Diabetes risk among overweight and obese metabolically healthy young adults

OBJECTIVE: To determine diabetes incidence over time among obese young adults without metabolic risk factors. RESEARCH DESIGN AND METHODS: Incident diabetes during a median follow-up of 6.1 years was assessed among 33,939 young men (mean age 30.9 ± 5.2 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults cohort who were stratified for BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ≥30 kg/m₂ in the presence of normoglycemia, normal blood pressure, and normal levels of fasting triglyceride and HDL-cholesterol levels (n = 631). RESULTS: A total of 734 new cases of diabetes were diagnosed during 210,282 person-years of follow-up. The incidence rate of diabetes among participants with no metabolic risk factors was 1.15, 2.10, and 4.34 cases per 1,000 person-years among lean, overweight, and obese participants, respectively. In a multivariable model adjusted for age, region of origin, family history of diabetes, physical activity, fasting plasma glucose, triglyceride level, HDL-cholesterol, systolic blood pressure, and white blood cell count, a higher diabetes risk was observed among MH-overweight (hazard ratio [HR] 1.89 [95% CI 1.25-2.86]; P < 0.001) and MH-obese (HR 3.88 [95% CI 1.94-7.77]; P < 0.001) compared with MH-normal weight subjects. There was no interaction between BMI and the number ofmetabolic abnormalities at enrollment in predicting diabetes risk. CONCLUSIONS: Healthy metabolic profile and the absence of diabetes risk factors do not protect young adults from incident diabetes associated with overweight and obesity.