–4.07), 3.04 (95% CI: 1.69–
5.47), and 4.04 (95% CI: 2.14–7.63), respectively. MUNO individuals
had 1.82 greater risk of diabetes compared to MHO subjects (95% CI:
1.04–3.22). The HRs for incident diabetes per 1-SD increment in BMI
and TyG indexes were 1.23 (95% CI: 1.04–1.44) and 1.54 (95% CI:
1.40–1.68). The increase in BMI did not raise the risk of developing
diabetes among metabolically unhealthy subjects, whereas increasing
the TyG index significantly affect the risk in all metabolic health
categories.
Metabolic health is more important determinant for diabetes onset
than weight gain. The increase in weight does not raise the risk of
developing diabetes among metabolically unhealthy subjects.
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