Weight gain since age of 20 as risk of metabolic syndrome even in non-overweight individuals

Correlation between the triglyceride-glucose index and arterial stiffness in Japanese individuals with normoglycaemia: a cross-sectional study

BACKGROUND

The association between the triglyceride-glucose (TyG) index and arterial stiffness in individuals with normoglycaemia remains unclear. We aimed to evaluate the relationship between the TyG index and arterial stiffness in Japanese individuals with normoglycaemia, providing additional evidence for predicting early arterial stiffness.

METHODS

This study included 15,453 adults who participated in the NAGALA Physical Examination Project of the Murakami Memorial Hospital in Gifu, Japan, from 2004 to 2015. Data on clinical demographic characteristics and serum biomarker levels were collected. The TyG index was calculated from the logarithmic transformation of fasting triglycerides multiplied by fasting glucose, and arterial stiffness was measured using the estimated pulse wave velocity calculated based on age and mean blood pressure. The association between the TyG index and arterial stiffness was analysed using a logistic regression model.

RESULTS

The prevalence of arterial stiffness was 3.2% (500/15,453). After adjusting for all covariates, the TyG index was positively associated with arterial stiffness as a continuous variable (adjusted odds ratio (OR) = 1.86; 95% Confidence Interval = 1.45-2.39; P<0.001). Using the quartile as the cutoff point, a regression analysis was performed for arterial stiffness when the TyG index was converted into a categorical variable. After adjusting for all covariates, the OR showed an upward trend; the trend test was P<0.001. Subgroup analysis revealed a positive association between the TyG index and arterial stiffness in Japanese individuals with normoglycaemia and different characteristics.

CONCLUSION

The TyG index in Japanese individuals with normoglycaemia is significantly correlated with arterial stiffness, and the TyG index may be a predictor of early arterial stiffness.

Association between weight change and risk of metabolic abnormalities in non-overweight/obese and overweight/obese population: A retrospective cohort study among Chinese adults

OBJECTIVES

To explore the effects of weight change on the risk of metabolic abnormalities in the Chinese population.

METHODS

A total of 1895 metabolically healthy adults aged 21-78 years completed anthropometric and biological measurements at baseline (2012) and at an eight year follow-up (2020). Based on absolute weight change and relative weight change, the participants were split into five classes. A Cox proportional hazards regression model was used to estimate the relative risk (RR) and 95% confidence intervals (95% CI) for the risk of metabolic abnormalities using stable weight as the reference group. Stratified analysis was used to explore this relationship in participants with different baseline body mass index (BMI) levels.

RESULTS

During the follow-up period, 35.41% of the participants retained a stable weight, and 10.71% had metabolic abnormalities. After covariate adjustment, for every kilogram gained over eight years, the risk of developing metabolic abnormalities increased by 22% (RR: 1.094; 95% CI: 1.063-1.127). Compared with stable weight participants, weight gain of 2-4 Kg and weight gain ≥ 4 Kg exhibited significantly higher risks of metabolic abnormalities, with RR of 1.700 (95% CI 1.150-2.513) and 1.981 (95% CI 1.372-2.859), respectively. A weight gain of ≥ 4 Kg had an opposite effect on the overweight/obesity and non-overweight/obesity groups, with an increased risk of metabolic abnormalities only in the non-overweight/obesity group (RR, 2.291; 95% CI, 1.331-3.942). Moreover, weight loss ≥ 4 Kg significantly reduced the risk of metabolic abnormalities only among overweight/obese adults (RR 0.373; 95% CI 0.154-0.906). Similar results were observed in relative body weight change analyses.

CONCLUSIONS

Long-term excessive body weight gain is positively associated with an increased risk of metabolic abnormalities among adults with non-overweight/obesity, whereas long-term body weight loss is a protective factor for metabolic health among adults with overweight/obesity.

Association Between METS-IR and Prehypertension or Hypertension Among Normoglycemia Subjects in Japan: A Retrospective Study

AIM

Our study aimed to investigate the association between the novel non-insulin-based metabolic score for insulin resistance (METS-IR) index and pre-hypertension (HTN) or HTN in normoglycemia Japanese participants.

METHODS

The NAGALA medical examination program at Murakami Memorial Hospital in Gifu, Japan was found in 1994. 15,453 participants enrolled in this program from 2004 to 2015 was included in this retrospective study to explore the association between the METS-IR index and pre-HTN or HTN. Covariates included serum biomarkers and clinicodemographic characteristics. Logistic regression was applied to explore the association between METS-IR level and pre-HTN or HTN.

RESULTS

This study includes a total of 15453 participants. The prevalence rates of pre-HTN and HTN were 28.55% (4412/15453) and 6.23% (962/15453), respectively. Adjusted for confounding factors in the multivariable logistic regression analysis models, when METS-IR was used as a categorical variable, high METS-IR was significantly associated with both pre-HTN (adjusted odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.61-2.36) and HTN (adjusted OR = 2.12, 95% CI: 1.44-3.11). When METS-IR was used as a continuous variable, each 1 unit increase in METS-IR was associated with a 7% increase in the prevalence of pre-HTN (adjusted OR = 1.07, 95% CI: 1.06-1.08) and with a 13% increase in the prevalence of HTN (adjusted OR = 1.13, 95% CI: 1.10-1.16). Stratified analyses indicated a positive correlation between METS-IR and pre-HTN or HTN in normoglycemia subjects with different characteristics.

CONCLUSIONS

METS-IR levels are significantly associated with pre-HTN or HTN in normoglycemia individuals in Gifu, Japan. METS-IR may be used as a monitoring indicator for the development of HTN primary prevention and management strategies in the future, but it still needs more research to confirm.

Weight Gain Predicts Metabolic Syndrome among North Korean Refugees in South Korea

Previous cross-sectional studies showed that immigrants from low-income to high-income countries have higher risk of cardiovascular disease and type 2 diabetes mellitus. We investigated the association between weight gain during the resettlement in South Korea and risk of metabolic syndrome (MetS) among North Korean refugees (NKRs) in this cross-sectional study. In total, 932 NKRs aged 20-80 years in South Korea voluntarily underwent health examination from 2008 to 2017. We compared the risk of MetS and its components between the weight gain group (gained ≥5 kg) and the non-weight gain group (gained <5 kg, maintained or lost body weight) during resettlement in South Korea after defection from North Korea. Multiple logistic regression analysis predicted odds ratio of MetS on the basis of weight change, adjusting for covariates and current body mass index (BMI). We also evaluated the difference in body composition of NKRs between two groups. The prevalence of MetS in the weight gain group was 26%, compared to 10% in the non-weight gain group (p-value < 0.001). The weight gain group had a two-fold higher risk of MetS than the non-weight gain group after adjusting for current BMI (odds ratio 1.875, p-value = 0.045). The prevalence of central obesity, impaired fasting glucose, elevated blood pressure, and hypertriglyceridemia were higher in the weight gain group than the non-weight gain group (36% vs. 12%, p-value < 0.001; 32% vs. 19%, p-value < 0.001; 34 vs. 25%, p-value = 0.008; 19% vs. 13%, p-value = 0.025, respectively). The analysis of body composition showed that the percentage of body fat in the weight gain group was higher than in the non-weight gain group, indicating increased fat mass rather than muscle mass in the weight gain group as their body weight increased during resettlement (33.4 ± 6.53% vs. 28.88 ± 7.40%, p < 0.005). Excess weight gain after defection from North Korea increased the risk of MetS among NKRs in South Korea. It is necessary to monitor weight change among NKRs and their effect on their metabolic health in the long term.

Impact of Body Weight Gain on the Incidence of Nonalcoholic Fatty Liver Disease in Nonobese Japanese Individuals

INTRODUCTION

We aimed to investigate the effect of recent short-term weight gain on the incidence of nonalcoholic fatty liver disease (NAFLD) in nonobese (body mass index < 25 kg/m) participants.

METHODS

This retrospective cohort study included nonobese individuals who participated in an annual health checkup between 2008 and 2018 in Tokyo, Japan. We estimated the multivariable adjusted hazard ratio for the development of NAFLD diagnosed via ultrasound after a 3-kg unit gain in weight measured at a 2-year landmark time point postbaseline. Multivariable adjustments included weight change from the age of 20 and other relevant confounding factors. Sensitivity analyses using additional landmark time points at 1, 3, 4, and 5 years postbaseline and time-dependent Cox proportional hazards regressions were performed.

RESULTS

Among the 27,064 nonobese participants (142,699 person years of follow-up), 2,895 were diagnosed with NAFLD. Approximately 90% of the patients with NAFLD maintained their nonobese status before disease diagnosis. The adjusted hazard ratio for the development of NAFLD (for a 3-kg unit of weight gain) at the 2-year landmark time point postbaseline was 1.60 (95% confidence interval, 1.46-1.76) in nonobese men and 1.66 (95% confidence interval, 1.51-1.83) in nonobese women. This association was maintained in the sensitivity analyses.

DISCUSSION

Recent short-term weight gain is an independent risk factor for NAFLD development in nonobese men and women. Clinicians should be mindful of the association between weight gain and NAFLD onset, even in the nonobese population.

Derivation and Validation of a Prediction Model for Predicting the 5-Year Incidence of Type 2 Diabetes in Non-Obese Adults: A Population-Based Cohort Study

PURPOSE

The aim of this study was to derivate and validate a nomogram based on independent predictors to better evaluate the 5-year risk of T2D in non-obese adults.

PATIENTS AND METHODS

This is a historical cohort study from a collection of databases that included 12,940 non-obese participants without diabetes at baseline. All participants were randomised to a derivation cohort (n = 9651) and a validation cohort (n = 3289). In the derivation cohort, the least absolute shrinkage and selection operator (LASSO) regression model was used to determine the optimal risk factors for T2D. Multivariate Cox regression analysis was used to establish the nomogram of T2D prediction. The receiver operating characteristic (ROC) curve, C-index, calibration curve, and decision curve analysis were performed by 1000 bootstrap resamplings to evaluate the discrimination ability, calibration, and clinical practicability of the nomogram.

RESULTS

After LASSO regression analysis of the derivation cohort, it was found that age, fatty liver, γ-glutamyltranspeptidase, triglycerides, glycosylated hemoglobin A1c and fasting plasma glucose were risk predictors, which were integrated into the nomogram. The C-index of derivation cohort and validation cohort were 0.906 [95% confidence interval (CI), 0.878-0.934] and 0.837 (95% CI, 0.760-0.914), respectively. The AUC of 5-year T2D risk in the derivation cohort and validation cohort was 0.916 (95% CI, 0.889-0.943) and 0.829 (95% CI, 0.753-0.905), respectively. The calibration curve indicated that the predicted probability of nomogram is in good agreement with the actual probability. The decision curve analysis demonstrated that the predicted nomogram was clinically useful.

CONCLUSION

Our nomogram can be used as a reasonable, affordable, simple, and widely implemented tool to predict the 5-year risk of T2D in non-obese adults. With this model, early identification of high-risk individuals is helpful to timely intervene and reduce the risk of T2D in non-obese adults.

Association Between the Triglyceride-Glucose Index and the Incidence of Diabetes in People With Different Phenotypes of Obesity: A Retrospective Study

AIM

We aimed to examine the relationship between the Triglyceride-glucose (TyG) index and the incidence of type 2 diabetes in people with different phenotypes of obesity.

METHODS

From May 1, 1994 to December 31, 2016, 15,464 participants were enrolled in the medical examination program at the Murakami Memorial Hospital to determine the relationship between the TyG index and the incidence of type 2 diabetes in people with different phenotypes of obesity after 5.38 years of follow-up.

RESULTS

Besides triglycerides, HbA1c%, and FPG, the incidence of type 2 diabetes was found to be significantly associated with the TyG index (p <0.001), age (p <0.001), BMI (p = 0.033), current smoker (p <0.001), and fatty liver (p <0.001). In participants with visceral fat obesity and/or ectopic fat obesity and normal BMI, the TyG index was significantly associated with the incidence of type 2 diabetes after adjusting for confounding factors. In patients with BMI ≥25 mg/m², although there was a trend of the relationship between the TyG index and the incidence of type 2 diabetes, the relationship was no longer positive.

CONCLUSION

In participants with obesity involving visceral fat obesity and/or fatty liver and normal BMI which is not a measure of body fat distribution, there was a significant association between the TyG index and incidence of T2DM.

Intermittent Versus Continuous Energy Restriction for Weight Loss and Metabolic Improvement: A Meta-Analysis and Systematic Review

OBJECTIVE

This study aimed to evaluate the effects of intermittent energy restriction (IER; only for 2-3 d/wk) versus continuous energy restriction (CER) on weight loss and metabolic outcomes in adults with overweight or obesity.

METHODS

Methods included searching databases from the last decade to December 18, 2019, for randomized controlled trials (RCTs) that assessed weight loss and metabolic outcomes in IER and CER. RevMan version 5.3 software was used for statistical analysis of the data. The effect sizes were expressed as weight mean differences and 95% CI.

RESULTS

This review included 11 RCTs (n = 850). Meta-analysis showed that IER had greater effects on absolute weight loss, the percentage of weight loss, and improving insulin sensitivity than CER. In the subgroup analysis, short-term (2-3 months) intervention (P < 0.0001) was associated with weight loss.

CONCLUSIONS

This systematic review shows that IER (2-3 d/wk) had greater effects on short-term weight loss than CER and that IER results in comparative metabolic improvements. Furthermore, longer RCTs are needed to validate these findings.

Body Mass Index and Its Change from Adolescence to Adulthood Are Closely Related to the Risk of Adult Metabolic Syndrome in China

AIMS

To investigate the influence of body mass index (BMI) and its change from adolescence to adulthood (ΔBMI) on the risk of metabolic syndrome (MetS) in early adulthood.

METHODS

We selected 931 students from 12 to 16 years of age in Liaoyang City, China. Ninety-three participants from 18 to 22 years of age with complete baseline data were available for follow-up after 5 years. Statistical analysis determined the relationship of MetS at follow-up with baseline BMI (BMI_b), ΔBMI, and follow-up BMI (BMI_f).

RESULTS

ΔBMI was positively correlated with the change of waist circumference (ΔWC), systolic blood pressure (ΔSBP), triglycerides (ΔTG), uric acid, and glycosylated hemoglobin (ΔHbA1c) in follow-up (p < 0.05). For every 1 kg/m² increase in BMI_b, ΔBMI, and BMI_f, the risk of MetS at follow-up increased 1.201-fold, 1.406-fold, and 1.579-fold, respectively. Both BMI_b and ΔBMI were predictive of MetS at follow-up, with prediction thresholds of 23.47 kg/m² and 1.95 kg/m². The participants were divided by the predicted BMI_b and ΔBMI threshold values into four study groups. Interestingly, the group with lower BMI but a higher increase in BMI presented the same metabolic derangements and Mets% of the group with higher BMI but lower Δ BMI.

CONCLUSION

Both BMI of adolescence and ΔBMI were predictive of MetS and cardiovascular risk factors in adulthood. Control of both variables in adolescents would be more effective in decreasing the risk of MetS in young adults than control of BMI alone.

Lifestyle Changes and Weight Gain: A 2-Year Follow-up Study of Japanese Workers

OBJECTIVE

To examine age-dependent trends in weight and lifestyle changes in Japanese workers.

METHODS

Using annual health examination data, 60,143 eligible Japanese workers aged 20 to 59 years were examined for their 2-year changes in weight and smoking, eating, exercise, drinking, and sleep habits.

RESULTS

Young male workers aged 20 to 24 years showed the greatest weight gain and the highest incidence of unhealthy lifestyle habits. Multivariate analyses indicated that quitting "exercise less than two times/week," "walking less than 60 min/d," and "smoking everyday" contributed to weight gain to a considerable extent except in young female workers aged 20 to 24 years.

CONCLUSIONS

Greater weight gain associated with unhealthy lifestyle changes tended to occur in early rather than middle-to-old adulthood. It is important to deliver health promotion programs targeting young male workers.

Associations between caries experience, dietary habits, and metabolic syndrome in Japanese adults

Dental caries could be a risk factor for metabolic syndrome (MetS); however, there is limited evidence of such a relationship in the literature. This cross-sectional study investigated the relationships among dental caries experience, dietary habits, and MetS in Japanese adults. A total of 937 participants aged 40-74 years underwent a health check, including dental examination. Decayed, missing, and filled teeth (DMFT) were used as an index of caries experience. The mean DMFT score was 14, and 12% of the participants had MetS in this study. Multivariate logistic regression analyses showed that the prevalence of MetS was significantly related to DMFT (first vs. fourth quartile, odds ratio [OR] = 1.80; P < 0.05). In addition, the OR of DMFT for MetS was found to be greater in each successively higher DMFT quartile. The prevalence of MetS was significantly related to daily coffee consumption (OR = 0.51, P < 0.01), and the relationship between DMFT and MetS was noted after adjusting for daily coffee consumption. There appears to be a positive association between caries experience and MetS in Japanese adults. This relationship increased with the increase in DMFT regardless of dietary habits.

The Triglyceride and Glucose Index Is a Predictor of Incident Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study

BACKGROUND

The triglyceride and glucose index (TyG), defined as the product of triglycerides (TG) and fasting plasma glucose (FPG), is reported as a surrogate index for insulin resistance. Although a cross-sectional study revealed the association between the TyG-index and the prevalence of nonalcoholic fatty liver disease (NAFLD), few studies have investigated the association between the TyG-index and incident NAFLD. Here we investigated whether the TyG-index can be used to predict incident NAFLD.

METHODS

This historical cohort study included 16,093 apparently healthy Japanese individuals. The TyG-index was calculated by the established formula: TyG = Ln [TG (mg/dl) ×  FPG (mg/dl)/2]. Fatty liver was diagnosed based on the subjects' abdominal ultrasonography results. We divided the subjects into tertiles according to the levels of TyG-index. Hazard ratios (HRs) of the TyG-index for incident NAFLD were calculated by a Cox proportional hazards regression model.

RESULTS

During the observation period, 27.4% of the men and 11.0% of the women developed NAFLD. The highest TyG-index tertile (men, 8.48 ≤ TyG and women, 7.97 ≤ TyG) (adjusted HR 1.67, 95% CI 1.44-1.94, p < 0.001 in the men and 2.06, 1.59-2.70, p < 0.001 in the women) and the middle TyG-index tertile (men, 8.00 < TyG ≤ 8.48 and women, 7.53 <TyG ≤7.97) (1.33, 1.15-1.54, p < 0.001 in the men and 1.52, 1.16-2.01, p < 0.001 in the women) presented a significantly higher risk of incident NAFLD compared to the lowest TyG-index tertile (men, TyG < 8.00 and women, TyG < 7.53).

CONCLUSIONS

Our findings demonstrate that the TyG-index is significantly associated with incident NAFLD.

Understanding of antidiabetic medication is associated with blood glucose in patients with type 2 diabetes: At baseline date of the KAMOGAWA-DM cohort study

AIMS/INTRODUCTION

Medication adherence, which is decreased by a poor understanding of medications, has a close association with blood glucose level in patients with type 2 diabetes. However, a relationship between the understanding of antidiabetic medication and blood glucose level in patients with type 2 diabetes is unclear. Here, we aimed to investigate the relationship between the understanding of antidiabetic medication and blood glucose level in patients with type 2 diabetes.

MATERIALS AND METHODS

Lifestyle factors were evaluated by a questionnaire method, in the present cross-sectional study. Poor understanding of antidiabetic medication (PUAD) was defined as a discrepancy between the answer and the actual use of oral antidiabetic medication on the questionnaire. Poor blood glucose level was defined as hemoglobin A1c ≥8%. To investigate the impact of PUAD on poor blood glucose level, propensity-score matching analysis was used to remove the bias of confounding variables, including sex, age, log (duration of diabetes +1), body mass index, number of oral antidiabetic medications, smoking status, alcohol drinking, exercise, nephropathy, neuropathy, oral antidiabetic medications and insulin.

RESULTS

Among 479 patients, 40 patients (8.4%) were categorized into the PUAD group. The hemoglobin A1c of patients with PUAD was higher than that of patients without (7.5 [1.3] vs 7.2 [0.9]%, P = 0.041). In the propensity-matched 74 patients, PUAD was associated with poor blood glucose level (odds ratio 5.45, 95% confidence interval 1.54-25.8, P = 0.007) by logistic regression analysis.

CONCLUSION

A poor understanding of antidiabetic medication is associated with poor blood glucose level in patients with type 2 diabetes.

Impact of respiratory function on the progression from metabolically healthy non-overweight to metabolically abnormal phenotype

BACKGROUND AND AIMS

Recent studies identified that metabolically abnormal non-overweight phenotype is a risk factor for cardiovascular diseases. However, only little is known about risk factors for the progression from metabolically healthy non-overweight (MHNO) to metabolically abnormal phenotype. In this study, we investigated the impact of respiratory function on the progression from MHNO to metabolically abnormal phenotype.

METHODS AND RESULTS

In this retrospective cohort study, 8949 (3872 men and 5077 women) individuals with MHNO, who participated in a health-checkup program from 2004 to 2015, were enrolled. Four metabolic factors (high-normal blood pressure or hypertension, impaired fasting glucose or diabetes, hypertriglyceridemia, and low HDL cholesterol concentration) were used to define metabolically healthy (less than two factors) or metabolically abnormal (two or more factors) phenotypes. Respiratory function was measured by spirometry. Over a median 4.0 years of follow-up, 927 participants progressed to metabolically abnormal phenotype. The percentage of FVC for predicted values (HR 0.98, 95% CI 0.93-1.03, p = 0.418) was not associated with the progression to metabolically abnormal phenotype after adjusting for covariates, including age, sex, alcohol consumption, exercise, smoking status, and body mass index, whereas the percentage of FEV₁ for predicted values (%FEV₁) (HR 0.87, 95% CI 0.84-0.91, p < 0.001) and the FEV₁/FVC ratio (HR 0.86, 95% CI 0.78-0.95, p = 0.004) were associated with the progression to metabolically abnormal phenotype.

CONCLUSION

Decrease in respiratory function in terms of %FEV₁ and the FEV₁/FVC ratio is associated with the progression to metabolically abnormal phenotype in individuals with MHNO.

Ectopic fat obesity presents the greatest risk for incident type 2 diabetes: a population-based longitudinal study

OBJECTIVES

Obesity is a risk factor for type 2 diabetes mellitus. Among obesity, visceral fat obesity, and ectopic fat obesity, it has been unclear which has the greatest effect on incident diabetes.

METHODS

In this historical cohort study of 8430 men and 7034 women, we investigated the effect of obesity phenotypes on incident diabetes. Obesity, visceral fat obesity, and ectopic fat obesity were defined as body mass index ≥25 kg/m², waist circumference ≥90 cm in men or ≥80 cm in women, and having fatty liver diagnosed by abdominal ultrasonography, respectively. We divided the participants into eight groups according to the presence or absence of the three obesity phenotypes.

RESULTS

During the median 5.8 years follow-up for men and 5.1 years follow-up for women, 286 men and 87 women developed diabetes. Compared to the non-obese group, the hazard ratios (HRs) of incident diabetes in the only-obesity, only-visceral fat obesity, only-ectopic fat obesity groups, and with all-three types of obesity group were 1.85 (95%CI 1.06-3.26, p = 0.05) in men and 1.79 (0.24-13.21, p = 0.60) in women, 3.41 (2.51-4.64, p < 0.001) in men and 2.30 (0.87-6.05, p = 0.12) in women, 4.74 (1.91-11.70, p < 0.001) in men and 13.99 (7.23-27.09, p < 0.001) in women and 10.5 (8.02-13.8, p < 0.001) in men and 30.0 (18.0-50.0, p < 0.001) in women. Moreover, the risk of incident diabetes of the groups with ectopic fat obesity were almost higher than that of the four groups without ectopic fat obesity.

CONCLUSION

Ectopic fat obesity presented the greatest risk of incident type 2 diabetes.

Late-night-dinner is associated with poor glycemic control in people with type 2 diabetes: The KAMOGAWA-DM cohort study

Skipping breakfast or irregular breakfast is associated with poor glycemic control. However, a relationship between the timing of dinner and glycemic control in people with type 2 diabetes remains indefinite. Therefore, we investigated the relationship between late-night-dinner and glycemic control in people with type 2 diabetes. We performed questionnaire survey for lifestyle factors in this cross-sectional study. We defined having dinner later than eight pm as late-night-dinner. We examined the differences in clinical and metabolic parameters between those who have late-night-dinner and those who do not have. We also examined the relationship between late-night-dinner and HbA1c, using multiple regression analysis. Ninety-five people (23.2%) had a late-night-dinner, among 409 people with type 2 diabetes. Metabolic parameters (mean (SD) or median (interquartile range)) of people with late-night-dinner were worse than those of without, including body mass index (BMI) (24.4 (4.0) vs. 23.2 (3.4) kg/m², p = 0.006), triglycerides (1.5 (1.1-2.1) vs. 1.2 (0.8-1.7) mmol/L, p < 0.001), HDL-cholesterol (1.4 (0.4) vs. 1.6 (0.4) mmol/L, p = 0.004) and hemoglobin A1c (58.1 (13.3) vs. 55.2 (10.2) mmol/mol, (7.5 (1.2) vs. 7.2 (0.9) %), p = 0.023)). Late-night-dinner (standardized regression coefficient = 0.13, p = 0.028) was associated with hemoglobin A1c after adjusting for age, BMI, sex, duration of diabetes, smoking, exercise, alcohol, snacking after dinner, nighttime sleep duration, time from dinner to bedtime, skipping breakfast, and medication for diabetes. Late-night-dinner is independently associated with poor glycemic control in people with type 2 diabetes.

Metabolically healthy obesity without fatty liver and risk of incident type 2 diabetes: A meta-analysis of prospective cohort studies

OBJECTIVE

A meta-analysis indicated that metabolically healthy obesity (MHO) presents a risk of incident type 2 diabetes, but it has not yet been established whether MHO without fatty liver (w/o FL) also presents a risk of incident diabetes.

METHODS

plus the presence of non or one of the following factors: hypertension, impaired fasting glucose, low high-density lipoprotein cholesterol, and hypertriglyceridemia. Using a random effects model, we calculated the pooled relative risks (RRs) and 95% confidence intervals (CIs) of incident diabetes.

RESULTS

Our meta-analysis included three studies from the databases plus the NAGALA study, with a total of 134,667 subjects, including 8675 MHO subjects w/o FL and 7218 MHO subjects with fatty liver (wFL). Compared to the metabolically healthy non-overweight subjects w/o FL, the RRs of incident diabetes in the MHO w/o FL and MHO wFL groups were 1.42 (95%CI 1.11-1.77) and 3.28 (95%CI 2.30-4.67).

CONCLUSIONS

Our meta-analysis results demonstrate that the MHO phenotype, with or without fatty liver, presents a risk of the development of type 2 diabetes. Individuals with MHO who do not have fatty liver should be monitored carefully - similarly to those with fatty liver - for the development of diabetes.