Journal
OBESITY REVIEWS
Volume 15, Issue 6, Pages 504-515Publisher
WILEY
DOI: 10.1111/obr.12157
Keywords
obesity; type 2 diabetes; Metabolic health
Categories
Funding
- National Institute on Aging in the United States [2RO1AG7644-01A1, 2RO1AG017644]
- consortium of UK government departments
- Economic and Social Research Council (ESRC)
- Medical Research Council [K013351]
- National Heart, Lung and Blood Institute [HL36310]
- National Institute of Aging [AG034454]
- Academy of Finland
- ESRC
- British Heart Foundation [RE/10/005/28296]
- Economic and Social Research Council [ES/J023299/1, 1223506] Funding Source: researchfish
- Medical Research Council [MR/K013351/1] Funding Source: researchfish
- ESRC [ES/J023299/1] Funding Source: UKRI
- MRC [MR/K013351/1] Funding Source: UKRI
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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 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.
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