Abstract
Considering that the data available on the cardiovascular (CV) risk of metabolically healthy obesity phenotype, and the effect of transition to an unhealthy status are inconsistent, the aim of this study was to investigate the possible role of transition to unhealthy status among metabolically healthy overweight/obese (MHO) subjects on CVD incidence over a median follow-up of 15.9 years. In this large population-based cohort, 6758 participants (41.6% men) aged ≥ 20 years, were enrolled. Participants were divided into 4 groups based on their obesity phenotypes and follow-up results, including persistent metabolically healthy normal weight (MHNW), persistent MHO, transitional MHO and metabolically unhealthy overweight/obese (MUO). Metabolic health was defined as not having metabolic syndrome based on the Joint Interim Statement (JIS) criteria. Multivariable adjusted hazard ratios (HRs) were calculated for cardiovascular events. During follow-up, rate of CVD Incidence per 1000 person-years were 12 and 7 in males and females, respectively. Multivariable adjusted HRs (CI 95%) of CVD incidence among males and females were 1.37 (.78-2.41) and .85 (.34-2.15) in persistent MHO group, 1.55 (1.02-2.37) and .93 (.41-2.12) in transitional MHO group and 2.64 (1.89-3.70) and 2.65 (1.24-5.68) in MUO group. Our findings showed that CVD risk did not increase in the persistent MHO phenotype over a 15.9-year follow-up in both sexes. However, transition from MHO to MUO status during follow-up increased the CVD risk just in male individuals. Further studies are needed to provide conclusive evidence in favor of benign nature of transitional MHO phenotype in females.
Highlights
Obesity is a notorious risk factor for cardiovascular disease (CVD) and its prevalence continues to rise rapidly, throughout the world [1]
metabolically healthy overweight/obese (MHO) subjects in both sex groups had lower prevalence of Insulin resistance than metabolically unhealthy overweight/obese (MUO) subjects, it was higher than metabolically healthy normal weight (MHNW) participants
We did the analysis after entering the interaction of Diabetes and obesity phenotypes into the model; leading to the same results. Findings of this population-based cohort study showed that over 15.9-years of follow-up, transition from MHO to MUO phenotype increased the risk of CVD incidence in male subjects but not in females
Summary
Obesity is a notorious risk factor for cardiovascular disease (CVD) and its prevalence continues to rise rapidly, throughout the world [1]. While a few studies suggest that MHO is a benign phenotype [6, 8], longer prospective studies showed that, the risk of CVD this phenotype is between the normal weight healthy status and metabolically unhealthy [9,10,11]. This inconsistency could be explained by different lengths of follow-up, as long term studies are more likely to detect the transitional subgroup of MHO [12]. The definition of metabolically unhealthy status can be another reason for this inconsistency, as studies with a more strict definition of metabolic state found no CVD risk in the MHO phenotype [13]
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