title: The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity.
abstract: OBJECTIVE
  To validate a Cardiometabolic Disease Staging (CMDS) system for assigning risk level for diabetes, and all-cause and cardiovascular disease (CVD) mortality.
  
  
  METHODS
  Two large national cohorts, CARDIA and NHANES III, were used to validate CMDS. CMDS: Stage 0: metabolically healthy; Stage 1: one or two metabolic syndrome risk factors [other than impaired fasting glucose (IFG)]; Stage 2: IFG or impaired glucose tolerance (IGT) or metabolic syndrome (without IFG); Stage 3: two of three (IFG, IGT, and/or metabolic syndrome); and Stage 4: type 2 diabetes mellitus/CVD.
  
  
  RESULTS
  In the CARDIA study, compared with Stage 0 metabolically healthy subjects, adjusted risk for diabetes exponentially increased from Stage 1 [hazard ratio (HR) 2.83, 95% confidence interval (CI): 1.76-4.55], to Stage 2 (HR 8.06, 95% CI 4.91-13.2), to Stage 3 (HR 23.5, 95% CI 13.7-40.1) (P for trend <0.001). In NHANES III, both cumulative incidence and multivariable adjusted HRs markedly increased for both all-cause and CVD mortality with advancement of the risk stage from Stages 0 to 4. Adjustment for body mass index (BMI) minimally affected the risks for diabetes and all-cause/CVD mortality using CMDS.
  
  
  CONCLUSIONS
  CMDS can discriminate a wide range of risk for diabetes, CVD mortality, and all-cause mortality independent of BMI, and should be studied as a risk assessment tool to guide interventions that prevent and treat cardiometabolic disease.
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Fangjian
authors.initials: F
authors.lastname: Guo
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Moellering
authors.forename: W Timothy
authors.initials: WT
authors.lastname: Garvey
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000401:mortality*; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: Circulation. 2008 Feb 12;117(6):743-53
references.pmid: 18212285
references.citation: Lancet. 2009 Nov 14;374(9702):1677-86
references.pmid: 19878986
references.citation: Diabet Med. 2005 Nov;22(11):1476-81
references.pmid: 16241909
references.citation: Expert Opin Drug Saf. 2013 Sep;12(5):741-56
references.pmid: 23738843
references.citation: Am J Clin Nutr. 2012 Feb;95(2):297-308
references.pmid: 22158731
references.citation: Med J Aust. 2003 Dec 1-15;179(11-12):580-5
references.pmid: 14636121
references.citation: Endocr Pract. 2013 Mar-Apr;19(2):327-36
references.pmid: 23598536
references.citation: Diabetes Care. 2003 Mar;26(3):725-31
references.pmid: 12610029
references.citation: Circulation. 2004 Feb 17;109(6):706-13
references.pmid: 14970104
references.citation: Diabetes Care. 2011 Jan;34(1):84-9
references.pmid: 20855549
references.citation: Circulation. 2005 Nov 15;112(20):3066-72
references.pmid: 16275870
references.citation: Lancet. 2011 Jul 2;378(9785):31-40
references.pmid: 21705069
references.citation: Ann Surg. 2013 Jan;257(1):87-94
references.pmid: 23235396
references.citation: J Clin Endocrinol Metab. 2006 Aug;91(8):2906-12
references.pmid: 16735483
references.citation: Obesity (Silver Spring). 2012 Mar;20(3):651-9
references.pmid: 21799477
references.citation: Endocr Pract. 2008 Oct;14(7):933-46
references.pmid: 18996826
references.citation: Arch Intern Med. 2008 Aug 11;168(15):1617-24
references.pmid: 18695075
references.citation: Endocr Pract. 2013 Mar-Apr;19(2):337-72
references.pmid: 23529351
references.citation: Curr Opin Endocrinol Diabetes Obes. 2012 Oct;19(5):341-6
references.pmid: 22895358
references.citation: N Engl J Med. 1998 Jul 23;339(4):229-34
references.pmid: 9673301
references.citation: Diabetes Care. 2013 Apr;36(4):1033-46
references.pmid: 23468086
references.citation: Arch Intern Med. 2001 Feb 12;161(3):397-405
references.pmid: 11176766
references.citation: Am J Epidemiol. 1997 Jan 1;145(1):72-80
references.pmid: 8982025
references.citation: J Clin Endocrinol Metab. 2004 Sep;89(9):4197-205
references.pmid: 15356006
references.citation: JAMA. 2012 Feb 1;307(5):491-7
references.pmid: 22253363
references.citation: JAMA. 2002 Dec 4;288(21):2709-16
references.pmid: 12460094
references.citation: JAMA. 2001 May 16;285(19):2486-97
references.pmid: 11368702
references.citation: JAMA. 1998 Dec 2;280(21):1843-8
references.pmid: 9846779
references.citation: Obesity (Silver Spring). 2011 Jul;19(7):1469-75
references.pmid: 21436797
references.citation: Diabetes Care. 2004 Apr;27(4):978-83
references.pmid: 15047659
references.citation: Obes Res. 1998 Sep;6 Suppl 2:51S-209S
references.pmid: 9813653
references.citation: CMAJ. 2011 Oct 4;183(14):E1059-66
references.pmid: 21844111
references.citation: PLoS One. 2011;6(7):e22863
references.pmid: 21829540
references.citation: J Clin Epidemiol. 1988;41(11):1105-16
references.pmid: 3204420
references.citation: N Engl J Med. 2010 Jul 15;363(3):245-56
references.pmid: 20647200