Among adults in the United States, the prevalence of prediabetes is 38 %, 1 with this rate predicted to increase slightly, to 40 %, by 2030.2 Obesity has been found to be even more prevalent than prediabetes, with an estimated 42 % of U.S. adults currently living with obesity, 3 and this rate predicted to rise to 49 % by 2030.4 Both prediabetes and obesity have been found to be associated with cardiovascular and renal complications. Obesity has been identified as a risk marker for cardiovascular disease, given the associated higher prevalence of conditions such as hypertension and metabolic syndrome.5 However, obesity is also recognized as an independent risk factor for the development of cardiovascular disease.5 In addition, numerous population-based studies have shown the association between obesity and both the development and progression of chronic kidney disease.6 Similarly, a meta-analyses of 95 studies concluded that there is an association between prediabetes and an increased risk of cardiovascular disease, coronary heart disease, and chronic kidney disease.7

Given the complications associated with both obesity and prediabetes, it is not surprising that both conditions have also been found to be associated with higher mortality rates. For example, a cohort study of individuals from the original Framingham Heart study and their offspring found a significantly increased risk of mortality for individuals classified as obese 1 or obese 2 compared to normal-weight individuals, with hazard rates of 1.27 and 1.93, respectively.8 A meta-analysis of 129 studies found that prediabetes was associated with a statistically significant relative risk of all-cause mortality.9 A more recent meta-analysis also found that prediabetes was associated with an increased risk for all-cause mortality.7

The main purpose of this study was to understand the prevalence of mortality, cardiovascular, and cardio-renal outcomes among two high-risk populations. To this end, the study examined the 5-year prevalence rates of morbidity and mortality for two cohorts. One cohort consisted of individuals with obesity without a diagnosis of impaired glycemia (“obesity only”), while the other cohort consisted of people diagnosed with both obesity and prediabetes (“obesity plus prediabetes”). The study quantifies the prevalence of outcomes over an extended time horizon and also allows for an increased understanding of the marginal impact of prediabetes among a cohort of adults with obesity.