Short-Term Changes in Metabolically Healthy Overweight/Obesity Status Impact the Susceptibility to Type 2 Diabetes in Chinese Adults

Figures & data

Table 1 Baseline Characteristics of the Cohort

	Total	Metabolically Healthy		Metabolically Unhealthy		χ^2	P
		Normal Weight	Overweight/Obese	Normal Weight	Overweight/Obese
N	4604	2609 (56.7)	1239 (26.9)	179 (3.9)	577 (12.5)
Gender
Male	1554 (33.8)	942 (36.1)	374 (30.2)	45 (25.1)	193 (33.4)	19.473	<0.001
Female	3050 (66.2)	1667 (63.9)	865 (69.8)	134 (74.9)	384 (66.6)
Age, years	54.03 (8.43)	54.26 (8.65)	53.00 (8.12)	56.06 (8.51)	54.57 (7.80)		<0.001
Marital Status
Married	4361 (95.4)	2480 (95.6)	1168 (94.8)	170 (96.6)	543 (95.3)	1.827	0.609
Unmarried	211 (4.6)	114 (4.4%)	64 (5.2)	6 (3.4)	27 (4.7)
Education
Illiterate/Semi-literate	424 (9.5)	247 (9.8)	100 (8.4)	20 (11.6)	57 (10.2)	9.257	0.160
Junior high and below	3463 (77.8)	1986 (78.5)	922 (77.3)	134 (77.5)	421 (75.6)
High and above	565 (12.7)	296 (11.7)	171 (14.3)	19 (11.0)	79 (14.2)
Smoke
Never	3316 (74.4)	1795 (71.2)	952 (79.5)	140 (80.5)	429 (76.5)	42.708	<0.001
Past	254 (5.7)	145 (5.8)	59 (4.9)	12 (6.9)	38 (6.8)
Current	884 (19.8)	581 (23.0)	187 (15.6)	22 (12.6)	94 (16.8)
Drinking
Never	3369 (73.2)	1876 (71.9)	935 (75.5)	135 (75.4)	423 (73.3)	6.767	<0.343
Past	193 (4.2)	110 (4.2)	48 (3.9)	8 (4.5)	27 (4.7)
Current	1042 (22.6)	623 (23.9)	256 (20.7)	36 (20.1)	127 (22.0)
PA
Low	563 (14.7)	310 (14.4)	157 (14.8)	21 (13.9)	75 (16.0)	5.382	<0.496
Moderate	443 (11.5)	230 (10.7)	133 (12.5)	18 (11.9)	62 (13.2)
High	2834 (73.8)	1618 (75.0)	771 (72.7)	112 (74.2)	333 (70.9)
Sitting MET, minutes/week	1200 [720, 1320]	1020 [720,1320]	1320 [720,1320]	1320 [720,1320]	1320 [720,1500]		<0.001
Family history
Diabetes	45 (1.1)	25 (1.1)	12 (1.1)	2 (1.3)	6 (1.2)	0.067	0.995
CVD	260 (5.6)	132 (5.1)	80 (6.5)	12 (6.7)	36 (6.2)	3.971	0.265
Stroke	195 (4.2)	103 (3.9)	58 (4.7)	11 (6.1)	23 (4.0)	2.837	0.417
Height, cm	156.72 (7.20)	156.83 (7.20)	156.23 (7.04)	156.02 (6.98)	157.52 (7.48)		0.002
Weight, cm	57.96 (9.21)	53.07 (6.10)	63.79 (7.33)	54.35 (6.02)	68.62 (9.15)		<0.001
BMI, kg/m^2	23.55 (3.03)	21.53 (1.48)	26.08 (1.90)	22.26 (1.39)	27.59 (2.50)		<0.001
Waist, cm	78.48 (8.64)	73.70 (6.07)	83.18 (6.45)	78.67 (6.64)	89.93 (6.64)		<0.001
Hip, cm	90.97 (6.52)	87.94 (4.88)	94.40 (5.49)	89.47 (6.03)	97.77 (6.46)		<0.001
WHR	0.86 (0.07)	0.84 (0.06)	0.88 (0.06)	0.88 (0.06)	0.92 (0.06)		<0.001
SBP, mmHg	137.18 (20.95)	134.06 (20.15)	136.52 (20.61)	149.20 (19.20)	148.93 (20.35)		<0.001
DBP, mmHg	79.55 (12.16)	77.50 (11.74)	80.05 (11.84)	85.66 (11.03)	85.81 (12.14)		<0.001
FPG, mmol/L	5.66 (0.53)	5.60 (0.52)	5.60 (0.49)	6.00 (0.53)	5.91 (0.54)		<0.001
2hPG, mmol/L	6.87 (1.64)	6.61 (1.58)	6.75 (1.47)	8.21 (1.63)	7.88 (1.65)		<0.001
HbA1c, %	5.49 (0.43)	5.44 (0.41)	5.51 (0.41)	5.51 (0.53)	5.65 (0.45)		<0.001
TG, mmol/L	1.45 (1.09)	1.18 (0.73)	1.38 (0.75)	2.93 (2.34)	2.40 (1.51)		<0.001
CHOL, mmol/L	5.34 (0.98)	5.26 (0.94)	5.35 (0.93)	5.80 (1.48)	5.55 (1.00)		<0.001
HDL, mmol/L	1.69 (0.39)	1.80 (0.39)	1.62 (0.33)	1.47 (0.35)	1.43 (0.31)		<0.001
LDL, mmol/L	2.99 (0.81)	2.88 (0.78)	3.11 (0.80)	3.15 (1.00)	3.19 (0.82)		<0.001
ALT, U/L	18.70 (12.02)	17.18 (10.91)	19.68 (12.65)	19.63 (12.76)	23.21 (13.72)		<0.001
AST, U/L	26.25 (12.23)	26.11 (11.53)	25.46 (9.91)	29.66 (28.31)	27.48 (11.33)		<0.001
GGT, U/L	27.46 (44.35)	23.17 (30.15)	27.37 (27.50)	52.95 (159.19)	39.17 (41.52)		<0.001
CreaC, μmol/L	67.35 (12.78)	66.74 (11.61)	67.34 (13.81)	67.06 (10.39)	70.18 (15.50)		<0.001
Fasting Insulin, mIU/L	6.58 (4.07)	5.34 (2.94)	7.49 (3.27)	7.69 (7.46)	9.93 (5.71)		<0.001
HOMA-IR	1.68 (1.15)	1.34 (0.82)	1.88 (0.87)	2.09 (2.28)	2.62 (1.65)		<0.001
FLI	21.97 (20.38)	10.51 (8.84)	29.54 (16.95)	29.20 (19.06)	55.24 (19.72)		<0.001

Notes: Categorical variables were presented as count (percentages). Continuous variables were presented as mean (SD) or median [IQR].

Abbreviations: MET, metabolic equivalent of task; CVD, cardiovascular disease; BMI, body mass index; WHR, waist-hip ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; FLI, fatty liver index; PA, physical activity.

Table 2 Risk of Incident T2D by Categories of BMI and Metabolic Status

	Events/n	Incidence	Model 1	Model 2	Model 3
			OR (95% CI)	OR (95% CI)	OR (95% CI)
MHNW	101/2609	3.87%	1 (ref)	1 (ref)	1 (ref)
MHO	52/1239	4.20%	1.12 (0.79–1.58)	1.26 (0.85–1.85)	1.08 (0.64–1.83)
MUNW	20/179	11.17%	3.10 (1.86–5.14) ***	2.26 (1.16–4.41) *	1.75 (0.87–3.49)
MUO	85/577	14.73%	4.31 (3.18–5.84) ***	4.48 (3.12–6.43) ***	3.02 (1.63–5.60) ***

Notes: Model 1: Adjust for age and sex; Model 2: Model 1 plus the adjustment for smoking, physical activity, sitting MET, and family history (diabetes, CVD, and stroke); Model 3: Model 2 plus the adjustment for BMI, waist circumference, and FPG. * P < 0.05. *** P < 0.001.

Table 3 Transition Probabilities of BMI Cross Metabolic Status Changes from Baseline to Follow-Up

Baseline	Follow-Up
	MHNW	MHO	MUNW	MUO
MHNW (n=2609)	0.783 (0.782–0.784)	0.146 (0.145–0.147)	0.049 (0.049–0.049)	0.023 (0.023–0.023)
MHO (n=1239)	0.111 (0.11–0.112)	0.671 (0.669–0.673)	0.012 (0.012–0.012)	0.206 (0.205–0.207)
MUNW (n=179)	0.433 (0.427–0.438)	0.169 (0.166–0.171)	0.247 (0.245–0.250)	0.152 (0.150–0.154)
MUO (n=577)	0.034 (0.033–0.034)	0.347 (0.345–0.350)	0.011 (0.011–0.011)	0.609 (0.606–0.611)

Note: Data are expected proportion (95% CI).

Table 4 Risk for Incident T2DM According to the BMI-Metabolic Status Changes in 3-Year Follow-Up

Baseline	Events/n at Follow-Up			Model 1	Model 2	Model 3
	MHNW	MHO	MUO	OR (95% CI)	OR (95% CI)	OR (95% CI)
MHNW	66/2030	-	-	1 (ref)	1 (ref)	1 (ref)
MHO	-	23/828	-	0.89 (0.55–1.44)	1.02 (0.61–1.73)	1.02 (0.45–2.33)
MHO	-	-	24/254	3.20 (1.96–5.22)***	3.24 (1.83–5.73)***	3.04 (1.21–7.68)*
MUO	-	8/197	-	1.28 (0.60–2.70)	1.03 (0.40–2.63)	0.97 (0.31–3.03)
MUO	-	-	74/345	8.18 (5.73–11.69)***	8.34 (5.48–12.70)***	8.18 (3.53–18.99)***

Notes: Model 1: Adjust for age and sex; Model 2: Model 1 plus the adjustment for smoking, physical activity, sitting MET, and family history (diabetes, CVD, and stroke); Model 3: Model 2 plus the adjustment for BMI, waist circumference, and FPG. * P < 0.05 *** P < 0.001.

Table 5 Multivariate Logistic Regression Analysis for the Transition from Metabolically Healthy to Unhealthy in Overweight/Obese Population

	OR (95% CI)	P
Women	1.75 (1.19–2.57)	0.004
Waist, cm	1.06 (1.02–1.09)	0.003
SBP, mmHg	1.02 (1.01–1.03)	<0.001
FPG, mmol/L	1.64 (1.16–2.31)	0.005
TG, mmol/L	1.33 (1.05–1.70)	0.020
LDL, mmol/L	1.21 (0.98–1.48)	0.076
FLI Q1	1 (ref)
Q2	1.85 (0.97–3.50)	0.060
Q3	3.05 (1.58–5.87)	0.001
Q4	3.41 (1.56–7.46)	0.002

Notes: Age, smoking, physical activity, sitting MET, BMI, 2hPG, HDL, and HOMA-IR were excluded in the final model.

Abbreviations: SBP, systolic blood pressure; FPG, fasting plasma glucose; FLI, fatty liver index; Q1, the first quartile; Q2, the second quartile; Q3, the third quartile; Q4, the fourth quartile.