When Metabolically Healthy Is Not Low Risk: Body Mass Index (BMI) Thresholds for Incident Diabetes in East Asian Adults
Authors' conclusion
Metabolic health did not eliminate BMI-related diabetes risk in East Asian adults. Diabetes risk increased at BMI levels below conventional overweight thresholds
Study context
- Population
- East Asian adults (Chinese and Japanese) from two longitudinal cohorts; metabolic health defined as absence of elevated blood pressure, dyslipidaemia and impaired fasting glucose113,354 Chinese, 12,489 Japanese
- Participants
- 125,843 adults
- Exposure
- BMI and metabolic health categories vs metabolically healthy normal weight (MHNW)
- Outcome
- Incident diabetes
Methodological detailsCox proportional hazards models, restricted cubic splines
- Cox proportional hazards models
- Restricted cubic splines
Main finding
As reported in the abstract
Each group vs MHNWHazard ratio (95% CI)
Metabolically healthy overweightChinese
2.33(1.63–3.33)
Metabolically healthy overweightJapanese
3.32(1.50–7.35)
MHOChinese
12.40(6.77–22.68)
MHOJapanese
27.89(8.42–92.41)
- Developed diabetes, Chinese (352 036 person-years)
- 1483
- Developed diabetes, Japanese (89 483 person-years)
- 312
Observational data: associations, not effects.
Further findings
BMI change points for diabetes risk in metabolically healthy participants
kg/m²
- Chinese
- 22.2
- Japanese
- 21.8
- Restricted cubic splines
Original publication
When Metabolically Healthy Is Not Low Risk: BMI Thresholds for Incident Diabetes in East Asian Adults. Diabetes Obes Metab. Published 17 August 2026. doi:10.
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