Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies
Summary The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self‐report) amo...
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| Vydané v: | Obesity reviews Ročník 15; číslo 6; s. 504 - 515 |
|---|---|
| Hlavní autori: | , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
Blackwell Publishing Ltd
01.06.2014
Wiley Subscription Services, Inc BlackWell Publishing Ltd |
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| ISSN: | 1467-7881, 1467-789X, 1467-789X |
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| Abstract | Summary
The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self‐report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m−2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high‐density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta‐analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal‐weight adults. Although there was between‐study heterogeneity in the size of effects (I2 = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal‐weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. |
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| AbstractList | Summary
The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self‐report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m−2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high‐density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta‐analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal‐weight adults. Although there was between‐study heterogeneity in the size of effects (I2 = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal‐weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self‐report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m⁻² and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high‐density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta‐analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal‐weight adults. Although there was between‐study heterogeneity in the size of effects (I² = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal‐weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August 2013) and Embase (1947-August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged greater than or equal to 18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI greater than or equal to 30 kg m-2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66-6.09) in healthy obese adults and 8.93 (6.86-11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I2 = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August 2013) and Embase (1947-August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m(-2) and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66-6.09) in healthy obese adults and 8.93 (6.86-11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I(2) = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August 2013) and Embase (1947-August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m(-2) and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66-6.09) in healthy obese adults and 8.93 (6.86-11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I(2) = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition.The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August 2013) and Embase (1947-August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m(-2) and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66-6.09) in healthy obese adults and 8.93 (6.86-11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I(2) = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched M edline (1946– A ugust 2013) and E mbase (1947– A ugust 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self‐report) among metabolically healthy obese adults (defined by body mass index [ BMI ] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the E nglish L ongitudinal S tudy of A geing ( ELSA ), with metabolically healthy obesity defined as BMI ≥ 30 kg m −2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high‐density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta‐analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk ( RR ) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal‐weight adults. Although there was between‐study heterogeneity in the size of effects ( I 2 = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal‐weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. Summary The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August 2013) and Embase (1947-August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥30kgm-2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval=2.66-6.09) in healthy obese adults and 8.93 (6.86-11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I2=49.8%; P=0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. [PUBLICATION ABSTRACT] The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m−2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I2 = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition. |
| Author | Bell, J. A. Hamer, M. Kivimaki, M. |
| Author_xml | – sequence: 1 givenname: J. A. surname: Bell fullname: Bell, J. A. email: Address for correspondence: JA Bell, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK., joshua.bell.11@ucl.ac.uk organization: Department of Epidemiology & Public Health, University College London, London, UK – sequence: 2 givenname: M. surname: Kivimaki fullname: Kivimaki, M. organization: Department of Epidemiology & Public Health, University College London, London, UK – sequence: 3 givenname: M. surname: Hamer fullname: Hamer, M. organization: Department of Epidemiology & Public Health, University College London, London, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24661566$$D View this record in MEDLINE/PubMed |
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| Notes | Academy of Finland istex:9F9820E53563265220488A04D8F49B2574574FA1 Medical Research Council - No. K013351 National Institute on Aging in the United States - No. 2RO1AG7644-01A1; No. 2RO1AG017644; No. AG034454 ark:/67375/WNG-QPT0M0W4-5 Economic and Social Research Council (ESRC) National Heart, Lung and Blood Institute - No. HL36310 an ESRC professorial fellowship British Heart Foundation - No. RE/10/005/28296 Appendix S1. Characteristics of the ELSA study population at baseline (n = 3,066)Appendix S2. Metabolically healthy obesity and risk of incident type 2 diabetes over 6 years follow-up in ELSA. Participants free from physician diagnosed diabetes at baseline (n = 3,066)Appendix S3. Metabolically healthy obesity and risk of incident diabetes over 6 years follow-up in ELSA. Participants free from physician diagnosed diabetes at baseline ArticleID:OBR12157 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23 |
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Int J Obes (Lond) 2006; 30: 1529-1534. 2010; 53 2013; 26 2006; 30 2010; 18 2011; 11 2011; 54 2003; 17 2012; 17 2005; 28 2007; 33 2012; 10 2001; 345 2009; 12 2007; 29 2013; 98 2007; 298 2004; 292 2000; 283 2008; 67 2006; 29 2007; 65 2009; 207 2003; 289 2012; 21 2011; 365 2009; 169 2006; 444 2001; 286 2010; 33 2011; 378 2011; 377 2006; 91 2012 2000; 23 2010; 39 2013; 42 2010; 121 2010; 122 2011; 35 2011; 34 2008; 168 2008; 51 2001; 24 2009; 26 2013; 36 2013; 34 2002; 21 2010; 299 2010; 1186 2011; 342 2005; 13 e_1_2_9_31_1 e_1_2_9_52_1 e_1_2_9_50_1 e_1_2_9_10_1 e_1_2_9_56_1 e_1_2_9_12_1 e_1_2_9_33_1 e_1_2_9_54_1 e_1_2_9_14_1 e_1_2_9_39_1 e_1_2_9_16_1 Hwang L‐C (e_1_2_9_35_1) 2012; 21 e_1_2_9_37_1 e_1_2_9_18_1 e_1_2_9_41_1 e_1_2_9_20_1 e_1_2_9_22_1 e_1_2_9_45_1 e_1_2_9_24_1 e_1_2_9_43_1 e_1_2_9_8_1 e_1_2_9_6_1 e_1_2_9_4_1 e_1_2_9_2_1 e_1_2_9_26_1 e_1_2_9_49_1 e_1_2_9_28_1 e_1_2_9_47_1 e_1_2_9_30_1 e_1_2_9_53_1 e_1_2_9_51_1 e_1_2_9_11_1 e_1_2_9_34_1 e_1_2_9_13_1 e_1_2_9_32_1 e_1_2_9_55_1 e_1_2_9_15_1 e_1_2_9_38_1 e_1_2_9_17_1 e_1_2_9_36_1 e_1_2_9_19_1 e_1_2_9_42_1 e_1_2_9_40_1 e_1_2_9_21_1 e_1_2_9_46_1 e_1_2_9_23_1 e_1_2_9_44_1 e_1_2_9_7_1 e_1_2_9_5_1 e_1_2_9_3_1 e_1_2_9_9_1 e_1_2_9_25_1 e_1_2_9_27_1 e_1_2_9_48_1 e_1_2_9_29_1 |
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presence of metabolic syndrome? publication-title: BMC Public Health – volume: 11 start-page: 754 year: 2011 article-title: Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN‐D2D survey publication-title: BMC Public Health – volume: 34 start-page: 61 year: 2011 end-page: 65 article-title: Impact of BMI and the metabolic syndrome on the risk of diabetes in middle‐aged men publication-title: Diabetes Care – volume: 365 start-page: 1509 year: 2011 end-page: 1519 article-title: Neighborhoods, obesity, and diabetes – a randomized social experiment publication-title: N Engl J Med – volume: 299 start-page: E506 year: 2010 end-page: E515 article-title: Insulin‐sensitive obesity publication-title: Am J Physiol Endocrinol Metab – volume: 29 start-page: 115 year: 2007 end-page: 128 article-title: Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta‐analysis publication-title: Epidemiol Rev – volume: 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The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August... The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched M edline (1946– A ugust 2013)... The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August 2013)... Summary The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946-August... The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013)... |
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| SubjectTerms | adults Aging analysis blood blood glucose Blood Glucose - analysis Body Mass Index C-Reactive Protein C-Reactive Protein - analysis cholesterol Cholesterol, HDL Cholesterol, HDL - blood Cohort Studies complications confidence interval Diabetes Mellitus, Type 2 Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - etiology epidemiology etiology Female Glycated Hemoglobin Glycated Hemoglobin - analysis glycemic control Heterogeneity Humans Hypertension Hypertension - epidemiology inflammation insulin lipoproteins Longitudinal Studies Male MEDLINE meta-analysis Metabolic health metabolism noninsulin-dependent diabetes mellitus Obesity Obesity - complications Obesity - metabolism Obesity Comorbidity Prospective Studies relative risk Risk Risk Factors risk profile triacylglycerols Triglycerides Triglycerides - blood type 2 diabetes |
| Title | Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies |
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