Metabolically healthy obesity: different prevalences using different criteria (original) (raw)
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Background: Recent studies reveal that metabolically healthy obesity, which is free from the metabolic complications of obesity at present, is a risk of incident diabetes or cardiovascular disease (CVD). It may be because many metabolically healthy obesity individuals transit to metabolically abnormal obesity over time. However, the association between maintaining metabolically healthy obesity and incident diabetes or CVD is still unclear. Methods: 2190 participants without diabetes and/or CVD were examined at baseline and at 5-year follow-up, using a retrospective cohort study design. Metabolically abnormal was defined as having ≥ 2 of metabolic abnormalities, hypertension, hypertriglyceridemia, low HDL cholesterol and impaired fasting glucose. Overweight was defined as BMI ≥ 23 kg/ m2, which is recommended by WHO for Asian. Adjusted odds ratio (OR) and 95% confidence interval (CI) for incident diabetes or CVD at follow-up were estimated adjusting for potential confounders, compared to maintaining metabolically healthy non-overweight (MHNO). Results: At the follow-up examination, 82 participants developed diabetes. Crude incident proportions of diabetes were 0.6% in maintained MHNO (case/N = 5/859) and 1.3% in maintained metabolically healthy overweight (MHO)(4/314). Adjusted OR for incident diabetes of maintaining MHO was 1.71 (95% CI 0.42-6.57, P = 0.438). At the follow-up examination, 51 participants developed CVD. Crude incident proportions of CVD were 0.8% in maintained MHNO (7/859) and 1.6% in maintained MHO (5/314). Adjusted OR for incident CVD of maintaining MHO was 1.42 (95% CI 0.41-4.56, P = 0.565). Conclusions: Maintaining MHO phenotype was not associated with higher risk of incident diabetes or CVD. Keywords: Obesity; Body Mass Index; Type 2 Diabetes; Metabolic Syndrome; Epidemiology; Cardiovascular Disease. Abbreviations: FPG: Fasting Plasma Glucose, HDL: High-Density Lipoprotein, BMI: Body Mass Index, BP: Blood Pressure, MHNO: Metabolically Healthy Non-Overweight, MHO: Metabolically Healthy Overweight, MANO: Metabolically Abnormal Non-Overweight, MAO: Metabolically Abnormal Overweight.
2009
A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
Predictors of incident obesity phenotype in nonobese healthy adults
European Journal of Clinical Investigation, 2017
Background: Despite their different cardiovascular consequences, little is known about predictors of metabolically healthy (MHO) and metabolically unhealthy (MUHO) obesity. This cohort study was designed to address this question in participants of the Tehran Lipid and Glucose Study. Materials and methods: Employing the Joint Interim Statement (JIS) metabolic syndrome criteria to define MHO/MUHO phenotypes, non-obese, otherwise healthy individuals, aged >20 years (n= 3489) were recruited and followed up for a median of 13.4 years. Results: At the follow up, MHO incidence rate in obese individuals was 36.6%. Comparing MHO vs. MUHO, female gender (odds ratio (OR)=3.28, 95% confidence interval (CI) 1.27, 8.46)), increased body mass index (BMI) (OR=1.32, 95% CI 1.12, 1.60) and elevated high This article is protected by copyright. All rights reserved. density lipoprotein-cholesterol (HDL-C) levels (OR=1.04, 95% CI 1.02, 1.07) were related to higher odds of incident MHO, while older age (OR=0.95, 95% CI 0.92, 0.98), increased waist circumference (WC) (OR=0.86, 95% CI 0.81, 0.91), higher WC gain (OR=0.91, 95% CI 0.87, 0.95) and increased diastolic blood pressure (DBP) (OR=0.94, 95% CI 0.91, 0.98) prevented progression toward MHO. Conclusions: While baseline BMI and WC were detrimental for developing MHO vs. MUHO, gender was the strongest predictor of incident obesity phenotype in healthy non-obese individuals.
European Heart Journal, 2014
The metabolically healthy obese (MHO) phenotype refers to obese individuals with a favourable metabolic profile. Its prognostic value is unclear and may depend on the health outcome being examined. We examined the association of MHO phenotype with incident cardiovascular disease (CVD) and type 2 diabetes. Methods and results Body mass index and metabolic health, assessed using the Adult Treatment Panel-III (ATP-III) criteria, were assessed on 7122 participants (69.7% men) from the Whitehall II study, aged 39-63 years in 1991-93. Incident CVD (coronary heart disease or stroke) and type 2 diabetes were ascertained from medical screenings (every 5 years), hospital data, and registry linkage until 2009. A total of 657 individuals (9.2% of the cohort) were obese and 42.5% of these were classified as MHO in 1991-93. Over the median follow-up of 17.4 years, there were 828 incident cases of CVD and 798 incident cases of type 2 diabetes. Compared with metabolically healthy normal weight individuals, MHO subjects were at increased risk for CVD (HR ¼ 1.97, 95% CI: 1.38-2.80) and type 2 diabetes (3.25, 95% CI: 2.32-4.54). There was excess risk in metabolically unhealthy obese compared with MHO for type 2 diabetes (1.98, 95% CI: 1.39-2.83) but not CVD (1.23, 95% CI: 0.81-1.87). Treating all measures as time varying covariates produced similar findings. Conclusion For type 2 diabetes, the MHO phenotype is associated with lower risk than the metabolically unhealthy obese, but for CVD the risk is as elevated in both obesity phenotypes.
The Journal of Clinical Endocrinology & Metabolism, 2014
Context: The risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) associated with obesity appears to be influenced by the coexistence of other metabolic abnormalities. Objective: We examined the risk of developing CVD and DM in metabolically healthy obese (MHO) and metabolically unhealthy normal weight (MUH-NW) individuals. Design and Setting: We analyzed prospective data of the San Antonio Heart Study, a populationbased study among Mexican Americans and non-Hispanic whites (median follow-up, 7.4 y). Participants: Incident DM and CVD were assessed in 2814 and 3700 participants aged 25 to 64 years, respectively. Main Measures: MHO was defined as obesity (body mass index Ն 30 kg/m 2) with no more than one metabolic abnormality, and MUH-NW was defined as body mass index Ͻ25 kg/m 2 with two or more abnormalities. Results: In logistic regression models, BMI was associated with incident DM after controlling for demographics, family history of DM, and fasting glucose (odds ratio ϫ 1 SD, 1.7 [95% CI, 1.5-2.0]). Both MUH-NW and MHO individuals had an increased DM risk (2.5 [1.1-5.6] and 3.9 [2.0-7.4], respectively). Similarly, BMI was related to incident CVD after adjusting for demographics and Framingham risk score (1.3 [1.1-1.6]). Incident CVD was also increased in MUH-NW and MHO individuals (2.9 [1.3-6.4] and 3.9 [1.9-7.8], respectively). Results were consistent across gender and ethnic categories. Conclusion: The risk of developing DM and CVD is increased in MUH-NW and MHO individuals. Screening for obesity and other metabolic abnormalities should be routinely performed in clinical practice to institute appropriate preventive measures.
Risk of diabetes according to the metabolic health status and degree of obesity
Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 2017
Aim: To determine the progression rates from metabolically healthy or unhealthy normal weight, overweight and obese phenotype to type 2 diabetes (T2D) in a nondiabetic high risk population in Isfahan, Iran. Methods: T2D incidence during a mean (SD) follow-up of 10.1 (2.3) years was examined among 1,982 non-diabetic first-degree relatives (FDR) of patients with T2D 30-70 years old. Participants were divided into 6 groups based on body mass index and metabolic syndrome component, except waist circumference, at baseline: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW) and metabolically unhealthy obese (MUO). Results: The MHO, MUOW, and MUO individuals at baseline were associated with incidence of T2D, independently of age and gender. MHO were 3 times (OR 2.96; 2 95% CI 1.07, 8.24) and MUOW were 2.75 times (95% CI 1.17, 6.45) more likely to develop T2D than those with MHNW. There was excess risk in MUO than MHO (OR 3.86; 95% CI 1.64, 9.11). Conclusions: Obesity was a risk factor for T2D, even in the absence of any metabolic abnormalities. Metabolic abnormalities was a stronger predictor of incident T2D than obesity.
Prevalence of Metabolic Conditions Differentiated by BMI in U.S. Adults
Journal of Integrative Cardiology Open Access
Introduction: To investigate the prevalence of metabolic conditions by body mass index (BMI) in U.S. adults, with metabolic conditions including type 2 diabetes (T2D), hypertension and dyslipidemia for overall and undiagnosed conditions. Methods: Adult participants were from the U.S. CDC 2013-2014 National Health and Nutrition Examination Survey. BMI categories were: under/normal weight (BMI < 25kg/m2 ), overweight (25≤ BMI<30 kg/m2 ) and obese (BMI ≥30 kg/m2 ). The weighted prevalence and its 95% confidence interval by BMI were calculated. The proportional test identified if a significant difference in the prevalence of metabolic conditions existed using under/normal as the reference. Results: The overall weighted prevalence of diabetes, hypertension, high cholesterol and overall abnormal cardiometabolic conditions were 16.1%, 60.3%, 57.5% and 76.3%, respectively, and 8.8%, 11.3%, 16.8% and 30.2%, respectively for the undiagnosed conditions. The prevalence of each metabolic c...