Obese adults with excess visceral fat, biomarkers of insulin resistance more likely to develop diabetes

Over a median (midpoint) follow-up of 7 years, 84 participants (11.5 percent) developed diabetes. In multivariable analysis, higher measures of visceral fat mass at the beginning of the study, fructosamine level (a measurement used to estimate the average plasma glucose concentration over several weeks), fasting glucose level, family history of diabetes, systolic blood pressure, and weight gain over the follow-up period were independently associated with the development of diabetes.

The composite outcome of prediabetes or diabetes occurred in 39.1 percent of 512 participants with normal baseline glucose values, and was independently associated with baseline measurements of visceral fat mass; levels of fasting glucose, insulin, and fructosamine; older age; non-white race; family history of diabetes; and weight gain over follow-up, but not with measurements of general adiposity.

Diabetes incidence increased significantly among individuals with higher categories of visceral fat mass, but no association was seen for abdominal subcutaneous fat, total body fat or body mass index.

"These findings suggest that clinically measurable markers of adipose tissue distribution and insulin resistance may be useful in prediabetes and diabetes risk discrimination among obese individuals and support the notion of obesity as a heterogeneous disorder with distinct adiposity subphenotypes," the authors write.

"Further research is needed to determine whether assessment of adipose tissue distribution and function using imaging tools, circulating biomarkers, or both can improve clinical risk prediction in obese individuals."