Impact of the Dynamic Change of Metabolic Health Status on the Incident Type 2 Diabetes: A Nationwide Population-Based Cohort Study.
BACKGROUND
Metabolically healthy obese (MHO) is regarded as a transient concept. We examined the effect of the dynamic change of metabolic health status on the incidence of type 2 diabetes mellitus (T2DM) both in obese and normal weight individuals.


METHODS
We analyzed 3,479,514 metabolically healthy subjects aged over 20 years from the Korean National Health Screening Program, who underwent health examination between 2009 and 2010, with a follow-up after 4 years. The relative risk for T2DM incidence until the December 2017 was compared among the four groups: stable metabolically healthy normal weight (MHNW), unstable MHNW, stable MHO, and unstable MHO.


RESULTS
During the 4 years, 11.1% of subjects in the MHNW group, and 31.5% in the MHO group converted to a metabolically unhealthy phenotype. In the multivariate adjusted model, the unstable MHO group showed the highest risk of T2DM (hazard ratio [HR], 4.67; 95% confidence interval [CI], 4.58 to 4.77). The unstable MHNW group had a higher risk of T2DM than stable MHO group ([HR, 3.23; 95% CI, 3.16 to 3.30] vs. [HR, 1.81; 95% CI, 1.76 to 1.85]). The stable MHO group showed a higher risk of T2DM than the stable MHNW group. The influence of the transition into a metabolically unhealthy phenotype on T2DM incidence was greater in subjects with aged <65 years, women, and those with weight gain.


CONCLUSION
Metabolically healthy phenotype was transient both in normal weight and obese individuals. Maintaining metabolic health was critical for the prevention of T2DM, irrespective of their baseline body mass index.
['Kim|Jung A|JA|0000-0002-6595-6551', 'Kim|Da Hye|DH|', 'Kim|Seon Mee|SM|', 'Park|Yong Gyu|YG|', 'Kim|Nan Hee|NH|', 'Baik|Sei Hyun|SH|', 'Choi|Kyung Mook|KM|', 'Han|Kyungdo|K|0000-0002-6096-1263', 'Yoo|Hye Jin|HJ|0000-0003-0600-0266']
D000328:Adult D015415:Biomarkers D001786:Blood Glucose D016022:Case-Control Studies D003924:Diabetes Mellitus, Type 2 D005260:Female D005500:Follow-Up Studies D006304:Health Status D006801:Humans D015994:Incidence D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D000067329:Obesity, Metabolically Benign D011379:Prognosis D056910:Republic of Korea D012189:Retrospective Studies D012307:Risk Factors D015430:Weight Gain D055815:Young Adult
Obesity Diabetes mellitus, type 2 Metabolic syndrome