The Diabetes Risk and Determinants of Transition from Metabolically Healthy to Unhealthy Phenotypes in 49,702 Older Adults: 4-Year Cohort Study

Objective This study aimed to assess whether metabolically healthy obesity (MHO) increases the risk of diabetes and to explore how the occurrence of metabolic disorders affects the risk of diabetes and which factors determine metabolic health. Methods This study examined 49,702 older people without diabetes via the Binhai Health Screening Program in Tianjin. Results Compared with individuals with metabolic health and normal weight, the risk of diabetes was increased in older adults with MHO (hazard ratio [HR]: 1.786, 95% CI: 1.407-2.279) but was not significantly increased when metabolic health was characterized by the absence of metabolic abnormalities. The older adults who were initially affected by MHO and then converted to having an unhealthy phenotype had a higher diabetes risk than older individuals with stable and healthy normal weight (HR: 3.727, 95% CI: 2.721-5.105). Waist circumference was an independent predictor of the transition from a metabolically healthy status to an unhealthy status in all BMI categories (odds ratio: 1.059, 95% CI: 1.026-1.032). Conclusions The MHO phenotype was associated with an increased incidence of diabetes in older adults. The presence of metabolic disorders in the group with MHO was associated with an increased diabetes risk and was predicted by the waist circumference at baseline.