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Association of weight status and the risks of diabetes in adults: a systematic review and meta-analysis of prospective cohort studies

International Journal of Obesity volume 46, pages 1101–1113 (2022)Cite this article

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Abstract

Obesity is a known risk factor for type 2 diabetes mellitus (T2DM); however, the associations between underweight and T2DM and between weight status and prediabetes have not been systematically reviewed. We aimed to estimate the relative risks (RRs) of prediabetes/T2DM in underweight/overweight/obesity relative to normal weight. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to December 8, 2021. Prospective cohort studies with a minimum 12-month follow-up period reporting the association between baseline body mass index (BMI) categories and risk of prediabetes/T2DM in adults were included. Study quality was assessed using the Newcastle-Ottawa Scale. The main analyses of T2DM risk were performed using the ethnic-specific (Asian/non-Asian) BMI classification and additional analyses of prediabetes/T2DM risk by including all eligible studies. Random-effects models with inverse variance weighting were used. Subgroup analyses and meta-regression were conducted to explore the potential effects of pre-specified modifiers. The study protocol was registered with PROSPERO (CRD42020215957). Eighty-four articles involving over 2.69 million participants from 20 countries were included. The pooled RR of prediabetes risk was 1.24 (95% CI: 1.19–1.28, I2 = 9.7%, n = 5 studies) for overweight/obesity vs. normal weight. The pooled RRs of T2DM based on the ethnic-specific BMI categories were 0.93 (95% CI: 0.75–1.15, I2 = 55.5%, n = 12) for underweight, 2.24 (95% CI: 1.95–2.56, I2 = 92.0%, n = 47) for overweight, 4.56 (95% CI: 3.69–5.64, I2 = 96%, n = 43) for obesity, and 22.97 (95% CI: 13.58–38.86, I2 = 92.1%, n = 6) for severe obesity vs. normal weight. Subgroup analyses indicated that underweight is a protective factor against T2DM in non-Asians (RR = 0.68, 95% CI: 0.40–0.99, I2 = 56.1%, n = 6). The magnitude of the RR of T2DM in overweight/obesity decreased with age and varied by region and the assessment methods for weight and T2DM. Overweight/obesity was associated with an increased prediabetes/T2DM risk. Further studies are required to confirm the association between underweight and prediabetes/T2DM, particularly in Asian populations.

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Fig. 1
Fig. 2: The relative risk of prediabetes for different weight statuses vs. normal weight.
Fig. 3: The relative risk of diabetes for different weight statuses vs. normal weight based on the ethnic-specific BMI classification.

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Application for datasets generated during and/or analyzed during the current study may be considered by the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the consultant service provided by the medical librarian of the University of Hong Kong when designing the search strategy for different databases.

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Authors and Affiliations

  1. School of Nursing, the University of Hong Kong, Hong Kong, SAR, China

    Hong-jie Yu, Mandy Ho, Jundi Yang, Pui Hing Chau & Daniel Yee Tak Fong

  2. Shenzhen Second People’s hospital, Shenzhen, China

    Xiangxiang Liu

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  1. Hong-jie Yu
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Contributions

YHJ and HM conceived and designed this study. YHJ, LXX, and YJD conducted the database searches, screened titles, abstract, and full text. YHJ and LXX extracted data. YHJ and YJD assessed the study quality. YHJ did statistical analysis and data visualization. YHJ and HM drafted the manuscript. All Authors contributed data interpretation and review and revision of manuscript. HM was responsible for overall supervision to this study.

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Correspondence to Mandy Ho.

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Yu, Hj., Ho, M., Liu, X. et al. Association of weight status and the risks of diabetes in adults: a systematic review and meta-analysis of prospective cohort studies. Int J Obes 46, 1101–1113 (2022). https://doi.org/10.1038/s41366-022-01096-1

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