Krishnarajah. (2017) Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. Journal of the American College of Cardiology, 70 (12). pp. 1429-1437. Permanent WRAP URL:http://wrap.warwick.ac.uk/94321 Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. A note on versions:The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP url' above for details on accessing the published version and note that access may require a subscription. (1995 to 2015) in The Health Improvement Network (THIN) to assemble a cohort of 3.5 million individuals, 18 years or older and initially free from cardiovascular disease. We created body size phenotypes defined by BMI categories (underweight, normal weight, overweight and obesity) and three metabolic abnormalities (diabetes, hypertension, and hyperlipidemia). The primary endpoints were the first record of one of 4 cardiovascular presentations [coronary heart disease (CHD), cerebrovascular disease, heart failure, and peripheral vascular disease (PVD)].Results: During a mean follow-up period of 5.4 years, obese individuals with 0 metabolic abnormalities had a higher risk of CHD (multivariable-adjusted hazard ratio (HR) 1.49, 95% CI 1.45, 1.54), cerebrovascular disease (1.07, 95% CI 1.04, 1.11) and heart failure (1.96, 95% CI 1.86, 2.06) compared to normal weight individuals with 0 metabolic abnormalities. Risk of CHD, cerebrovascular disease and heart failure in normal weight, overweight and obese individuals increased with increasing number of metabolic abnormalities. Conclusion: Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities, and have similar risks for cardiovascular disease events.

Background National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m²).Methods In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15•0-50•0 kg/m² and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data. Findings 1 472 819 people were included in our study, of whom 1 333 816 (90•6%) were White, 75 956 (5•2%) were south Asian, 49 349 (3•4%) were Black, 10 934 (0•7%) were Chinese, and 2764 (0•2%) were Arab. After a median follow-up of 6•5 years (IQR 3•2-11•2), 97 823 (6•6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30•0 kg/m² in White populations, the BMI cutoffs were 23•9 kg/m² (95% CI 23•6-24•0) in south Asian populations, 28•1 kg/m² (28•0-28•4) in Black populations, 26•9 kg/m² (26•7-27•2) in Chinese populations, and 26•6 kg/m² (26•5-27•0) in Arab populations.Interpretation Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes.

The double burden of malnutrition among adolescents in LMICs is common. Context-sensitive implementation and scale-up of interventions and policies for the double burden of malnutrition are needed to achieve the Sustainable Development Goal to end malnutrition in all of its forms by 2030. This trial was registered at clinicaltrials.gov as NCT03346473.

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