Cardiometabolic disease risk in metabolically healthy and unhealthy obesity: Stability of metabolic health status in adults.

Published on Feb 1, 2016in Obesity3.969
· DOI :10.1002/oby.21344
Fangjian Guo12
Estimated H-index: 12
(UTMB: University of Texas Medical Branch),
W. Garvey52
Estimated H-index: 52
(UAB: University of Alabama at Birmingham)
Objective To assess the stability of metabolic status and body mass index (BMI) status and their relative contribution to risk of diabetes, cardiovascular events, and mortality. Methods A total of 14,685 participants from the Atherosclerosis Risk in Communities Study and 4,990 from the Coronary Artery Risk Development in Young Adults Study were included. People with healthy obesity (HO) are defined as those meeting all three indices of blood pressure, blood glucose, and blood lipids. People with unhealthy obesity crossed the risk threshold for all three criteria. Results In both healthy and unhealthy subgroups, risks for coronary heart disease (CHD), stroke, and mortality were comparable among BMI status during a mean 18.7-year follow-up. When compared with HO, hazard ratios were increased for diabetes (5.56, 95% confidence interval [CI] 4.12-7.48), CHD (5.60, 95% CI 3.14-9.98), stroke (4.84, 95% CI 2.13-10.97), and mortality (2.6, 95% CI 1.88-3.61) in people with unhealthy obesity. BMI only moderately increased the risks for diabetes among healthy subjects. In the Coronary Artery Risk Development in Young Adults Study over 20 years, 17.5% of lean subjects and 67.3% of overweight subjects at baseline developed obesity during follow-up. Despite rising BMI, metabolic status remained relatively stable. Conclusions Metabolic status is relatively stable despite rising BMI. HO had lower risks for diabetes, CHD, stroke, and mortality than unhealthy subjects but increased diabetes risks than healthy lean people. Cardiometabolic risk factors confer much higher risk than obesity per se.
Figures & Tables
  • References (33)
  • Citations (33)
📖 Papers frequently viewed together
1,016 Citations
219 Citations
148 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Chang Hee Jung (UOU: University of Ulsan)H-Index: 19
#2Min Jung Lee (UOU: University of Ulsan)H-Index: 7
Last. Woo Je Lee (UOU: University of Ulsan)H-Index: 20
view all 10 authors...
Objective: This study sought to investigate whether the metabolically healthy obese (MHO) phenotype is associated with an increased risk of incident type 2 diabetes in a Korean population and, if so, whether systemic inflammation affects this risk in MHO individuals. Design and Methods: The study population comprised 36 135 Koreans without type 2 diabetes. Participants were stratified by body mass index (cutoff value, 25.0 kg/m2) and metabolic health state (assessed using Adult Treatment Panel-I...
34 CitationsSource
#1Gilad Twig (Medical Corps)H-Index: 23
#2Arnon Afek (TAU: Tel Aviv University)H-Index: 20
Last. Amir Tirosh (Brigham and Women's Hospital)H-Index: 26
view all 7 authors...
OBJECTIVE To determine diabetes incidence over time among obese young adults without metabolic risk factors. RESEARCH DESIGN AND METHODS Incident diabetes during a median follow-up of 6.1 years was assessed among 33,939 young men (mean age 30.9 ± 5.2 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults cohort who were stratified for BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ...
47 CitationsSource
#1W. GarveyH-Index: 52
#2Alan M. GarberH-Index: 63
Last. Guillermo E. UmpierrezH-Index: 61
view all 13 authors...
85 CitationsSource
#1Hyun Suk Jung (SKKU: Sungkyunkwan University)H-Index: 43
#2Yoosoo Chang (SKKU: Sungkyunkwan University)H-Index: 27
Last. Seungho Ryu (SKKU: Sungkyunkwan University)H-Index: 40
view all 14 authors...
Objective The aim of this study was to examine an impact of body mass index (BMI) and weight change on the risk of diabetes according to metabolic health status. Methods Cohort study of 34,999 Korean men and women 30-59 years of age free of diabetes at baseline were followed-up annually or biennially for an average of 5.1 years. Being metabolically healthy was defined as not having any metabolic syndrome component. Results During 176,878.6 person-years of follow-up, 889 participants developed di...
24 CitationsSource
#1KoKo Aung (University of Texas Health Science Center at San Antonio)H-Index: 11
#2Carlos Lorenzo (University of Texas Health Science Center at San Antonio)H-Index: 30
Last. Steven M. Haffner (University of Texas Health Science Center at San Antonio)H-Index: 115
view all 4 authors...
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 population-based study among Mexican Americans and non-Hispanic whites (m...
109 CitationsSource
#1Fangjian Guo (UAB: University of Alabama at Birmingham)H-Index: 12
#2Douglas R. Moellering (UAB: University of Alabama at Birmingham)H-Index: 29
Last. W. Garvey (UAB: University of Alabama at Birmingham)H-Index: 52
view all 3 authors...
Objective To validate a Cardiometabolic Disease Staging (CMDS) system for assigning risk level for diabetes, and all-cause and cardiovascular disease (CVD) mortality. Design and Methods Two large national cohorts, CARDIA and NHANES III, were used to validate CMDS. CMDS: Stage 0: metabolically healthy; Stage 1: one or two metabolic syndrome risk factors [other than impaired fasting glucose (IFG)]; Stage 2: IFG or impaired glucose tolerance (IGT) or metabolic syndrome (without IFG); Stage 3: two o...
56 CitationsSource
#1Mette Thomsen (UCPH: University of Copenhagen)H-Index: 7
#2Børge G. Nordestgaard (UCPH: University of Copenhagen)H-Index: 119
Importance Overweight and obesity likely cause myocardial infarction (MI) and ischemic heart disease (IHD); however, whether coexisting metabolic syndrome is a necessary condition is unknown. Objective To test the hypothesis that overweight and obesity with and without metabolic syndrome are associated with increased risk of MI and IHD. Design, Setting, and Participants We examined 71 527 individuals from the Copenhagen General Population Study and categorized them according to body mass index (...
83 CitationsSource
33 CitationsSource
#1Sarah L. Appleton (University of Adelaide)H-Index: 27
Last. Robert J. Adams (University of Adelaide)H-Index: 45
view all 7 authors...
OBJECTIVE To determine the correlates of the “metabolically healthy obese” (MHO) phenotype and the longitudinal risks of diabetes and cardiovascular disease (CVD)/stroke associated with this phenotype. RESEARCH DESIGN AND METHODS The North West Adelaide Health Study is a prospective cohort study of 4,056 randomly selected adults aged ≥18 years. Participants free of CVD/stroke and not underweight ( n = 3,743) were stratified by BMI categories and metabolic risk, defined as having two or more Inte...
219 CitationsSource
#1Yoosoo Chang (SKKU: Sungkyunkwan University)H-Index: 27
#2Seungho Ryu (SKKU: Sungkyunkwan University)H-Index: 40
Last. Sung-Il Cho (SNU: Seoul National University)H-Index: 43
view all 6 authors...
Although the existence of metabolically healthy obese (MHO) individuals has been recognized, little is known regarding metabolic health status in these subjects over time. Thus, we evaluated longitudinal changes in metabolic parameters among MHO subjects compared with metabolically healthy, normal-weight (MHNW) subjects. A cohort study was performed on 2599 Korean men, 30–59 years of age, with no evidence of fatty liver disease on ultrasound and no traits of metabolic syndrome at baseline. BMI w...
60 CitationsSource
Cited By33
#1Siyuan Feng (Tianjin Medical University)
#2Xiaowen Gong (Tianjin Medical University)
Last. Yuanyuan Liu (Tianjin Medical University)H-Index: 5
view all 21 authors...
OBJECTIVE: This study aimed to assess whether metabolically healthy obesity (MHO) increases the risk of diabetes and to explore how the occurrence of metabolic disorders affects the risk of diabetes and which factors determine metabolic health. METHODS: This study examined 49,702 older people without diabetes via the Binhai Health Screening Program in Tianjin. RESULTS: Compared with individuals with metabolic health and normal weight, the risk of diabetes was increased in older adults with MHO (...
#1Francisco M. Gutierrez-Mariscal (UCO: University of Córdoba (Spain))H-Index: 10
#2Antonio Garcia-Rios (UCO: University of Córdoba (Spain))H-Index: 19
Last. Javier Delgado-Lista (UCO: University of Córdoba (Spain))H-Index: 19
view all 13 authors...
BACKGROUND: Aging is associated with a high risk for cardiovascular disease. The relation of obesity and risk of cardiovascular events appears to be more closely linked to certain clinical or metabolic phenotypes than to obesity itself. Our aim was to establish whether aging influenced the metabolic phenotypes regarding to cardiovascular risk, evaluated by changes in the intima media thickness-common carotid (IMT-CC), in coronary heart disease (CHD) patients. METHODS: In this cross-sectional stu...
#1Jeffrey I. Mechanick (Cardiovascular Institute of the South)H-Index: 39
#2Michael E. Farkouh (U of T: University of Toronto)H-Index: 49
Last. W. GarveyH-Index: 52
view all 4 authors...
Highlights •The cardiometabolic-based chronic disease model is designed to optimize early and sustainable preventive care. •Genetics, environment, and behavior are primary drivers, and adiposity and dysglycemia are metabolic drivers of cardiometabolic-based chronic disease. •Cardiometabolic endpoints include coronary heart disease, heart failure, and atrial fibrillation. •A detailed prevention plan can be fashioned based on this model.
#1Jelena Janac (University of Belgrade)H-Index: 2
#2Aleksandra Zeljkovic (University of Belgrade)H-Index: 12
Last. Vesna Spasojevic-Kalimanovska (University of Belgrade)H-Index: 16
view all 10 authors...
6 CitationsSource
#1Yun Kyung Cho (UOU: University of Ulsan)H-Index: 5
#2Yu Mi Kang (UOU: University of Ulsan)H-Index: 11
Last. Chang Hee Jung (UOU: University of Ulsan)H-Index: 19
view all 8 authors...
Abstract Aims We hypothesized that transitions in metabolic health status and obesity affect the cardiovascular (CV) risk and mortality in population with metabolically healthy obesity (MHO). Methods This study enrolled 514,866 participants from the Korean National Health Insurance Service–National Sample Cohort. Changes in metabolic health status and obesity from the baseline examination in 2009–2010 to the next biannual health examination in 2011–2012 were determined. Study participants were c...
#1William Johnson (Lboro: Loughborough University)H-Index: 18
#2Joshua A. Bell (UoB: University of Bristol)H-Index: 15
Last. Mark Hamer (Lboro: Loughborough University)H-Index: 69
view all 6 authors...
To describe 20-year risk factor trajectories according to initial weight/health status and investigate the extent to which baseline differences explain greater mortality among metabolically healthy obese (MHO) individuals than healthy non-obese individuals. The sample comprised 6529 participants in the Whitehall II study who were measured serially between 1991–1994 and 2012–2013. Baseline weight (non-obese or obese; body mass index (BMI) ≥30 kg/m2) and health status (healthy or unhealthy; two or...
4 CitationsSource
#1Paolo SbracciaH-Index: 24
#2Valeria GuglielmiH-Index: 10
#1Keith SmithH-Index: 27
#2Costan G. MagnussenH-Index: 33
Last. Olli T. RaitakariH-Index: 111
view all 14 authors...
Background: Adiposity in childhood and adolescence (youth) has been shown to associate with adult metabolic health. What is not known, is whether youth body mass index (BMI) associates with metabolically healthy obesity (MHO) in adulthood, and if so, the age when the BMI to MHO association emerges. This study aimed to determine if BMI trajectories from youth to adulthood differed between adults with MHO and metabolically unhealthy obesity (MUHO).Methods: The Cardiovascular Risk in Young Finns St...
#1Xin Chen (Soochow University (Suzhou))H-Index: 1
#2Guoping GuiH-Index: 1
Last. Hongmei Li (Soochow University (Suzhou))H-Index: 8
view all 6 authors...
The purpose of this study was to identify the effects of various obesity phenotypes and metabolic abnormalities on cardio-cerebrovascular disease. We performed a large-scale, cross-sectional study including 10,089 participants aged ≥18 years in the National High-Technology district of Suzhou, China, from March 2016 to April 2016. Cardio-cerebrovascular disease included stroke and coronary heart disease. The prevalence rates of cardio-cerebrovascular disease among people with normal weight, overw...
1 CitationsSource