Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model
Authors' conclusion
Even when obesity phenotype was treated as a time-varying exposure, individuals with MHO were still at higher risk for developing diabetes than those with MHNW. Consequently, such individuals should aim to avoid transitioning to a metabolically unfavourable state and strive to reduce their body weight to a normal range.
Study context
- Population
- Korean Genome and Epidemiology Study community-based cohort; obesity phenotype by BMI and metabolic syndrome criteria
- Participants
- 6,265 participants
- Exposure
- Metabolically healthy obesity vs metabolically healthy normal weight
- Outcome
- Incidence of diabetes
- Follow-up
- 16-year follow-up
Methodological details16-year follow-up, time-varying exposure, Cox proportional hazard model, marginal structural model
- 16-year follow-up
- Time-varying exposure
- Cox proportional hazard model
- Marginal structural model
Main finding
As reported in the abstract
Diabetes
MHO vs MHNWHazard ratio (95% CI)
Cox model
1.48(1.15–1.90)
Marginal structural model
1.49(1.01–2.20)
- Diabetes identified during follow-up (all participants)
- 903 (14.4%)
Observational data: associations, not effects.
Further findings
- Various sensitivity analyses consistently showed higher diabetes risk with metabolically healthy obesity (MHO) vs metabolically healthy normal weight (MHNW)
Original publication
Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model. Diabetes Obes Metab. Published 12 October 2023. doi:10.
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