Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Obesity Transitions by Age, Period, and Cohort: A Population-Based Application of the Lancet Commission Framework in the United States and Korea: Garam Jo, Dahyun Park, Shieon Kim, Hee Ju Jun, Faidon Magkos, Jordi Merino, Qi Sun, Rockli Kim, S.V. Subramanian, Paul W. Franks, Min-Jeong Shin; Received September 19, 2025 Accepted February 6, 2026 Published online April 10, 2026; DOI: https://doi.org/10.4093/dmj.2025.0918 [Epub ahead of print]

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Background
While emerging global classification frameworks highlight the need to redefine obesity beyond body mass index (BMI) to improve prevention strategies and public health policy, population-level applications remain scarce. We examined trends in BMI-based and newly proposed Lancet Commission definitions of obesity in the United States and South Korea, two countries with contrasting obesity trends.
Methods
Using representative data from the United States National Health and Nutrition Examination Survey (NHANES, 2003–2016) and the Korea National Health and Nutrition Examination Survey (KNHANES, 2007–2023), we conducted age-standardized and age-period-cohort (APC) analyses to compare obesity trends.
Results
Newly defined obesity phenotypes demonstrated a greater proportion of at-risk individuals than BMI alone, particularly among United States women and Korean men. Excess adiposity in the United States showed early increases from 55.6% to over 75%, followed by stabilization, while Korea exhibited a sustained upward trend. APC analyses revealed more divergent patterns. These sex-specific patterns align with differences in visceral adiposity by sex and in East Asian populations. Period effects on obesity were characterized by a high and sustained burden in the United States, but a more gradual yet persistent upward trend in Korea. Preclinical obesity displayed a U-shaped cohort effect in the United States, with higher prevalence in cohorts born after 1975, whereas clinical obesity continued to rise in Korea’s recent birth cohorts, especially among men.
Conclusion
Our findings emphasize the utility of expanded obesity definitions and APC analysis in capturing sex-specific and generational patterns of obesity and related complications. They support adopting life-course, cohort-informed approaches in obesity prevention.

Citations

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The Association Between Serum C-Reactive Protein Levels and Body Fat Parameters: Results from the Korean National Health and Nutrition Examination Survey
Hyemin Jeong
Medicina.2026; 62(6): 1014. CrossRef

Metabolic Risk/Epidemiology
Predictive Models for Type 2 Diabetes Mellitus in Han Chinese with Insights into Cross-Population Applicability and Demographic Specific Risk Factors: Ying-Erh Chen, Djeane Debora Onthoni, Shao-Yuan Chuang, Guo-Hung Li, Yong-Sheng Zhuang, Hung-Yi Chiou, Wayne Huey-Herng Sheu, Ren-Hua Chung; Diabetes Metab J. 2025;49(6):1272-1286. Published online May 21, 2025; DOI: https://doi.org/10.4093/dmj.2024.0319

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Background
The rising global incidence of type 2 diabetes mellitus (T2DM) underscores the need for predictive models that enhance early detection and prevention across diverse populations. This study aimed to identify predictors of incident T2DM within a Han Chinese population, assess their impact across various age and sex demographics, and explore their applicability to European populations.
Methods
Using data from about 65,000 participants in the Taiwan Biobank (TWB), we developed a predictive model, achieving an area under the receiver operating characteristic curve of 90.58%. Key predictors were identified through LASSO regression within the TWB cohort and validated using over 4 million records from Taiwan’s Adult Preventive Healthcare Services (APHS) program and the UK Biobank (UKB).
Results
Our analysis highlighted 13 significant predictors, including established factors like glycosylated hemoglobin (HbA1c) and blood glucose levels, and less conventionally considered variables such as peak expiratory flow. Notable differences in the effects of HbA1c levels and polygenic risk scores between the TWB and UKB cohorts were observed. Additionally, age and sex-specific impacts of these predictors, detailed through APHS data, revealed significant variances; for instance, waist circumference and diagnosed mixed hyperlipidemia showed greater impacts in younger females than in males, while effects remained uniform across male age groups.
Conclusion
Our findings offer novel insights into the diagnosis and management of diabetes for the Han Chinese and potentially for broader East Asian populations, highlighting the importance of ethnic and demographic diversity in developing predictive models for early detection and personalized intervention strategies.

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Plasminogen activator inhibitor-1, vaspin, and dietary inflammatory index in relation to cardiometabolic health in diabetic women
Sule Kocabas, Nevin Sanlier
Frontiers in Nutrition.2026;[Epub] CrossRef
The Relationship Between High-Density Lipoprotein (HDL) and Glycated Hemoglobin (HbA1C) in Type 2 Diabetes Mellitus Patients: Implications for Cardiovascular Risk
Setyoadi Setyoadi, Dina Dewi Sartika Lestari Ismail, Annisa Wuri Kartika, Dewi Purnama Sari, Angel Dwi Septian, Adelina Stefanie Lallo, Rara Kurniasari
Journal of Rural Community Nursing Practice.2025; 3(2): 234. CrossRef

Review

Metabolic Risk/Epidemiology
Role of Fenofibrate Use in Dyslipidemia and Related Comorbidities in the Asian Population: A Narrative Review: Chaicharn Deerochanawong, Sin Gon Kim, Yu-Cheng Chang; Diabetes Metab J. 2024;48(2):184-195. Published online January 26, 2024; DOI: https://doi.org/10.4093/dmj.2023.0168

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Hypertriglyceridemia and decreased high-density lipoprotein cholesterol (HDL-C) persist despite statin therapy, contributing to residual atherosclerotic cardiovascular disease (ASCVD) risk. Asian subjects are metabolically more susceptible to hypertriglyceridemia than other ethnicities. Fenofibrate regulates hypertriglyceridemia, raises HDL-C levels, and is a recommended treatment for dyslipidemia. However, data on fenofibrate use across different Asian regions are limited. This narrative review summarizes the efficacy and safety data of fenofibrate in Asian subjects with dyslipidemia and related comorbidities (diabetes, metabolic syndrome, diabetic retinopathy, and diabetic nephropathy). Long-term fenofibrate use resulted in fewer cardiovascular (CV) events and reduced the composite of heart failure hospitalizations or CV mortality in type 2 diabetes mellitus. Fenofibrate plays a significant role in improving irisin resistance and microalbuminuria, inhibiting inflammatory responses, and reducing retinopathy incidence. Fenofibrate plus statin combination significantly reduced composite CV events risk in patients with metabolic syndrome and demonstrated decreased triglyceride and increased HDL-C levels with an acceptable safety profile in those with high CV or ASCVD risk. Nevertheless, care is necessary with fenofibrate use due to possible hepatic and renal toxicities in vulnerable individuals. Long-term trials and real-world studies are needed to confirm the clinical benefits of fenofibrate in the heterogeneous Asian population with dyslipidemia.

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Arteriosclerosis, Thrombosis, and Vascular Biology.2026; 46(1): 195. CrossRef
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Song Wen, Chenglin Xu, Yue Yuan, Lijiao Chen, Yishu Ren, Zhimin Xu, Jianlan Jin, Jiyu Li, Ligang Zhou
Frontiers in Medicine.2026;[Epub] CrossRef
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