TOPLINE:

A higher estimated basal metabolic rate (BMR) was associated with an increased risk of developing diabetes and several related complications in both men and women, largely independent of BMI.

METHODOLOGY:

• Researchers conducted a prospective study of 341,790 UK Biobank participants without diabetes (mean age, 55.9 years; 182,467 women) to assess whether a higher BMR was associated with a subsequent risk of developing diabetes and its complications.
• The BMR was estimated at baseline using a body impedance analyser; the mean estimated BMR was 1849 kcal/d in men and 1340 kcal/d in women.
• Incident diabetes cases, diabetes subtypes, and the first diagnosis of diabetes-related complications — including microvascular events (retinopathy, neuropathy, peripheral vascular disease, or any other unspecified); macrovascular events (stroke, cardiac, and atherosclerotic diseases); and diabetic coma, ketoacidosis, and glycaemic disturbances — were assessed over a mean follow-up duration of 12 years.
• Mediation analysis evaluated whether baseline vascular‑metabolic biomarkers — A1c, triglycerides, high‑density lipoprotein cholesterol, cystatin C, and C‑reactive protein — explained part of the observed associations.

TAKEAWAY:

• During follow-up, 4626 new cases of diabetes were observed.
• A higher estimated BMR was associated with a substantially increased risk of developing diabetes: Each SD increase was linked to a 54% higher risk in men (hazard ratio [HR], 1.54; 95% CI, 1.49-1.59) and a 56% higher risk in women (HR, 1.56; 95% CI, 1.49-1.62); the associations were largely driven by type 2 diabetes.
• In both men and women who developed diabetes, a higher estimated BMR was associated with an increased risk for cardiac events, atherosclerotic disease, and stroke; in men, a higher estimated BMR was additionally associated with an increased risk for diabetic retinopathy; in women, it was associated with an increased risk for diabetic coma, ketoacidosis, and glycaemic disturbances.
• The associations were largely independent of residual BMI; vascular‑metabolic biomarkers collectively explained less than one fifth of the diabetes-BMR association in men and about one third in women.

IN PRACTICE:

"Up to 30% of the risk of BMR with diabetes and its vascular-metabolic complications appeared mediated by glucose, triglycerides, high-density cholesterol and inflammatory markers, suggesting that controlling for these factors, may mitigate the risk due to BMR, particularly among women," the authors wrote.

SOURCE:

This study was led by Joseph Frimpong, University of Oxford, Oxford, England. It was published online on March 09, 2026, in Diabetes Research and Clinical Practice.

LIMITATIONS:

The BMR was estimated using bioimpedance analysis rather than the gold-standard calorimetry. Analyses of diabetic retinopathy, stroke, and other microvascular complications had limited statistical power. The UK Biobank cohort consists of participants who are healthier and more socioeconomically advantaged than the general UK population, which may have limited the generalisability of the findings.

DISCLOSURES:

This study was funded by the Nuffield Department of Population Health at the University of Oxford. The authors reported having no known competing financial interests or personal relationships that could have influenced the work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.