Definitions of Metabolic Health and Risk of Future Type 2 Diabetes in BMI Categories: A Systematic Review and Network Meta-analysis

Luca A. Lotta, Ali Abbasi, Stephen J. Sharp, Anna-Stina Sahlqvist, Dawn Waterworth, Julia M. Brosnan, Robert A. Scott, Claudia Langenberg, Nicholas J. Wareham*

*Corresponding author for this work

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    36 Citations (Scopus)

    Abstract

    OBJECTIVE

    Various definitions of metabolic health have been proposed to explain differences in the risk of type 2 diabetes within BMI categories. The goal of this study was to assess their predictive relevance.

    RESEARCH DESIGN AND METHODS

    We performed systematic searches of MEDLINE records for prospective cohort studies of type 2 diabetes risk in categories of BMI and metabolic health. In a two-stage meta-analysis, relative risks (RRs) specific to each BMI category were derived by network meta-analysis and the resulting RRs of each study were pooled using random-effects models. Hierarchical summary receiver operating characteristic curves were used to assess predictive performance.

    RESULTS

    In a meta-analysis of 140,845 participants and 5,963 incident cases of type 2 diabetes from 14 cohort studies, classification as metabolically unhealthy was associated with higher RR of diabetes in all BMI categories (lean RR compared with healthy individuals 4.0 [95% CI 3.0-5.1], overweight 3.4 [2.8-4.3], and obese 2.5 [2.1-3.0]). Metabolically healthy obese individuals had a high absolute risk of type 2 diabetes (10-year cumulative incidence 3.1% [95% CI 2.6-3.5]). Current binary definitions of metabolic health had high specificity (pooled estimate 0.88 [95% CI 0.84-0.91]) but low sensitivity (0.40 [0.31-0.49]) in lean individuals and satisfactory sensitivity (0.81 [0.76-0.86]) but low specificity (0.42 [0.35-0.49]) in obese individuals. However, positive (0.4) likelihood ratios were consistent with insignificant to small improvements in prediction.

    CONCLUSIONS

    Although individuals classified as metabolically unhealthy have a higher RR of type 2 diabetes compared with individuals classified as healthy in all BMI categories, current binary definitions of metabolic health have limited relevance to the prediction of future type 2 diabetes.

    Original languageEnglish
    Pages (from-to)2177-2187
    Number of pages11
    JournalDiabetes Care
    Volume38
    Issue number11
    DOIs
    Publication statusPublished - Nov-2015

    Keywords

    • BODY-MASS INDEX
    • FASTING PLASMA-GLUCOSE
    • CARDIOVASCULAR-DISEASE
    • OBESE INDIVIDUALS
    • NORMAL-WEIGHT
    • INSULIN-RESISTANCE
    • FATTY LIVER
    • COHORT
    • POPULATION
    • OVERWEIGHT

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