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Sleep and napping were assessed according to the standardized questionnaire. General and abdominal obesity were defined by BMI or visceral fat area (VFA), respectively. Multivariable Cox regression, stratified, and joint analysis were performed to explore potential correlations. Furthermore, mediation models were constructed to figure out the mediating role of metabolic factors (blood pressure, UACR, and HbA1c).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a median 3.05\u2010year follow\u2010up period, short sleep increased the risk of obesity (HR 1.42, 95% CI 1.17\u20131.71; 1.33, 1.08\u20131.65) and weight gain (1.21, 1.09\u20131.34; 1.17, 1.06\u20131.29), while long sleep and napping were unrelated to abdominal obesity and weight gain. Mediation analysis showed that systolic blood pressure, UACR, and HbA1c mediated the statistical association between night sleep duration and general obesity with proportions (%) of 7.9, 1.8, and 8.8, respectively. Joint analysis showed both sleep and napping groups had no significance among the low genetic risk group, while long napping, short sleep, and long sleep increased the risk of general obesity in medium to high risk patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Short sleep, long sleep, and long napping increased the risk of general obesity and BMI\u2010defined weight gain, and were more pronounced in the medium to high genetic risk group. Napping was unrelated to abdominal obesity. Metabolic factors partially explain the mechanism between sleep and obesity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.70095","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T04:58:22Z","timestamp":1747803502000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sleep Phenotypes, Genetic Susceptibility, and Risk of Obesity in Patients With Type 2 Diabetes: A National Prospective Cohort Study"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1277-0841","authenticated-orcid":false,"given":"Lei","family":"Xi","sequence":"first","affiliation":[{"name":"Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, National Clinical Research Center for Metabolic Diseases (Shanghai), Ruijin Yangtze River Delta Health Institute, Research Unit of Clinical and Basic Research on Metabolic Diseases of Chinese Academy of Medical Sciences, Wuxi Branch of Ruijin Hospital, Ruijin Hospital Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Affiliated Hospital of Ningbo University  Ningbo China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8856-0978","authenticated-orcid":false,"given":"Songbo","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Hospital of Lanzhou University  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuancheng","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine of Traditional Chinese Medicine Sheyang Diabetes Hospital  Yancheng 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