Abstract
To investigate the relationship between metabolically healthy obesity and cardiovascular disease risk in Taiwanese individuals. Taiwanese individuals were recruited from a nationwide, representative community-based prospective cohort study and classified according to body mass index as follows: normal weight (18.5-23.9 kilogram (kg)/meter(m)2) and obesity/overweight (≥24 kg/m2). Participants without diabetes, hypertension, and hyperlipidemia and who did not meet the metabolic syndrome without waist circumference criteria were considered metabolically healthy. The study end points were cardiovascular disease morbidity and mortality. Multivariable adjusted hazard ratios and 95% confidence intervals were obtained from a Cox regression analysis. Among 5 358 subjects (mean [standard deviation] age, 44.5 [15.3] years; women, 48.2%), 1 479 were metabolically healthy with normal weight and 491 were metabolically healthy with obesity. The prevalence of metabolically healthy obesity/overweight was 8.6% in the Taiwanese general population, which included individuals who were >20 years old, not pregnant, and did not have CVD (n = 5,719). In the median follow-up period of 13.7 years, 439 cardiovascular disease events occurred overall and 24 in the metabolically healthy obesity group. Compared with the reference group, the metabolically healthy obesity group had a significantly higher cardiovascular disease risk (adjusted hazard ratio: 1.74, 95% confidence interval: 1.02, 2.99). Individuals with metabolically healthy obesity have a higher risk of cardiovascular disease and require aggressive body weight control for cardiovascular disease control.
Highlights
Cardiovascular disease (CVD) is the leading cause of mortality worldwide
Individuals with metabolically healthy obesity have a higher risk of cardiovascular disease and require aggressive body weight control for cardiovascular disease control
Obesity/overweight status is usually evaluated by body mass index (BMI), waist circumference (WC), or body fat
Summary
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. According to the World Health Organization, over million deaths occurred due to CVD in 2017 [1] and the number is increasing. Obesity and overweight are well-known risk factors for CVD due to metabolic dysregulation. Some obesity phenotypes that are protected from adverse metabolic effects of excess body fat are considered “metabolically healthy” [2]. The concept of metabolically healthy obesity (MHO), indicating that some individuals with obesity do not have any negative health outcomes, was first reported in 2001 [3]. Individuals with no diagnosis of metabolic syndrome or those who are insulin sensitive or have normal blood pressure, glucose level, and lipid profile are considered metabolically healthy [6, 7]. According to the updated definition of metabolic health that was proposed in 2019, metabolically healthy means absence of cardiometabolic diseases and a healthy cardiometabolic blood profile [11]
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