Definitions of metabolic health andrisk of future type 2 diabetes in bmi categories: A systematic review and network Meta-analysis

Luca A. Lotta, Ali Abbasi, Stephen J. Sharp, Anna Stina Sahlqvist, Dawn Waterworth, Julia M. Brosnan, Robert A. Scott, Claudia Langenberg, Nicholas J. Wareham

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE Various definitions of metabolic health have been proposed to explain differences in the risk of type 2 diabetes within 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 twostage meta-analysis, relative risks (RRs) 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, classification as metabolically unhealthy was associated with higher RR of diabetes in all BMI categories (lean RR compared with healthy individuals 4.0 [95% CI 3.0-5.1], overweight 3.4 [2.8-4.3], and obese 2.5 [2.1-3.0]). Metabolically healthy obese individuals had a high absolute risk of type 2 diabetes (10-year cumulative incidence 3.1% [95% CI 2.6-3.5]). Current binary definitions of metabolic health had high specificity (pooled estimate 0.88 [95% CI 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 (0.4) likelihood ratios were consistent with insignificant to small improvements in prediction. CONCLUSIONS Although individuals classified as metabolically unhealthy have a higher RR 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.

Original languageEnglish
Pages (from-to)2177-2187
Number of pages11
JournalDiabetes Care
Volume38
Issue number11
DOIs
Publication statusPublished - Nov 1 2015

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Type 2 Diabetes Mellitus
Health
Meta-Analysis
Cohort Studies
Network Meta-Analysis
MEDLINE
ROC Curve
Prospective Studies
Incidence

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Lotta, L. A., Abbasi, A., Sharp, S. J., Sahlqvist, A. S., Waterworth, D., Brosnan, J. M., ... Wareham, N. J. (2015). Definitions of metabolic health andrisk of future type 2 diabetes in bmi categories: A systematic review and network Meta-analysis. Diabetes Care, 38(11), 2177-2187. https://doi.org/10.2337/dc15-1218

Definitions of metabolic health andrisk of future type 2 diabetes in bmi categories : A systematic review and network Meta-analysis. / Lotta, Luca A.; Abbasi, Ali; Sharp, Stephen J.; Sahlqvist, Anna Stina; Waterworth, Dawn; Brosnan, Julia M.; Scott, Robert A.; Langenberg, Claudia; Wareham, Nicholas J.

In: Diabetes Care, Vol. 38, No. 11, 01.11.2015, p. 2177-2187.

Research output: Contribution to journalArticle

Lotta, LA, Abbasi, A, Sharp, SJ, Sahlqvist, AS, Waterworth, D, Brosnan, JM, Scott, RA, Langenberg, C & Wareham, NJ 2015, 'Definitions of metabolic health andrisk of future type 2 diabetes in bmi categories: A systematic review and network Meta-analysis', Diabetes Care, vol. 38, no. 11, pp. 2177-2187. https://doi.org/10.2337/dc15-1218
Lotta, Luca A. ; Abbasi, Ali ; Sharp, Stephen J. ; Sahlqvist, Anna Stina ; Waterworth, Dawn ; Brosnan, Julia M. ; Scott, Robert A. ; Langenberg, Claudia ; Wareham, Nicholas J. / Definitions of metabolic health andrisk of future type 2 diabetes in bmi categories : A systematic review and network Meta-analysis. In: Diabetes Care. 2015 ; Vol. 38, No. 11. pp. 2177-2187.
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N2 - OBJECTIVE Various definitions of metabolic health have been proposed to explain differences in the risk of type 2 diabetes within 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 twostage meta-analysis, relative risks (RRs) 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, classification as metabolically unhealthy was associated with higher RR of diabetes in all BMI categories (lean RR compared with healthy individuals 4.0 [95% CI 3.0-5.1], overweight 3.4 [2.8-4.3], and obese 2.5 [2.1-3.0]). Metabolically healthy obese individuals had a high absolute risk of type 2 diabetes (10-year cumulative incidence 3.1% [95% CI 2.6-3.5]). Current binary definitions of metabolic health had high specificity (pooled estimate 0.88 [95% CI 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 (0.4) likelihood ratios were consistent with insignificant to small improvements in prediction. CONCLUSIONS Although individuals classified as metabolically unhealthy have a higher RR 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.

AB - OBJECTIVE Various definitions of metabolic health have been proposed to explain differences in the risk of type 2 diabetes within 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 twostage meta-analysis, relative risks (RRs) 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, classification as metabolically unhealthy was associated with higher RR of diabetes in all BMI categories (lean RR compared with healthy individuals 4.0 [95% CI 3.0-5.1], overweight 3.4 [2.8-4.3], and obese 2.5 [2.1-3.0]). Metabolically healthy obese individuals had a high absolute risk of type 2 diabetes (10-year cumulative incidence 3.1% [95% CI 2.6-3.5]). Current binary definitions of metabolic health had high specificity (pooled estimate 0.88 [95% CI 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 (0.4) likelihood ratios were consistent with insignificant to small improvements in prediction. CONCLUSIONS Although individuals classified as metabolically unhealthy have a higher RR 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.

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