Risk of Developing Diabetes and Cardiovascular Disease in Metabolically Unhealthy Normal-Weight and Metabolically Healthy Obese Individuals

The Journal of Clinical Endocrinology & Metabolism: November 20, 2013


Context: The risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) associated with obesity appears to be influenced by the coexistence of other metabolic abnormalities.

Objective: We examined the risk of developing CVD and DM in metabolically healthy obese (MHO) and metabolically unhealthy normal weight (MUH-NW) individuals.

Design and Setting: We analyzed prospective data of the San Antonio Heart Study, a population-based study among Mexican Americans and non-Hispanic whites (median follow-up, 7.4 y).

Participants: Incident DM and CVD were assessed in 2814 and 3700 participants aged 25 to 64 years, respectively.

Main Measures: MHO was defined as obesity (body mass index ≥ 30 kg/m2) with no more than one metabolic abnormality, and MUH-NW was defined as body mass index <25 kg/m2 with two or more abnormalities.

Results: In logistic regression models, BMI was associated with incident DM after controlling for demographics, family history of DM, and fasting glucose (odds ratio × 1 SD, 1.7 [1.5–2.0]). Both MUH-NW and MHO individuals had an increased DM risk (2.5 [1.1–5.6] and 3.9 [2.0–7.4], respectively). Similarly, BMI was related to incident CVD after adjusting for demographics and Framingham risk score (1.3 [1.1–1.6]). Incident CVD was also increased in MUH-NW and MHO individuals (2.9 [1.3–6.4] and 3.9 [1.9–7.8], respectively). Results were consistent across gender and ethnic categories. Read more