Go DJ, Kim DH, Guermazi A, et al. - Metabolic impacts of obesity on knee cartilage damage and bone marrow lesions (BML) were not shown in this cohort, and there is a need for further large-scale studies to prove the causal association between metabolic obesity and knee osteoarthritis (OA).

• From the Hallym Aging Study cohort in Korea, a total 226 participants were included in whom knee magnetic resonance imaging scans, along with dual-energy X-ray absorptiometry, were evaluated at baseline and after 3 years.

• In women, fat mass was found to be linked with cartilage loss in the medial compartment, but the statistical significance vanished post-adjustment for body mass index.

• Metabolic syndrome and each of its components were not related to cartilage loss or increase of BML.

• There were no significant interaction effects of metabolic syndrome on the link between obesity and knee OA progression.