Metabolically healthy obese phenotype and risk of cardiovascular disease: Results from the China Health and Retirement Longitudinal Study

Li, Haibin; He, Dongyi; Zheng, Deqiang; Amsalu, Endawoke; Wang, Anxin; Tao, Lixin; Guo, Jin; Li, Xia; Wang, Wei; Guo, Xiuhua

doi:10.1016/j.archger.2019.01.004

Cited by 32 publications

(29 citation statements)

References 46 publications

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“…The prevalence of MHO in the Chinese population varied from 4.2% to 11.4% due to the heterogeneous de nition [21,22]. In our study, the prevalence of MHO was 6.29% in the general population and 32.7% in obese subjects.…”

Section: Discussionmentioning

confidence: 49%

“…Some studies demonstrated that obesity status exerted no extra in uence on CVD [12,13]. Others indicated MHO was a transient condition between metabolically healthy and unhealthy phenotypes, and obesity was a risk factor for CVD regardless of the metabolic health status [14][15][16]. Taking the above-mentioned researches into consideration, the role of obesity on the association between MetS and baPWV is worth further exploration.…”

Section: Introductionmentioning

confidence: 99%

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Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort

Wang

Zuo

et al. 2021

Aging

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BackgroundTo investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population. Materials and methodsThe Kailuan study is an ongoing prospective cohort study, 37,180 participants with at least one-time measurement of branchial-ankle pulse wave velocity (baPWV) were included in the cross-sectional analysis, and 16,236 participants with repeated measurement of baPWV during the follow-ups were included in the longitudinal study from March 1, 2010, to January 31, 2020. Cross-classi cation of body mass index (BMI) categories and metabolic health status created six groups. Linear and logistic regression analyses were used to assess the association between BMI-metabolic status phenotypes and baPWV in mono-factor and multi-factor models. ResultsThe results of cross-sectional and longitudinal investigation were basically the same, as the abnormality of baPWV increased with BMI categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants. A 1.6-fold, 2.8-fold increased risk for the new occurrence of arterial stiffness were documented in MHO and metabolically unhealthy obese participants compared to metabolically healthy normal weight controls in the fully adjusted model. Further strati ed analysis shown that metabolic health status was an interaction factor between BMI and arterial stiffness in either study population (P<0.0001 for cross-sectional study and P=0.0003 for longitudinal study). ConclusionsMetabolic health status and BMI categories contribute to the progression of arterial stiffness, while BMI is positively associated with arterial stiffness only in metabolically healthy participants. Moreover, MHO is an intermediate stage between metabolically healthy and unhealthy status.

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Section: Discussionmentioning

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort

Wang

Zuo

et al. 2021

Aging

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“…However, no Asian studies were included in this meta-analysis. More recently, the Beijing Cohort Study [ 18 ] and the China Health and Retirement Longitudinal Study [ 19 ], including 9,393 and 7,849 Chinese adults, showed that MHO individuals had a higher risk of CVD (HR 1.91 [1.13–3.24] and 1.33 [1.19–1.49]) than MHN ones. However, both studies have a smaller sample size and shorter follow-up time than ours, with very few cases in subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a meta-analysis demonstrated that such increased CVD risk of MHO individuals is considerably lower than that of individuals with metabolically unhealthy obesity (MUO) [ 17 ]. However, these estimates were mostly from Western populations, with little evidence from China [ 18 , 19 ], where adiposity distribution, risk of obesity, lifestyle, and disease patterns differ substantially from those in Western populations [ 20 – 22 ]. Importantly, the Western cohort studies demonstrated that metabolic health changed over time across body mass index (BMI) categories and was associated with cardiovascular risk [ 9 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: A cohort study

Gao

et al. 2020

PLoS Med

139

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Background Metabolically healthy obesity (MHO) and its transition to unhealthy metabolic status have been associated with risk of cardiovascular disease (CVD) in Western populations. However, it is unclear to what extent metabolic health changes over time and whether such transition affects risks of subtypes of CVD in Chinese adults. We aimed to examine the association of metabolic health status and its transition with risks of subtypes of vascular disease across body mass index (BMI) categories. Methods and findings The China Kadoorie Biobank was conducted during 25 June 2004 to 15 July 2008 in 5 urban (Harbin, Qingdao, Suzhou, Liuzhou, and Haikou) and 5 rural (Henan, Gansu, Sichuan, Zhejiang, and Hunan) regions across China. BMI and metabolic health information were collected. We classified participants into BMI categories: normal weight (BMI 18.5–23.9 kg/m²), overweight (BMI 24.0–27.9 kg/m²), and obese (BMI ≥ 28 kg/m²). Metabolic health was defined as meeting less than 2 of the following 4 criteria (elevated waist circumference, hypertension, elevated plasma glucose level, and dyslipidemia). The changes in obesity and metabolic health status were defined from baseline to the second resurvey with combination of overweight and obesity. Among the 458,246 participants with complete information and no history of CVD and cancer, the mean age at baseline was 50.9 (SD 10.4) years, and 40.8% were men, and 29.0% were current smokers. During a median 10.0 years of follow-up, 52,251 major vascular events (MVEs), including 7,326 major coronary events (MCEs), 37,992 ischemic heart disease (IHD), and 42,951 strokes were recorded. Compared with metabolically healthy normal weight (MHN), baseline MHO was associated with higher hazard ratios (HRs) for all types of CVD; however, almost 40% of those participants transitioned to metabolically unhealthy status. Stable metabolically unhealthy overweight or obesity (MUOO) (HR 2.22, 95% confidence interval [CI] 2.00–2.47, p < 0.001) and transition from metabolically healthy to unhealthy status (HR 1.53, 1.34–1.75, p < 0.001) were associated with higher risk for MVE, compared with stable healthy normal weight. Similar patterns were observed for MCE, IHD, and stroke. Limitations of the analysis included lack of measurement of lipid components, fasting plasma glucose, and visceral fat, and there might be possible misclassification. Conclusions Among Chinese adults, MHO individuals have increased risks of MVE. Obesity remains a risk factor for CVD independent of major metabolic factors. Our data further suggest that metabolic health is a transient state for a large proportion of Chinese adults, with the highest vascular risk among those remained MUOO.

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“…Previous studies have made this classification based on the presence of the metabolic syndrome components using metabolic syndrome criteria from the Adult Treatment Panel III, while others have used the criteria from the International Diabetes Federation and further studies have included insulin resistance and inflammatory markers as part of the assessment of metabolic status. 8 In conclusion, there is a widespread inconsistency in the definition and subsequent investigation of the impact of the MHO phenotype on health outcomes and association of diet with the MHO phenotype is frequently inappropriate. In order to advance this area, there is an urgent need for a clear consensus definition of MHO.…”

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confidence: 99%

There is an urgent need for a consistent definition of the metabolically healthy but obese phenotype

Calton

2019

Nutrition & Dietetics

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Metabolically healthy obese phenotype and risk of cardiovascular disease: Results from the China Health and Retirement Longitudinal Study

Cited by 32 publications

References 46 publications

Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort

Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort

Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: A cohort study

There is an urgent need for a consistent definition of the metabolically healthy but obese phenotype

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