Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2019; 10(6): 350-361
Published online Jun 15, 2019. doi: 10.4239/wjd.v10.i6.350
Different metabolic/obesity phenotypes are differentially associated with development of prediabetes in adults: Results from a 14-year cohort study
Fahimeh Haghighatdoost, Masoud Amini, Ashraf Aminorroaya, Majid Abyar, Awat Feizi
Fahimeh Haghighatdoost, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Fahimeh Haghighatdoost, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Masoud Amini, Ashraf Aminorroaya, Majid Abyar, Awat Feizi, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Awat Feizi, Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
Author contributions: Amini M and Aminorroaya A contributed to the concept, design, and data collection; Feizi A and Majid Abyar M analyzed data and interpreted results; Haghighatdoost F interpreted results and drafted the manuscript; Feizi A supervised the current study; All authors approved the final version of manuscript.
Institutional review board statement: This study was conducted at Isfahan Endocrine and Metabolism Research Center and approved by the ethics committee of Isfahan University of Medical Sciences.
Informed consent statement: All involved subjects gave their informed written consent prior to study inclusion.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Awat Feizi, PhD, Professor, Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, P.O. Box 319, Hezar-Jerib Ave, Isfahan 81746-73461, Iran. awat_feiz@hlth.mui.ac.ir
Telephone: +98-313-7923250 Fax: +98-313-7923232
Received: February 24, 2019
Peer-review started: February 26, 2019
First decision: March 11, 2019
Revised: May 10, 2019
Accepted: May 14, 2019
Article in press: May 14, 2019
Published online: June 15, 2019
Processing time: 111 Days and 2 Hours
Abstract
BACKGROUND

The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated.

AIM

To examine the association of baseline metabolic/obesity phenotypes and their changes over time with the risk of prediabetes development.

METHODS

In a population-based cohort study, 1741 adults (aged > 19 years) with normal blood glucose were followed for 14 years. Anthropometric and biochemical measures were evaluated regularly during the follow-up period. According to body mass index and metabolic health status, participants were categorized into four groups: Metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Multivariable Cox regression analysis was used to measure the risk of prediabetes according to the baseline metabolic/obesity phenotype and their changes during the follow-up.

RESULTS

In the whole population with a mean (95CCI for mean) follow up duration of 12.7 years (12.6-12.9), all three MUNW, MHO, MUO groups were at higher risk for developing prediabetes compared to the MHNW group (P = 0.022). The MUNW group had the highest risk for developing prediabetes (hazard ratio (HR): 3.84, 95%CI: 1.20, 12.27). In stratified analysis by sex, no significant association was found in men, while women in the MUNW group were at the greatest risk for prediabetes (HR: 6.74, 95%CI: 1.53, 29.66). Transforming from each phenotype to MHNW or MHO was not related to the risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes (HR > 1; P < 0.05).

CONCLUSION

Our findings indicate that MHO is not a high risk, unless it transforms into MUO over time. However, people in the MUNW group have the greatest risk for developing prediabetes, and therefore, they should be screened and treated.

Keywords: Prediabetes; Obesity; Metabolic status; Cohort study

Core tip: The risk of developing prediabetes based on metabolic/obesity phenotypes has been poorly investigated. In a 14-year follow-up cohort study, we observed that metabolically unhealthy normal weight, metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) were at higher risk for developing prediabetes compared to metabolically healthy normal weight (MHNW) subjects. The results stratified by sex demonstrated no significant association in men, while the risk of prediabetes development was significantly higher in all metabolic/obesity phenotypes in women compared to MHNW. Transforming from each phenotype to MHNW or MHO was not related to an increased risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes.