Metabolically Healthy Obesity and Risk of Mortality
Top Cited Papers
Open Access
- 11 July 2013
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 36 (8), 2294-2300
- https://doi.org/10.2337/dc12-1654
Abstract
OBJECTIVE To assess the association of a “metabolically healthy obese” phenotype with mortality using five definitions of metabolic health. RESEARCH DESIGN AND METHODS Adults (n = 5,269; 71.7% men) aged 39–62 years in 1991 through 1993 provided data on BMI and metabolic health, defined using data from the Adult Treatment Panel-III (ATP-III); criteria from two studies; and the Matsuda and homeostasis model assessment (HOMA) indices. Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Cox proportional hazards regression models were used to analyze associations with all-cause and cardiovascular disease (CVD) mortality during a median follow-up of 17.7 years. RESULTS A total of 638 individuals (12.1% of the cohort) were obese, of whom 9–41% were metabolically healthy, depending on the definition. Regardless of the definition, compared with metabolically healthy, normal-weight individuals, both the metabolically healthy obese (hazard ratios [HRs] ranged from 1.81 [95% CI 1.16–2.84] for ATP-III to 2.30 [1.13–4.70] for the Matsuda index) and the metabolically abnormal obese (HRs ranged from 1.57 [1.08–2.28] for the Matsuda index to 2.05 [1.44–2.92] for criteria defined in a separate study) had an increased risk of mortality. The only exception was the lack of excess risk using the HOMA criterion for the metabolically healthy obese (1.08; 0.67–1.74). Among the obese, the risk of mortality did not vary as a function of metabolic health apart from when using the HOMA criterion (1.93; 1.15–3.22). Similar results were obtained for cardiovascular mortality. CONCLUSIONS For most definitions of metabolic health, both metabolically healthy and unhealthy obese patients carry an elevated risk of mortality.Keywords
This publication has 34 references indexed in Scilit:
- Body mass index, waist circumference and waist–hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual‐participant meta‐analysis of 82 864 participants from nine cohort studiesObesity Reviews, 2011
- National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participantsThe Lancet, 2011
- Characterizing the profile of obese patients who are metabolically healthyInternational Journal of Obesity, 2010
- Prevalence, Metabolic Features, and Prognosis of Metabolically Healthy Obese Italian IndividualsDiabetes Care, 2010
- Are Metabolically Normal but Obese Individuals at Lower Risk for All-Cause Mortality?Diabetes Care, 2009
- Inclusion of C-reactive protein in the identification of metabolically healthy but obese (MHO) individualsDiabetes & Metabolism, 2008
- Metabolically Healthy but Obese Women Have an Intermediate Cardiovascular Risk Profile Between Healthy Nonobese Women and Obese Insulin-Resistant WomenDiabetes Care, 2007
- Obesity and Diabetes in the Developing World — A Growing ChallengeThe New England Journal of Medicine, 2007
- Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years OldThe New England Journal of Medicine, 2006
- Methods for Determining the Amount of Glucose in BloodCRC Critical Reviews in Clinical Laboratory Sciences, 1973