Are all metabolically healthy individuals with obesity at the same risk of diabetes onset?
To examine the risk of diabetes and the development of an unhealthy status according to metabolic health. To assess the effect of changes in metabolic health among participants with metabolically healthy obesity (MHO) on the risk of diabetes.



A total of 4,340 subjects were included. Unhealthy metabolic status was defined as having three or more risk factors of the Adult Treatment Panel-III criteria. A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of developing diabetes across the change in the metabolic status of subjects with MHO.



After 40,622 person-years of follow-up, the risk of becoming unhealthy was 1.53 times higher for participants with MHO, compared with lean or overweight healthy subjects. A greater risk of diabetes was found in MHO, but it was attributable to those who progressed to an unhealthier status over time: HR of 4.78 (95% CI: 3.38-6.78). The combination of being metabolically unhealthy and obesity heightened the risk of diabetes: HR of 10.09 (95% CI: 4.82-21.55).



The increased risk of diabetes in MHO is attributed to the progression to an unhealthier state. "Healthy obesity" is not a permanent situation but a transitory state.
Navarra Health Service-Osasunbidea, Garcia-Orcoyen Hospital, Spain.
David
D
Navarro-González
Navarra Health Service-Osasunbidea, Garcia-Orcoyen Hospital, Spain.
Laura
L
Sánchez-Íñigo
Department of Occupational Medicine, Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.|IdiSNA-Health Research Institute of Navarra, Pamplona, Spain.
Alejandro
A
Fernández-Montero
IdiSNA-Health Research Institute of Navarra, Pamplona, Spain.|Department of Internal Medicine, University of Navarra Clinic, Pamplona, Spain.
Juan
J
Pastrana-Delgado
IdiSNA-Health Research Institute of Navarra, Pamplona, Spain.|Nutrition and Physiology, Nutrition and Research Center, University of Navarra, Pamplona, Spain.|Centre of Biomedical Research in Pathophysiology of Obesity and Nutrition (CIBERObn), Carlos III, Madrid, Spain.
J
J
Alfredo Martínez
D000328:Adult; D000886:Anthropometry; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D000067329:Obesity, Metabolically Benign / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors