Abstract
BMI, metabolic health status, and their interactions should be considered for estimating mortality risk; however, the data are controversial and unknown in Asians. We aimed to investigate this issue in Korean population. Total 323175 adults were followed-up for 96 (60–120) (median [5–95%]) months in a nationwide population-based cohort study. Participants were classified as “obese” (O) or “non-obese” (NO) using a BMI cut-off of 25 kg/m2. People who developed ≥1 metabolic disease component (hypertension, diabetes, dyslipidaemia) in the index year were considered “metabolically unhealthy” (MU), while those with none were considered “metabolically healthy” (MH). The MUNO group had a significantly higher risk of all-cause (hazard ratio, 1.28 [95% CI, 1.21–1.35]) and cardiovascular (1.88 [1.63–2.16]) mortality, whereas the MHO group had a lower mortality risk (all-cause: 0.81 [0.74–0.88]), cardiovascular: 0.73 [0.57–0.95]), compared to the MHNO group. A similar pattern was noted for cancer and other-cause mortality. Metabolically unhealthy status was associated with higher risk of all-cause and cardiovascular mortality regardless of BMI levels, and there was a dose-response relationship between the number of incident metabolic diseases and mortality risk. In conclusion, poor metabolic health status contributed more to mortality than high BMI did, in Korean adults.
Highlights
Body mass index (BMI), metabolic health status, and their interactions should be considered for estimating mortality risk; the data are controversial and unknown in Asians
Body mass index (BMI) is the most widely used measure of obesity, and higher BMI has been linked to the development of various metabolic diseases and their underlying pathophysiologies that could lead to increased mortality
Large-scale studies in Asians are scarce; we aimed to investigate the risk of mortality according to BMI and metabolic health status using a nationwide dataset of the Korean population with a long-term follow-up period
Summary
BMI, metabolic health status, and their interactions should be considered for estimating mortality risk; the data are controversial and unknown in Asians. Body mass index (BMI) is the most widely used measure of obesity, and higher BMI has been linked to the development of various metabolic diseases and their underlying pathophysiologies that could lead to increased mortality This association is not necessarily linear, and many studies suggest the existence of ‘obesity paradox’ with different ranges of optimal BMI associated to mortality[1,2,3,4]. Some obese individuals exhibit lower degrees of insulin resistance and visceral adiposity and more favorable cardiovascular risk profiles despite their high BMI, and are classified as having metabolically healthy obese (MHO) phenotype[11,12]. Large-scale studies in Asians are scarce; we aimed to investigate the risk of mortality according to BMI and metabolic health status using a nationwide dataset of the Korean population with a long-term follow-up period
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