Incidence of diabetes according to metabolically healthy or unhealthy normal weight or overweight/obesity in postmenopausal women: the Women's Health Initiative

Amber R.Cordola Hsu, Susan L. Ames, Bin Xie, Darleen V. Peterson, Lorena Garcia, Scott B. Going, Lawrence S. Phillips, Jo Ann E. Manson, Hoda Anton-Culver, Nathan D. Wong

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To determine the relationship of metabolic weight categories with incident diabetes mellitus (DM) in postmenopausal women. METHODS: The Women's Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50 to 79 years. We included those with cardiovascular disease (CVD) biomarkers and free of CVD and prevalent DM (n = 17,043) at baseline. Normal weight was defined as a body mass index (BMI) ≥18.5 and <25 kg/m, and waist circumference (WC) <88 cm and overweight/obesity as a BMI ≥25 kg/m or WC ≥88 cm. Metabolically healthy was based on <2 and metabolically unhealthy ≥2 traits of the following: triglycerides ≥150 mg/dL, systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥85 mm Hg, or antihypertensives or diuretics, fasting glucose ≥100 mg/dL or DM medication, and high-density lipoprotein cholesterol <50 mg/dL. Cox regression was performed to determine the risk of incident DM among metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO). RESULTS: Among our sample, 2,253 (13.3%) participants developed DM over a mean ± standard deviation follow-up time of 15.6 ± 3.4 years. Compared with MHNW (n = 162 incident DM cases), an increased risk of incident DM was observed in MUHNW (n = 102 cases) (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.74-2.88, P < 0.0001), MHO (n = 624 cases) (HR 1.68, 95% CI 1.40-2.00, P < 0.0001), and MUHO (n = 1,365 cases) (HR 4.51, 95% CI 3.82-5.35, P < 0.0001). CONCLUSIONS: Among postmenopausal women, MUHNW and MHO confer an approximate doubling in the risk and MUHO more than a four-fold increased risk for developing DM.

Original languageEnglish (US)
Pages (from-to)640-647
Number of pages8
JournalMenopause (New York, N.Y.)
Volume27
Issue number6
DOIs
StatePublished - Jun 1 2020

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Hsu, A. R. C., Ames, S. L., Xie, B., Peterson, D. V., Garcia, L., Going, S. B., Phillips, L. S., Manson, J. A. E., Anton-Culver, H., & Wong, N. D. (2020). Incidence of diabetes according to metabolically healthy or unhealthy normal weight or overweight/obesity in postmenopausal women: the Women's Health Initiative. Menopause (New York, N.Y.), 27(6), 640-647. https://doi.org/10.1097/GME.0000000000001512