Associations of obesity, systemic inflammation, and hyperinsulinemia with the incidence of non‐communicable chronic disease and mortality: A prospective cohort study
Authors' conclusion
After adjustment for confounding by systemic inflammation and hyperinsulinemia, obesity was associated with a lower risk of death but with a higher risk of incident NCD. As there are more people with metabolic syndrome without obesity than with obesity, future research should prioritise the study of how to best diagnose, monitor and treat inflammation and hyperinsulinemia rather than obesity.
Study context
- Population
- Canadian residents aged ≥18 years from the Canadian Health Measure Survey
- Participants
- ≈8,280 residents
- Exposure
- Body mass index (BMI), C-reactive protein (CRP) and fasting insulin percentiles vs 5th percentile
- Outcome
- All-cause mortality and incident NCD
- Follow-up
- Median 6.7 years
Methodological detailspopulation-representative, external validation in NHANES and UK Biobank
- Population-representative
- External validation in NHANES and UK Biobank
Main finding
As reported in the abstract
All-cause mortality, adjusted for age, sex and smoking · median 6.7 years
Hazard ratio (95% CI)
CRP 1st %ilevs 5th %ile
0.72(0.61–0.84)
CRP 99th %ilevs 5th %ile
7.67(2.89–20.38)
Fasting insulin 1st %ilevs 5th %ile
0.88(0.78–0.99)
Fasting insulin 99th %ilevs 5th %ile
3.22(1.12–9.29)
BMI 1st %ilevs 5th %ile
1.45(1.11–1.88)
BMI 95th %ilevs 5th %ile
0.46(0.22–0.97)
BMI 99th %ilevs 5th %ile
0.51(0.20–1.27)
- Deaths
- 3.1%
Observational data: associations, not effects.
Further findings
Incident NCD · median 6.7 years
- Developed an NCD
- 7.4%
- CVD
- 1.8%
- All three exposures mostly positively associated with incident NCD, varying by NCD type
Baseline prevalence
- Obesity (BMI ≥30 kg/m²)
- 24.4%
- Inflammation (CRP >1 mg/L)
- 56.5%
- Hyperinsulinemia (fasting insulin >75 pmol/L)
- 36.6%
- Metabolic syndrome without obesity
- 42.8%; ≈3544 participants
- Metabolic syndrome with obesity
- 22.9%; ≈1896 participants
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Associations of obesity, systemic inflammation, and hyperinsulinemia with the incidence of non‐communicable chronic disease and mortality: A prospective cohort study. Diabetes Obes Metab. Published 19 February 2026. doi:10.
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