Table 3.

Associations of Obesity, Metabolic Health Status, and Variability of BMI and Metabolic Health With Risk of Incident Obesity and Metabolically Unhealthy State: Framingham Offspring Examination Cycle 4–Examination Cycle 9

	Incident Obesity					Incident Metabolically Unhealthy State
	Cases	Ratea	HRb	95% CI	P difference c	Cases	Ratea	HRd	95% CI	P difference d
Obesity
SNO	390	510.3	1.00	Reference	<0.0001	483	1291.4	1.00	Reference	<0.0001
VNO	177	1444.9	2.63	2.07–3.35		122	1882.7	1.67	1.30–2.15
SO						97	2607.5	1.93	1.46–2.54	0.34
VO						69	2863.1	2.35	1.69–3.26
Metabolic health
SMH	247	501.9	1.00	Reference	0.53	629	1534.9	1.00	Reference	0.90
VMH	69	593.8	1.10	0.83–1.46		142	1572.5	1.01	0.82–1.25
SMU	160	808.5	1.66	1.32–2.08	0.10	…
VMU	81	1218.0	2.23	1.58–3.14

HR indicates hazard ratio; SMH, stable metabolic health, metabolically healthy; SMU, stable metabolic health, metabolically unhealthy; SNO, stable body mass index, without obesity; SO, stable body mass index, with obesity; VMH, variable metabolic health, metabolically healthy; VMU, variable metabolic health, metabolically unhealthy; VNO, variable body mass index, without obesity; VO, variable body mass index, with obesity.

^aCrude rate per 10 000 person‐periods.

^bAdjusted for age, sex, examination cycle, education, smoking status, physical activity index, and body mass index (BMI).

^c P value comparing the association of stability with diabetes mellitus with that of variability within a given obesity/metabolic health status.

^dAdjusted for age, sex, examination cycle, education, smoking status, physical activity index, systolic blood pressure, diastolic blood pressure, current antihypertensive medication use, high‐density lipoprotein, triglycerides, blood glucose, and current use of antidiabetic medication.