title: The risk of incident type 2 diabetes in a Korean metabolically healthy obese population: the role of systemic inflammation.
abstract: OBJECTIVE
  This study sought to investigate whether the metabolically healthy obese (MHO) phenotype is associated with an increased risk of incident type 2 diabetes in a Korean population and, if so, whether systemic inflammation affects this risk in MHO individuals.
  
  
  METHODS
  The study population comprised 36 135 Koreans without type 2 diabetes. Participants were stratified by body mass index (cutoff value, 25.0 kg/m(2)) and metabolic health state (assessed using Adult Treatment Panel-III criteria). High-sensitive C-reactive protein (hsCRP) was used as a surrogate marker of systemic inflammation. Subjects were classified into low (ie, hsCRP < 0.5 mg/L) and high (ie, hsCRP ≥ 0.5 mg/L) systemic inflammation groups.
  
  
  RESULTS
  During a median followup of 36.5 months (range, 4.8-81.7 mo), 635 of the 36 135 individuals (1.8%) developed type 2 diabetes. The MHO group had a significantly higher risk of incident type 2 diabetes (multivariate-adjusted hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.16-2.11) than the metabolically healthy nonobese (MHNO) group. However, the risk of the MHO group varied according to the degree of systemic inflammation. Compared with the MHNO/low systemic inflammation group, the risk of type 2 diabetes in the MHO/low systemic inflammation group was not significantly elevated (multivariate-adjusted HR, 1.61; 95% CI, 0.77-3.34). However, the MHO/high systemic inflammation group had an elevated risk of incident type 2 diabetes (multivariate-adjusted HR, 3.73; 95% CI 2.36-5.88).
  
  
  CONCLUSIONS
  MHO subjects show a substantially higher risk of incident type 2 diabetes than MHNO subjects. The level of systemic inflammation partially explains this increased risk.
authors.affiliation: Department of Internal Medicine (C.H.J., M.J.L., Y.M.K., J.E.J., J.L., J.-Y.P., W.J.L), and Department of Health Screening and Promotion Center (J.Y.H., E.H.K., H.-K.K), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Jung
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Kang
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Jang
authors.forename: Jaechan
authors.initials: J
authors.lastname: Leem
authors.forename: Jenie Yoonoo
authors.initials: JY
authors.lastname: Hwang
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Kim
authors.forename: Joong-Yeol
authors.initials: JY
authors.lastname: Park
authors.forename: Hong-Kyu
authors.initials: HK
authors.lastname: Kim
authors.forename: Woo Je
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006262:Health; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology* / Q000378:metabolism; D056910:Republic of Korea / Q000453:epidemiology; D012306:Risk; D055815:Young Adult