Transitions in Metabolic Health Status and Obesity Over Time and Risk of Diabetes: The Dongfeng–Tongji Cohort Study

Abstract Context Evidence regarding the association between metabolically healthy overweight or obesity (MHOO) and diabetes is controversial, and mostly ignores the dynamic change of metabolic health status and obesity. Objective To explore the association between transitions of metabolic health status and obesity over 5 years and diabetes incidence. Methods We examined 17 309 participants derived from the Dongfeng–Tongji cohort and followed from 2008 to 2018 (median follow-up 9.9 years). All participants were categorized into 4 phenotypes based on body mass index (BMI) and metabolic health status: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), MHOO, and metabolically unhealthy overweight or obesity (MUOO). The associations of changes in BMI–metabolic health status (2008-2013) with diabetes incidence (2018) were performed among 12 206 individuals with 2 follow-up examinations. Results Compared with stable MHNW, stable MHOO (hazard ratio [HR] 1.76; 95% CI 1.26, 2.45) and transition from MHOO to metabolically unhealthy phenotypes were associated with higher risk for diabetes (HR 2.97; 95% CI 1.79, 4.93 in MHOO to MUNW group and HR 3.38; 95% CI 2.54, 4.49 in MHOO to MUOO group). Instead, improvements to metabolic healthy phenotypes or weight loss occurring in MUOO reduced the risk of diabetes compared with stable MUOO, changing from MUOO to MHNW, MUNW, and MHOO resulted in HRs of 0.57 (95% CI 0.37, 0.87), 0.68 (95% CI 0.50, 0.93), and 0.45 (95% CI 0.34, 0.60), respectively. Conclusion People with MHOO, even stable MHOO, or its transition to metabolically unhealthy phenotypes were at increased risk of diabetes. Metabolic improvements and weight control may reduce the risk of diabetes.