Table 4.

Associations of Obesity, Metabolic Health Status, and Variability of BMI and Metabolic Health With Risk of Incident Diabetes Mellitus and Hypertension: Framingham Offspring Examination Cycle 4–Examination Cycle 9

	Incident Diabetes Mellitus					Incident Hypertension
	Cases	Ratea	HRb	95% CI	P difference c	Cases	Ratea	HRb	95% CI	P difference c
Obesity
SNO	109	135.1	1.00	Reference	0.03	301	1659.3	1.00	Reference	0.0003
VNO	29	195.3	1.58	1.04–2.40		108	2529.3	1.74	1.29–2.34
SO	103	548.5	2.92	2.19–3.88	0.17	41	3831.8	2.34	1.43–3.83	0.97
VO	31	329.8	2.16	1.41–3.33		53	4690.3	2.31	1.45–3.68
Metabolic health
SMH	70	109.9	1.00	Reference	0.16	338	1860.2	1.00	Reference	0.39
VMH	11	70.8	0.63	0.33–1.19		87	2096.4	1.09	0.81–1.46
SMU	152	476.3	3.24	2.38–4.40	0.13	50	3448.3	1.61	1.11, 2.34	0.72
VMU	36	334.9	2.44	1.60–3.73		21	4285.7	1.88	0.84–4.21

BMI, body mass index; HR, 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, and physical activity index.

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