title: Changes in Metabolic Health Status Over Time and Risk of Developing Type 2 Diabetes: A Prospective Cohort Study.
abstract: Metabolic health and obesity are not stable conditions, and changes in the status of these conditions might lead to different clinical outcomes. We aimed to determine whether changes in metabolic health status or obesity over time have any effect on the risk of future diabetes. Nondiabetic individuals (n = 2692) from a population-based prospective cohort study with baseline and 2 follow-up examinations at 4-year intervals were included. Being "metabolically obese" (MO) was defined as being in the highest quartile of the TyG index (ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]), whereas falling into the lower 3 quartiles was regarded as being "metabolically healthy" (MH). Individuals were classified as "obese" (O) or "nonobese" (NO) using a body mass index of 25 kg/m2 as a cut-off. The risk of diabetes at year 8 was assessed according to changes of metabolic health status between year 0 and 4. Multivariate-adjusted relative risks (RRs) (95% confidence interval [CI]) of diabetes were significantly higher in individuals who retained the MONO phenotype (RR 3.72, 95% CI 2.10, 6.60) or who had progressed to MONO from the MHNO phenotype (RR 1.96, 95% CI 1.06, 3.61), whereas it was not significant in individuals who had improved to MHNO from the MONO phenotype (RR 0.67, 95% CI 0.26, 1.74) compared with individuals who retained the MHNO phenotype. In contrast, obese individuals had significantly higher RRs for diabetes, independent of changes in metabolic health status, whereas weight reduction resulted in a decreased risk of diabetes. Sensitivity analysis using the presence or absence of the metabolic syndrome as a definition of metabolic health revealed similar results. Changes in metabolic health status were an independent risk factor for future diabetes in nonobese individuals, whereas general obesity had a greater contribution to the risk of obese individuals developing diabetes. These observations might imply a different intervention strategy for diabetes prevention according to obesity status.
authors.affiliation: From the Department of Internal Medicine, College of Medicine, The Catholic University of Korea (S-HL, HKY, H-SK, M-IK, H-YS, K-HY); Division of Endocrinology and Metabolism, Seoul St Mary's Hospital (S-HL, HKY, M-IK, H-YS, K-HY); Department of Preventive Medicine, College of Medicine (H-SH, Y-MP, H-WY, W-CL); Catholic Institute of U-Healthcare, The Catholic University of Korea (J-HL); Division of Endocrinology and Metabolism, Yeouido St Mary's Hospital, Seoul, Korea (H-SK); and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Y-MP).
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Hae Kyung
authors.initials: HK
authors.lastname: Yang
authors.forename: Hee-Sung
authors.initials: HS
authors.lastname: Ha
authors.forename: Jin-Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Hyuk-Sang
authors.initials: HS
authors.lastname: Kwon
authors.forename: Yong-Moon
authors.initials: YM
authors.lastname: Park
authors.forename: Hyeon-Woo
authors.initials: HW
authors.lastname: Yim
authors.forename: Moo-Il
authors.initials: MI
authors.lastname: Kang
authors.forename: Won-Chul
authors.initials: WC
authors.lastname: Lee
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Son
authors.forename: Kun-Ho
authors.initials: KH
authors.lastname: Yoon
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000378:metabolism*; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D014280:Triglycerides