Metabolic Health Has Greater Impact on Diabetes than Simple Overweight/Obesity in Mexican Americans

Abstract

Purpose. To compare the risk for diabetes in each of 4 categories of metabolic health and BMI. Methods. Participants were drawn from the Cameron County Hispanic Cohort, a randomly selected Mexican American cohort in Texas on the US-Mexico border. Subjects were divided into 4 phenotypes according to metabolic health and BMI: metabolically healthy normal weight, metabolically healthy overweight/obese, metabolically unhealthy normal weight, and metabolically unhealthy overweight/obese. Metabolic health was defined as having less than 2 metabolic abnormalities. Overweight/obese status was assessed by BMI higher than 25 kg/m2. Diabetes was defined by the 2010 ADA definition or by being on a diabetic medication. Results. The odds ratio for diabetes risk was 2.25 in the metabolically healthy overweight/obese phenotype (95% CI 1.34, 3.79), 3.78 (1.57, 9.09) in the metabolically unhealthy normal weight phenotype, and 5.39 (3.16, 9.20) in metabolically unhealthy overweight/obese phenotype after adjusting for confounding factors compared with the metabolically healthy normal weight phenotype. Conclusions. Metabolic health had a greater effect on the increased risk for diabetes than overweight/obesity. Greater focus on metabolic health might be a more effective target for prevention and control of diabetes than emphasis on weight loss alone.

The prevalence, metabolic risk and effects of lifestyle intervention for metabolically healthy obesity

“…[ 22 – 24 ] Five studies were excluded, because they did not define obesity by using the criteria of BMI. Finally, 40 population-based provided the prevalence of MHO in obesity, [ 13 – 18 , 25 – 58 ] 12 cohort studies [ 5 , 6 , 33 , 59 – 67 ] had reported the incidences of MA in MHO subjects, and seven studies [ 8 , 10 , 68 – 72 ] evaluated the effects of lifestyle intervention for MHO.…”

“…Wang et al [ 12 ] reported the prevalence of MHO in general population was 7.27%. After that, several studies also published their results with large sample size, [ 13 – 15 ] especially for the investigations conducted in Cameroon, Australia, and Brazil. [ 16 – 18 ] Additionally, no meta-analysis has been conducted on the transition from MHO to MAO status based on available evidence.…”

Transition from pre-diabetes to diabetes and predictors of risk in Mexican-Americans

“…These observations are entirely consistent with our previous study of the association of obesity and metabolic health with diabetes. 25 In that study, highest prevalence of diabetes was in those obese with significant metabolic abnormalities and the second highest prevalence in those not obese but with significant metabolic abnormalities. Although obesity alone is important, metabolic health is more so.…”

“…Potential confounders were adjusted for likely associated with diabetes outcomes. Since our previous findings suggested the importance of metabolic health on diabetes risk 25 and the purpose being to improve the power of statistics, our analyses used the composite indicator – metabolic health rather than single metabolic biomarker in the multivariable-adjusted models. Besides age, gender and follow-up time, other factors with significant univariate effect on diabetes risk were included into the final model.…”

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“…The complex pathogenesis of obesity indicates the need for different intervention strategies to confront this problem with a simple drug therapy which is more acceptable to patients. The regulation of energy homeostasis for metabolic diseases is one of the most rapidly advancing topics in biomedical research today 21 . Breakthrough in understanding the molecular mechanisms regulating body weight have also provided potential opportunities for therapeutic intervention and has brought renewed hope and vitality for the development of anti-obesity drugs 22 .…”