The idea of a metabolic syndrome that precedes diabetes may be unhelpful and "simplistic", British researchers say today following a major analysis of the evidence.
Factors such as fasting blood sugar and triglyceride levels and high blood pressure – together with obesity – are used to define the syndrome and identify people thought to be at risk of type 2 diabetes.
But the Medical Research Council researchers at Cambridge University, UK, report that obesity alone is a bigger risk factor than the others put together.
The findings come from a metanalysis of more than 140,000 people involved in 14 cohort studies. Nearly 6,000 of these developed type 2 diabetes, they report in Diabetes Care.
These divided people into metabolically healthy and unhealthy and included people judged to be metabolically unhealthy but lean.
This showed that 2.2% of metabolically unhealthy lean people developed diabetes in a ten year period. This compared with 3.1% of obese people found to be metabolically "healthy" and 7.6% of those who were obese and metabolically unhealthy.
The researchers say the definitions of metabolic healthy do not predict future risk of diabetes accurately.
Researcher Dr Luca Lotta said: “This work indicates that current simplistic definitions of obesity and metabolic health are of limited value in a clinical setting and that the notion of ‘metabolically healthy obesity’ is a misnomer as this category of people, while at lower risk than people who had metabolically unhealthy obesity, still had a higher absolute risk of developing type 2 diabetes than people who are lean but apparently metabolic unhealthy.”
Professor Nick Wareham, director of the research unit, said: "As all the obese categories were at increased risk, these data support population-level interventions aimed at reducing the prevalence of obesity.”
Definitions of metabolic health and risk of future type 2 diabetes in body mass index categories: a systematic review and network meta-analysis. Diabetes Care 23 October 2015 [abstract]
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