Transition of metabolic phenotypes and risk of subclinical atherosclerosis according to BMI: a prospective study

Abstract

Aims/hypothesis The cardiometabolic risk associated with metabolically healthy obesity (MHO) remains the subject of debate. It is unclear whether MHO is a transient condition that affects subclinical atherosclerosis risk. In this study, we aimed to investigate the association of MHO and its transition over time with incident subclinical atherosclerosis. Methods A prospective study was conducted with 6220 Chinese adults who were free of cardiovascular disease (CVD) at baseline. Obesity was defined as BMI ≥25.0 kg/m 2. Metabolic health was defined as an individual having fewer than two of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria for components of the metabolic syndrome (excluding waist circumference). Subclinical atherosclerosis was measured by brachial-ankle pulse wave velocity, pulse pressure and albuminuria, separately or combined. Participants were cross-classified by BMI categories and by metabolic health status and its transition during follow-up. Inverse probability weighted logistic regression models were used to estimate ORs and 95% CIs for subclinical atherosclerosis. Results The MHO phenotype accounted for 16.3% of the total population and 32.8% of the population with obesity at baseline. Baseline MHO was not significantly associated with incident subclinical atherosclerosis. During a follow-up period of 4.4 years, 46.8% of individuals with MHO developed a metabolically unhealthy status. Those with transient MHO had an increased risk of composite subclinical atherosclerosis compared with those in the metabolically healthy non-obesity reference group (OR 2.52 [95% CI 1.89, 3.36]). A transition from metabolically unhealthy to healthy status was shown to decrease the outcome risk. The relationship between BMI and subclinical atherosclerosis was partly mediated by BP and plasma glucose. Conclusions/interpretation MHO is not a stable condition and transient MHO conferred an increased risk of subclinical atherosclerosis, the early stage of CVD. Hence, individuals may benefit from early behavioural or medical management in order to avoid a deterioration of metabolic status and prevent atherosclerosis and CVD.

Effects of time-restricted feeding in weight loss, metabolic syndrome and cardiovascular risk in obese women

“…It is widely accepted that obesity is associated with all-cause mortality and the development of cardiovascular events in mid-age adults [26,27]. Also, overweight per se, without the presence of MetS, is an independent factor related to increased mortality and cardiovascular events [28][29][30]. In our study, 75% of obese women in the TRF group did not exhibit MetS at baseline measurements (presence of 3 or more risk factors, according to Fig.…”

Transition from Metabolically Healthy to Unhealthy Associated with Risk of Carotid Artery Plaque in Chinese Adults

“…Lin et al have performed a very interesting cohort study in 6,220 Chinese adults with metabolically healthy (≤2 components of metabolic syndrome based on ATP III). Transition to metabolic abnormalities was associated with a odd ratio of 2.52 (95%CI: 1.89, 3.36) for the risk of atherosclerosis compared with their normal weight counterparts (23). Similar to Lin's study, we also con rmed that the transition was associated with future risk of atherosclerosis.…”

“…Data regarding the effects of the transition on the development of atherosclerosis is limited. To the best of our knowledge, only one cohort study to date evaluated the association of transition from metabolically healthy to unhealthy with the development of atherosclerosis (23). The transition, but not baseline metabolically healthy status, was associated with high risk of atherosclerosis (23).…”

“…To the best of our knowledge, only one cohort study to date evaluated the association of transition from metabolically healthy to unhealthy with the development of atherosclerosis (23). The transition, but not baseline metabolically healthy status, was associated with high risk of atherosclerosis (23). However, it has been doubtful to classify individuals with one metabolic risk factors, such as high blood pressure or impaired glucose regulation, as metabolically healthy status.…”

Metabolically Healthy and Unhealthy Normal Weight and Obesity

“…For example in a community-based population in Shanghai, China, 46.8% of individuals with MHO developed a metabolically unhealthy status during a follow-up period of 4.4 years. While subjects with transient MHO had an increased risk (152%) of a composite subclinical atherosclerosis endpoint, the risk was statistically not different (8%) in subjects with stable MHO, when compared to subjects who were metabolically healthy and non-obese (MHNO) [ 32 ].…”