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目的:探讨中国成年人代谢健康型超重/肥胖(metabolically healthy overweight/obesity, MHO)与新发糖尿病的相关性。方法:本研究是对一项回顾性队列研究的二次分析，选取2010年至2016年于中国瑞慈集团相关医疗机构进行健康体检的117 056名中国成年人作为研究对象，根据基线体重指数和代谢状态分为代谢健康型非肥胖(metabolically healthy non-obesity, MHNO)组、MHO组、代谢不健康型非肥胖(metabolically unhealthy non-obesity, MUNO)组和代谢不健康型超重/肥胖(metabolically unhealthy overweight/obesity, MUO)组。采用 Kaplan- Meier法( log- rank检验)估计各组的糖尿病累积发病率，采用 Cox比例风险模型估计不同肥胖代谢表型组别的糖尿病发病风险 HR(95% CI)，并进行亚组分析。 结果:纳入的117 056名中国成年人中，MHO占总人群的24.3%。经过平均(3.1±1.0)年的随访，共有2 685例糖尿病新发病例，累积发病率为2.3%。MHNO、MHO、MUNO和MUO组的累积发病率分别为0.5%、1.6%、4.8%和7.9%，组间比较差异有统计学意义( χ2＝1 224.164, P<0.001)。 Cox比例风险模型分析显示，在校正性别、年龄、空腹血糖、吸烟、饮酒及糖尿病家族史之后，MHO组人群新发糖尿病风险是MHNO组的2.19倍(95% CI 1.89～2.55)，而MUNO和MUO组人群发生糖尿病事件的 HR值分别为2.25(95% CI 1.93～2.64)和3.00(95% CI 2.61～3.45)。 结论:中国成年人中，MHO与新发糖尿病风险升高有显著相关性。

Objective:To investigate the association between metabolically healthy overweight/obesity(MHO) and risk of new-onset diabetes among Chinese adults.Methods:This study was a secondary analysis of a retrospective cohort study recruiting 117 056 Chinese adults who received a health check at the Rich Healthcare Group from 2010 to 2016.Participants were classified into metabolically healthy non-obesity(MHNO), MHO, metabolically unhealthy non-obesity(MUNO), and metabolically unhealthy overweight/obesity(MUO) group according to body mass index and metabolic status at baseline. Kaplan-Meier method(log-rank test) was used to estimate the cumulative incidence of diabetes in each group. The Cox proportional hazards model was employed to estimate the hazard ratios( HR and 95% CI) for diabetes incidence across different obesity metabolic phenotype groups, followed by subgroup analysis. Results:A total of 117 056 Chinese adults were enrolled and the prevalence of MHO was 24.3%. During the follow-up time of (3.1±1.0) years, 2 685 new-onset diabetes adults occurred, resulting in a cumulative incidence rate of 2.3%. The cumulative incidences of MHNO, MHO, MUNO and MUO groups were 0.5%, 1.6%, 4.8%, and 7.9%, respectively, and there was a statistical difference ( χ2=1 224.164, P<0.001). Cox proportional hazards model showed that after adjusting for sex, age, fasting plasma glucose, smoking, alcohol drinking, and diabetes family history, the risk of new-onset diabetes in MHO group was 2.19 folds of MHNO group(95% CI 1.89-2.55). Additionally, the HR for diabetes in MUNO and MUO groups were 2.25(95% CI 1.93-2.64)and 3.00(95% CI 2.61-3.45). Conclusion:The MHO phenotype was significantly associated with an increased risk of new-onset diabetes in Chinese adults.