title: The normal-weight type 2 diabetes phenotype revisited.
abstract: BACKGROUND
  Type 2 diabetes (T2DM) is associated with obesity, insulin resistance and the metabolic syndrome (MetS). In non-diabetic populations, features of metabolic obesity (MO) are observed in a minority of normal-weight (NW) subjects. The cardiometabolic status of metabolically obese but normal-weight (MONW) individuals has not yet been phenotyped in T2DM.
  
  
  METHODS
  Prevalence and features of MONW were analyzed in 1244 T2DM patients, in whom MONW was identified as a BMI <25.0 and a MetS score ≥3/5. Among NW (n=262; 21%), those without MetS (n=152; NW-MetS[-]) were compared to NW-MetS[+] (n=110; i.e. 42% of NW and 9% of all T2DM).
  
  
  RESULTS
  There were no differences between groups in age; gender; diabetes duration; smoking; BP; and LDL-C. NW-MetS[+] had higher BMI; waist; fat mass; visceral fat; liver steatosis and HbA1c, and lower insulin sensitivity. Non-right-handedness was twice-higher (18%) in NW-MetS[-]. NW-MetS[+] had higher apoB100 and triglycerides, and lower HDL-C and LDL size. Macroangiopathy was present in 39% of NW-MetS[+] vs. 22% of NW-MetS[-], as coronary (23% vs. 14%) or peripheral artery disease (14% vs. 5%) and TIA/stroke (15% vs. 7%). Microangiopathy was present in 54% of NW-MetS[+] vs. 32% of NW-MetS[-], as retinopathy (25% vs. 13%); neuropathy (29% vs. 18%); and albuminuria (39% vs. 20%).
  
  
  CONCLUSIONS
  MONW among T2DM represents a significant minority (about 1 in 10). Their cardiometabolic phenotype deserves attention due to multiple comorbidities, including a twice-higher prevalence of micro-/macrovascular damage in patients wrongly perceived at lower risk due to normal BMI. Unexpectedly, non-right-handedness was over-represented among metabolically healthy patients.
authors.affiliation: Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium. Electronic address: michel.hermans@diab.ucl.ac.be.
authors.forename: Michel P
authors.initials: MP
authors.lastname: Hermans
authors.affiliation: Departmental Hospital and University Centre 1, Service de Médecine interne-Endocrinologie, CHUD/OP Porto-Novo, Université d'Abomey-Calavi, Benin.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Amoussou-Guenou
authors.affiliation: Service de Maladies Métaboliques et Endocriniennes, Centre Hospitalier et Universitaire de Brazzaville, Congo.
authors.forename: Evariste
authors.initials: E
authors.lastname: Bouenizabila
authors.affiliation: International Diabetes Federation & Diabetes India, 50, Manoel Gonsalves Rd., Bandra (W), Mumbai 400050, India.
authors.forename: Shaukat S
authors.initials: SS
authors.lastname: Sadikot
authors.affiliation: Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Sylvie A
authors.initials: SA
authors.lastname: Ahn
authors.affiliation: Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Michel F
authors.initials: MF
authors.lastname: Rousseau
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000378:metabolism; D010641:Phenotype
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Atherogenic dyslipidemia; Diabetes; Handedness; Metabolic syndrome; Obesity