Type 2 Diabetes in Obese Individuals Is Associated With Central Adiposity and Atherogenic Dyslipidemia but Does Not Exacerbate Systemic Inflammation: A Cross-Sectional Study

BACKGROUND: Obesity and type 2 diabetes mellitus (T2DM) are frequently coexisting conditions characterized by low-grade chronic inflammation. The primary objective of this study was to investigate the impact of T2DM, in the context of obesity, on body fat distribution, atherogenic lipid profiles, and systemic inflammatory markers derived from hematologic parameters. METHODOLOGY: This cross-sectional study included a total of 171 participants with a body mass index (BMI) greater than 30 kg/m². Participants were divided into two groups: those with a diagnosis of T2DM (n = 86) and those without T2DM (n = 85). Between-group comparisons were performed for demographic characteristics, anthropometric measurements (waist-to-hip ratio (WHR), visceral adiposity score), lipid profiles (triglycerides, low-density lipoprotein (LDL)/triglyceride ratio), and systemic inflammatory markers derived from hematologic parameters, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Appropriate parametric and nonparametric tests were used for statistical analyses. RESULTS: Although both groups exhibited comparable BMI values (p = 0.121), the diabetic cohort had a significantly higher WHR (0.97 ± 0.08 vs. 0.91 ± 0.10, p < 0.001). Metabolically, individuals with diabetes demonstrated elevated triglyceride levels (p = 0.023) and a lower LDL/triglyceride ratio (p = 0.003). Systemic inflammatory indices such as NLR, PLR, and SII were comparable between the two groups (all p > 0.05). Correlation analyses revealed that the relationship between visceral adiposity and inflammation was stronger in the non-diabetic group. CONCLUSIONS: Our findings indicate that, in obese individuals, the presence of T2DM is associated not with a greater degree of overall adiposity, but rather with a distinct metabolic phenotype characterized by centralization of fat distribution and accentuated atherogenic dyslipidemia. The inability of commonly used systemic inflammatory markers to discriminate between groups may be attributed to a "ceiling effect" resulting from the elevated inflammatory background inherent to obesity and the potential "masking effect" of antidiabetic therapies with anti-inflammatory properties in the diabetic cohort. These results underscore the superiority of the WHR over BMI for cardiometabolic risk stratification in obese individuals and highlight the critical importance of treatment history when interpreting inflammatory indices.