EASO
's New Obesity Framework and Incident Type 2 Diabetes: A Prospective Cohort Study
Zejin Hao, Lifeng Pi, Junping Zhang, Yuanyuan Deng, Yuhang Chen, Ying Hu, Jixiong Xu, Jiancheng Wang ABSTRACT
Aim
We prospectively investigated the association between the European Association for the Study of Obesity (EASO) modified obesity definition and the incidence of type 2 diabetes mellitus (T2DM).
Materials and Methods
We analysed data from the NAfld in the Gifu Area Longitudinal Analysis (NAGALA) cohort, an ongoing community‐based health screening program in Japan. Obesity was defined using both traditional body mass index (BMI) categories and the new EASO definition (BMI 23–27.5 kg/m 2 plus waist‐to‐height ratio ≥ 0.5 and at least one obesity‐related comorbidity). T2DM was identified during follow‐up based on haemoglobin A1c (HbA1c) ≥ 6.5%, fasting plasma glucose ≥ 7.0 mmol/L, or self‐reported physician diagnosis of diabetes.
Results
The study included 13 825 adults without diabetes at baseline. According to the new EASO definition, 10.3% of the study population (1424 individuals, representing 31.3% of those originally classified as overweight by BMI) were reclassified as having obesity. Compared with individuals with normal weight, those with EASO‐defined overweight showed an increased risk of T2DM [hazard ratio (HR): 1.48, 95% confidence interval (CI): 1.10–2.00], while those with EASO‐defined new obesity demonstrated a significantly elevated risk (HR: 5.06, 95% CI: 3.86–6.62). After multivariable adjustment for age, sex, smoking status, alcohol consumption, physical activity, and HbA1c, the adjusted HR for EASO‐defined new obesity remained significantly elevated at 2.68 (95% CI: 2.03–3.54). When compared with normal‐weight individuals without comorbidities, EASO‐defined new obesity was associated with a higher T2DM risk (HR: 4.14, 95% CI: 2.77–6.19) than normal‐weight individuals with comorbidities (HR: 1.95, 95% CI: 1.30–2.92).
Conclusions
The new EASO framework may improve the identification of individuals at high risk of incident type 2 diabetes mellitus compared with traditional BMI criteria alone.