Fig. 1Study flow sheet. CVD, cardiovascular disease.
Fig. 2Cumulative incidence of type 2 diabetes according to body phenotype and metabolic stability. MHNW, metabolically healthy normal weight; MHO, metabolically healthy obese.
Fig. 3Hazard ratio (HR) and 95% confidence interval (CI) for the incidence of diabetes according to body weight change in the subjects with unstable metabolically healthy normal weight (MHNW) versus stable MHNW and in the subjects with unstable metabolically healthy obese (MHO) versus stable MHO. The reference group contains subjects who remained metabolically healthy over a 4-year follow-up, stable MHNW and stable MHO.
Table 1Baseline Characteristics of Subjects According to Body Phenotype and Metabolic Stability
Characteristic |
Stable MHNW |
Unstable MHNW |
Stable MHO |
Unstable MHO |
Number |
2,377,219 |
305,924 |
545,546 |
250,825 |
Age, yr |
42.45±12.07 |
49.56±12.40 |
43.22±11.45 |
46.00±12.29 |
Men |
1,246,808 (52.45) |
168,036 (54.93) |
383,226 (70.25) |
168,953 (67.36) |
Current smoker |
584,003 (24.57) |
84,545 (27.64) |
158,513 (29.06) |
79,684 (31.77) |
Alcohol consumption |
146,859 (6.18) |
26,082 (8.53) |
50,597 (9.27) |
27,620 (11.01) |
Regular exercise |
419,238 (17.64) |
59,957 (19.60) |
116,658 (21.38) |
52,796 (21.05) |
Income (lower 20%) |
500,161 (21.04)a
|
69,340 (22.67) |
111,059 (20.36)a
|
52,314 (20.86) |
Family history of diabetes |
264,493 (11.13) |
35,394 (11.57) |
66,700 (12.23) |
31,649 (12.62) |
Body weight, kg |
59.37±8.67 |
61.55±8.61 |
74.05±8.90 |
75.18±10.10 |
Body mass index, kg/m2
|
21.76±1.96 |
22.83±1.60 |
26.67±1.60 |
27.21±1.94 |
Waist circumference, cm |
75.07±6.94 |
78.85±6.10 |
85.55±6.02 |
87.25±6.44 |
Systolic BP, mm Hg |
117.03±12.96 |
123.29±13.93 |
121.65±12.44 |
124.77±13.25 |
Diastolic BP, mm Hg |
73.37±9.02 |
77.10±9.39 |
76.46±8.85 |
78.44±9.18 |
Fasting glucose, mg/dL |
90.42±11.25 |
93.79±12.47 |
91.55±11.02 |
93.09±11.66 |
Total cholesterol, mg/dL |
187.99±32.61 |
202.33±36.72 |
197.55±33.10 |
204.12±35.65 |
Triglyceride, mg/dL |
89.06 (89.00–89.11) |
122.48 (122.26–122.70) |
110.54 (110.40–110.68) |
131.32 (131.06–131.57) |
HDL-C, mg/dL |
58.62±16.96 |
54.47±19.30 |
54.47±16.32 |
52.76±17.89 |
LDL-C, mg/dL |
111.06±48.20 |
121.87±48.34 |
119.79±45.81 |
123.36±47.39 |
ALT, U/L |
18.99 (18.98–19.00) |
22.37 (22.33–22.40) |
25.83 (25.79–25.86) |
28.35 (28.29–28.41) |
AST, U/L |
22.60 (22.59–22.61) |
24.48 (24.45–24.51) |
25.07 (25.05–25.09) |
26.30 (26.26–26.33) |
GGT, U/L |
21.97 (21.96–21.99) |
28.39 (28.32–28.46) |
30.56 (30.51–30.61) |
35.53 (35.44–35.63) |
Table 2HR (95% CI) for the Incidence of Type 2 Diabetes According to Body Size Phenotype and Metabolic Stability
Variable |
Total |
Events |
Follow-up duration, person-yr |
Incidence rate, /1,000 person-yr |
HR (95% CI) |
Model 1 |
Model 2 |
Model 3 |
Model 4 |
Stable MHNW |
2,377,219 |
21,312 |
9,258,446 |
2.30 |
1 |
1 |
1 |
1 |
Unstable MHNW |
305,924 |
15,071 |
1,170,674 |
12.87 |
5.60 (5.48–5.72) |
4.33 (4.24–4.43) |
4.20 (4.41–4.29) |
3.23 (3.16–3.30) |
Stable MHO |
545,546 |
9,274 |
2,121,322 |
4.37 |
1.90 (1.85–1.95) |
1.77 (1.73–1.81) |
1.77 (1.72–1.81) |
1.81 (1.76–1.85) |
Unstable MHO |
250,825 |
15,693 |
951,933 |
16.49 |
7.19 (7.04–7.34) |
6.10 (5.97–6.22) |
5.96 (5.84–6.08) |
4.67 (4.58–4.77) |