Metabolically healthy overweight/obesity are associated with increased risk of cardiovascular disease in adults, even in the absence of metabolic risk factors: A systematic review and meta‐analysis of prospective cohort studies

Opio, Jacob; Croker, Emma E; Odongo, George; Attia, John; Wynne, Katie; McEvoy, Mark

doi:10.1111/obr.13127

Cited by 87 publications

(78 citation statements)

References 46 publications

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“…Finally, one should mention that our results were somewhat different in men and women: there was a higher risk of clinical events in men with MHO compared with metabolically healthy men of normal weight, but a lower risk for most events in women with MHO than in metabolically healthy women of normal weight. The recent meta-analysis conducted by Opio et al 8 30 which may partly explain our different results in men and women.…”

Section: Discussionmentioning

confidence: 75%

“…Several meta-analyses have reported that, compared with metabolically healthy individuals of normal weight, those with MHO are at an increased risk of CV events. 8,16 Another meta-analysis, which examined the association between MHO and CV events and was limited to studies using the strictest definition for metabolic health (i.e. an absence of all metabolic abnormalities), reported an insignificant association between MHO and CV events.…”

Section: Discussionmentioning

confidence: 99%

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Metabolically healthy obesity and cardiovascular events: A nationwide cohort study

Fauchier

Bisson

Bodin

et al. 2021

Diabetes Obesity Metabolism

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Aim: To evaluate the associations between metabolically healthy obesity (MHO) and different types of incident cardiovascular events in a contemporary population.Materials and Methods: All patients discharged from French hospitals in 2013 with at least 5 years of follow-up and without a history of major adverse cardiovascular event (MACE; myocardial infarction, heart failure [HF], ischaemic stroke or cardiovascular death [MACE-HF]) or underweight/malnutrition were identified. They were categorized by phenotypes defined by obesity and three metabolic abnormalities (diabetes, hypertension and hyperlipidaemia). Hazard ratios (HRs) for cardiovascular events during follow-up were adjusted on age, sex and smoking status at baseline. Results: In total, 2 873 039 individuals were included in the analysis, among whom 272 838 (9.5%) had obesity. During a mean follow-up of 4.9 years, when pooling men and women, individuals with MHO had a higher risk of MACE-HF (multivariate-

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Metabolically healthy obesity and cardiovascular events: A nationwide cohort study

Fauchier

Bisson

Bodin

et al. 2021

Diabetes Obesity Metabolism

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“…In contrast, we show that the relationships between BMI and CVD mortality in a Norwegian population differ by sex: with no or negative association in women and positive association in men. A meta-analysis of 21 prospective studies showed that compared to the MHNO group, the HR for CVD in women with MHO were lower than those in men with MHO (HR 1.71 vs 2.15, respectively) (34). However, the meta-analysis included few sex-strati ed studies.…”

Section: Discussionmentioning

confidence: 99%

Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study

Michalsen

Kvaløy

Svartberg

et al. 2021

Preprint

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Background: The mortality of metabolic―obesity phenotypes has been thoroughly studied, but it is not known how the association between continuous measures of body mass index (BMI) or waist circumference differ in strata of cardiometabolic health status. Methods: We linked data on 12,815 men and women aged 36―79 years from the SAMINOR 1 Survey with mortality data from the Norwegian Cause of Death Registry. We defined metabolically healthy and unhealthy as having zero and ≥1, respectively, of the following: MetS, pre-existing diabetes or cardiovascular disease (CVD), or prescribed drugs for high blood pressure, hyperglycaemia or dyslipidaemia. We defined general and abdominal obesity as BMI ≥30 kg/m2 and waist circumference ≥88 cm (women) or 102 cm (men), respectively, and cross-classified these categories with metabolic status to create metabolically healthy non-obese and obese (MHNO and MHO) and metabolically unhealthy non-obese and obese (MUNO and MUO) phenotypes. We used Cox regression to estimate the hazard ratio (HR) for all-cause and CVD mortality for 1) the four phenotypes and 2) continuous measures of BMI and waist circumference fitted with restricted cubic splines. We adjusted for age, leisure-time physical activity, education, smoking and alcohol consumption, and tested for interactions with sex and metabolic status (only continuous measures). Results: The MHO phenotype was present in 7.8% of women and 5.8% of men. During a median follow-up of 15.3/15.2 years, 596/938 women/men had died, respectively. The MUNO and MUO group had higher mortality than the MHNO group. Sex and phenotypes interacted with respect to CVD mortality (p=0.05 for general and p=0.02 for abdominal obesity): relative to the MHNO group, the MHO group had an adjusted HR (95% confidence interval) for CVD mortality of 1.05 (0.38–2.88) in women and 2.92 (1.71–5.01) in men. We found curvilinear associations between BMI/waist circumference and all-cause mortality irrespective of metabolic status. Corresponding relationships with CVD mortality were linear and the slope differed by sex and metabolic status.Conclusion: The relationships between continuous measures of BMI/waist circumference and mortality differed by sex, metabolic status and cause of death. Poor metabolic health substantially increases mortality regardless of obesity status.

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“…Modifiable risk factors such as unhealthy lifestyle behaviour contribute to the shifting disease burden and so should primarily targeted [3], particularly for cardiovascular diseases' prevention [4,5]. Systematic reviews and meta-analyses have assessed the relationships between the modifiable lifestyle factors such as the alcohol consumption [6], tobacco use [7,8], oral hygiene practices [9], fruit and/or vegetable (FV) consumption [10,11], physical inactivity [12] excess weight [13][14][15] and the metabolic disorders. The World Health Organization (WHO) recommends the implementation of a national surveillance system for the risk factors for the NCDs (stepwise approach to surveillance [STEPS]) including those for cardiovascular diseases [16] and while the US Centre for Disease Control and Prevention recommends the Behavioural Risk Factor Surveillance System [17].…”

Section: Introductionmentioning

confidence: 99%

Modifiable Lifestyle Factors and their Relationships with Metabolic Disorders among Adults in Burkina Faso: Findings from the First National Survey

Diendéré¹,

Kaboré²,

Zeba³

et al. 2021

Preprint

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This study aimed to report the magnitude of modifiable lifestyle factors, their relationships with metabolic disorders in Burkinabè adults by using nationally representative data. This cross-sectional study included 4100 adults selected through multistage cluster sampling performed during the first national survey conducted in 2013 in Burkina Faso. The modifiable factors we considered were tooth cleaning, fruit and/or vegetable (FV) intake, substances’ use, physical activity and overweight/obesity, while metabolic syndrome abnormal components defined metabolic disorders. We performed logistic regressions. 31.1% cleaned the teeth at least twice a day, 14.7% consumed five or more FV, 39.7% used alcohol and/or tobacco, the prevalence of physical inactivity and overweight/obesity was respectively 6.6% and 17.7%. About 41.0% had at least two metabolic disorders and 9.5% had at least three. Lifestyle factors associated with having at least two metabolic disorders were overweight/obesity, more FV intake (when five or more aOR=1.5, p<0.001), physical inactivity (aOR=1.3, p<0.05), tooth cleaning (aOR=0.8, p<0.01). Except for consuming five or more FV (aOR=1.4, p=0.09), the same trend of relationships was observed with having at least three metabolic disorders. Excluding overweight/obesity and physical inactivity, unhealthy modifiable lifestyle factors were common and tooth cleaning was found as a protective practice for metabolic disorders.

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Metabolically healthy overweight/obesity are associated with increased risk of cardiovascular disease in adults, even in the absence of metabolic risk factors: A systematic review and meta‐analysis of prospective cohort studies

Cited by 87 publications

References 46 publications

Metabolically healthy obesity and cardiovascular events: A nationwide cohort study

Metabolically healthy obesity and cardiovascular events: A nationwide cohort study

Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study

Modifiable Lifestyle Factors and their Relationships with Metabolic Disorders among Adults in Burkina Faso: Findings from the First National Survey

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