{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:01:09Z","timestamp":1793138469872,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,11,2]],"date-time":"2016-11-02T00:00:00Z","timestamp":1478044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the risk of diabetes and the development of an unhealthy status according to metabolic health. To assess the effect of changes in metabolic health among participants with metabolically healthy obesity (MHO) on the risk of diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 4,340 subjects were included. Unhealthy metabolic status was defined as having three or more risk factors of the Adult Treatment Panel\u2010III criteria. A Cox proportional\u2010hazard analysis was conducted to estimate the hazard ratio (HR) of developing diabetes across the change in the metabolic status of subjects with MHO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 40,622 person\u2010years of follow\u2010up, the risk of becoming unhealthy was 1.53 times higher for participants with MHO, compared with lean or overweight healthy subjects. A greater risk of diabetes was found in MHO, but it was attributable to those who progressed to an unhealthier status over time: HR of 4.78 (95% CI: 3.38\u20106.78). The combination of being metabolically unhealthy and obesity heightened the risk of diabetes: HR of 10.09 (95% CI: 4.82\u201021.55).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The increased risk of diabetes in MHO is attributed to the progression to an unhealthier state. \u201cHealthy obesity\u201d is not a permanent situation but a transitory state.<\/jats:p><\/jats:sec>","DOI":"10.1002\/oby.21667","type":"journal-article","created":{"date-parts":[[2016,11,2]],"date-time":"2016-11-02T05:03:54Z","timestamp":1478063034000},"page":"2615-2623","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Are all metabolically healthy individuals with obesity at the same risk of diabetes onset?"],"prefix":"10.1002","volume":"24","author":[{"given":"David","family":"Navarro\u2010Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Navarra Health Service\u2014Osasunbidea Garcia\u2010Orcoyen Hospital  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"S\u00e1nchez\u2010\u00cd\u00f1igo","sequence":"additional","affiliation":[{"name":"Navarra Health Service\u2014Osasunbidea Garcia\u2010Orcoyen Hospital  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Fern\u00e1ndez\u2010Montero","sequence":"additional","affiliation":[{"name":"Department of Occupational Medicine, Preventive Medicine and Public Health University of Navarra Pamplona Spain"},{"name":"IdiSNA\u2014Health Research Institute of Navarra Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Pastrana\u2010Delgado","sequence":"additional","affiliation":[{"name":"IdiSNA\u2014Health Research Institute of Navarra Pamplona Spain"},{"name":"Department of Internal Medicine University of Navarra Clinic Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Alfredo Mart\u00ednez","sequence":"additional","affiliation":[{"name":"IdiSNA\u2014Health Research Institute of Navarra Pamplona Spain"},{"name":"Nutrition and Physiology Nutrition and Research Center, University of Navarra Pamplona Spain"},{"name":"Centre of Biomedical Research in Pathophysiology of Obesity and Nutrition (CIBERObn), Carlos III Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,11,2]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Global Status Report on Noncommunicable Diseases 2014","author":"World Health Organization","year":"2014"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.21344"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-0594"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-0869"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu123"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2832"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1971"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0098369"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4253"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12583"},{"key":"e_1_2_7_12_1","volume-title":"Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation on Obesity","year":"1998"},{"key":"e_1_2_7_13_1","first-page":"1009","article-title":"1999 World Health Organization\u2010International Society of Hypertension Guidelines for the management of hypertension. 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