ORIGINAL ARTICLE Very severely obese patients have a high prevalence of type 2 diabetes mellitus and cardiovascular disease Federica Vinciguerra • Roberto Baratta • Maria Grazia Farina • Patrizia Tita • Giuseppa Padova • Riccardo Vigneri • Lucia Frittitta Received: 3 December 2012 / Accepted: 4 February 2013 / Published online: 28 February 2013 Ó Springer-Verlag Italia 2013 Abstract The prevalence of very severe obesity has increased progressively and faster than other classes of obesity over the last years. It is unclear whether the preva- lence of obesity-related complications and health risks increases progressively or reaches a plateau above a certain degree of obesity. The aim of our study was to investigate whether the severity of obesity was correlated with the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose, impaired glucose tolerance (IGT), meta- bolic syndrome (MS), and cardiovascular diseases (CVDs) in a large cohort of patients with different degrees of obesity. A cross-sectional study was conducted in 938 obese patients without a previous diagnosis of diabetes. Patients were assigned to different categories of obesity: mild-moderate obesity (BMI 30–39.9 kg/m 2 ), morbid obesity (BMI 40–49.9 kg/m 2 ), and super-obesity (SO, BMI C50 kg/m 2 ). The prevalence of IGF, IGT, screen-detected T2DM, MS, and CVD was higher in SO patients than in the other groups. Interestingly, the association between SO and either MS or CVD was independent of glucose tolerance status, indicating that factors other than glucose metabolism also favor cardio-metabolic complications in obese patients. In patients without screen-detected T2DM (n = 807), insulin sensitiv- ity and secretion OGTT-derived indexes indicated that SO patients had the worst glucose homeostasis relative to the other categories of obesity, which was indicated by the most reduced disposition index in these patients, a predictor of future T2DM. In conclusion, SO patients have an extremely high prevalence of glucose metabolism deterioration, and cardio-metabolic complications are more prevalent in these patients compared to less obese patients. Keywords Obesity Á Super-obesity Á Severe obesity Á Type 2 diabetes Á Metabolic syndrome Á Cardiovascular diseases Á Cardio-metabolic diseases Introduction Obesity is dramatically increasing throughout the world. A recent study showed that more than one-third of US adults are obese [1]. Similarly, almost half of Italian men and approximately one-third of Italian women are overweight or obese. From 2001 to 2008, the age-standardized preva- lence of overweight and obesity increased in Italy by 1.4 and 1.9 % in men and 0.4 and 0.5 % in women, respec- tively [2]. Obesity increases mortality from all causes and cardiovascular risk. In particular, obesity is associated with insulin resistance and other metabolic complications such as type 2 diabetes mellitus (T2DM), dyslipidemia, and hypertension. Obesity is also a major component of met- abolic syndrome, a cluster of metabolic and clinical con- ditions associated with elevated cardiovascular disease risk [3, 4]. The T2DM prevalence increases with age [5] and BMI, reaching 18.3 % in obese individuals (over 35 kg/ m 2 )[6]. Data on the prevalence of these metabolic diseases in very morbidly obese patients are scarce. Communicated by Massimo Federici. Federica Vinciguerra and Roberto Baratta equally contributed. F. Vinciguerra Á R. Baratta (&) Á M. G. Farina Á P. Tita Á G. Padova Á R. Vigneri Á L. Frittitta (&) Endocrinology Unit, Department of Clinical and Molecular Bio-Medicine, University of Catania Medical School, Garibaldi Hospital, Via Palermo 636, 95122 Catania, Italy e-mail: rob.baratta@gmail.com L. Frittitta e-mail: lfritti@unict.it 123 Acta Diabetol (2013) 50:443–449 DOI 10.1007/s00592-013-0460-3