Epidemiology and population health

Ectopic fat obesity presents the greatest risk for incident type 2 diabetes: a population-based longitudinal study




Obesity is a risk factor for type 2 diabetes mellitus. Among obesity, visceral fat obesity, and ectopic fat obesity, it has been unclear which has the greatest effect on incident diabetes.


In this historical cohort study of 8430 men and 7034 women, we investigated the effect of obesity phenotypes on incident diabetes. Obesity, visceral fat obesity, and ectopic fat obesity were defined as body mass index ≥25 kg/m2, waist circumference ≥90 cm in men or ≥80 cm in women, and having fatty liver diagnosed by abdominal ultrasonography, respectively. We divided the participants into eight groups according to the presence or absence of the three obesity phenotypes.


During the median 5.8 years follow-up for men and 5.1 years follow-up for women, 286 men and 87 women developed diabetes. Compared to the non-obese group, the hazard ratios (HRs) of incident diabetes in the only-obesity, only-visceral fat obesity, only-ectopic fat obesity groups, and with all-three types of obesity group were 1.85 (95%CI 1.06–3.26, p = 0.05) in men and 1.79 (0.24–13.21, p = 0.60) in women, 3.41 (2.51–4.64, p < 0.001) in men and 2.30 (0.87–6.05, p = 0.12) in women, 4.74 (1.91–11.70, p < 0.001) in men and 13.99 (7.23–27.09, p < 0.001) in women and 10.5 (8.02–13.8, p < 0.001) in men and 30.0 (18.0–50.0, p < 0.001) in women. Moreover, the risk of incident diabetes of the groups with ectopic fat obesity were almost higher than that of the four groups without ectopic fat obesity.


Ectopic fat obesity presented the greatest risk of incident type 2 diabetes.

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We thank all of the staff members in the medical health checkup center at Murakami Memorial Hospital.

Author contributions

TO contributed to the data research and analyses and wrote the manuscript. YH originated and designed the study, analyzed the data and reviewed the manuscript for intellectual content. MH contributed to the manuscript organization and reviewed and edited the manuscript. AO and TK originated the study, analyzed the data and contributed to the discussion. MF analyzed the data and reviewed and edited the manuscript. HM is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors were involved in the writing of the manuscript and approved the manuscript’s final version.

Author information


  1. Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    • Takuro Okamura
    • , Yoshitaka Hashimoto
    •  & Michiaki Fukui
  2. Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan

    • Masahide Hamaguchi
  3. Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu, Japan

    • Akihiro Obora
    •  & Takao Kojima


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Conflict of interest

YH received grants from the Fuji Foundation for Protein Research, outside the submitted work. MF reports grants from AstraZeneca plc, grants from Astellas Pharma Inc., grants from Nippon Boehringer Ingelheim Co., Ltd., grants from Daiichi Sankyo Co., Ltd., grants from Eli Lilly Japan K.K., grants from Kyowa Hakko Kirin Company Ltd., grants from Kissei Pharmaceutical Co., Ltd., grants from MSD K.K., grants from Mitsubishi Tanabe Pharma Corporation, grants from Novo Nordisk Pharma Ltd., grants from Sanwa Kagaku Kenkyusho Co., Ltd., grants from Sanofi K.K., grants from Ono Pharmaceutical Co., Ltd., and grants from Takeda Pharmaceutical Co., Ltd., outside the submitted work. The remaining authors have no conflict of interest.

Corresponding author

Correspondence to Masahide Hamaguchi.

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