Definitions of metabolic health and risk of future type 2 diabetes in body mass index categories: a systematic review and network meta-analysis
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Authors
Lotta, Luca
Abbasi, Ali
Sahlqvist, Anna-Stina
Waterworth, Dawn
Brosnan, Julia M
Scott, Robert
Publication Date
2015-08-18Journal Title
Diabetes Care
ISSN
0149-5992
Volume
38
Pages
2177-2187
Language
English
Type
Article
Metadata
Show full item recordCitation
Lotta, L., Abbasi, A., Sharp, S., Sahlqvist, A., Waterworth, D., Brosnan, J. M., Scott, R., et al. (2015). Definitions of metabolic health and risk of future type 2 diabetes in body mass index categories: a systematic review and network meta-analysis. Diabetes Care, 38 2177-2187. https://doi.org/10.2337/dc15-1218
Abstract
Objective: Various definitions of metabolic health have been proposed to explain differences in the risk of type 2 diabetes within body mass index (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 metaanalysis, relative risks (RR) 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, being classified as metabolically unhealthy was associated with higher relative risk of diabetes in all BMI categories (RR compared with healthy individuals [95% confidence interval, CI]: lean, 4.0 [3.0 – 5.1]; overweight, 3.4 [2.8 – 4.3]; obese, 2.5 [2.1 – 3.0]). Metabolically healthy obese individuals had a high absolute risk of type 2 diabetes (10-year cumulative incidence [95% CI]: 3.1% [2.6 – 3.5%]). Current binary definitions of metabolic health had high specificity (pooled estimate [95% CI]: 0.88 [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 (< 3.3 in all BMI categories) and negative (> 0.4) likelihood ratios were consistent with insignificant to small improvements in prediction. Conclusions: Although individuals classified as metabolically unhealthy have a higher relative risk 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.
Sponsorship
The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under EMIF grant agreement n° 115372, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution. This work was supported by the Netherlands Organization for Scientific Research (NWO), and the Medical Research Council UK (grant no. MC_U106179471). A.A. is supported by a Rubicon grant from the NWO (Project no. 825.13.004).
Funder references
MRC (MC_UU_12015/1)
Netherlands Organisation for Scientific Research (NWO) (82513004)
Medical Research Council (MC_U106179471)
Identifiers
External DOI: https://doi.org/10.2337/dc15-1218
This record's URL: https://www.repository.cam.ac.uk/handle/1810/250305
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